What is a penile rehabilitation program (PRP)?
The prostate gland is surrounded by nerves that are critical for a man’s ability to have an erection.
When a man has prostate cancer, he may have a procedure called a prostatectomy, which involves removing the prostate gland. During a prostatectomy, a surgeon tries to preserve the surrounding nerves as much as possible. However, many men still have problems with erections after surgery.
Penile rehabilitation programs (PRPs) are like a form of physical therapy. For example, if a man has knee surgery, he may go to physical therapy and do exercises to strengthen his knee and get it back into good condition. If he doesn’t do his exercises, his knee may get weaker.
PRPs work in a similar way. They can help men recover their erectile function by inducing erections to “exercise” the penis. This process keeps erectile tissue healthy while the remaining nerves heal from surgery. The erections may be induced through oral medication, injections into the penis, penile suppositories, or vacuum devices. Some men are advised to masturbate on a regular basis.
Through penile rehabilitation, it is hoped that the patient will eventually have satisfactory erections on his own or will respond well to oral medications for erectile dysfunction.
It should be noted that some experts do not think penile rehabilitation is a worthwhile strategy.
Penile rehabilitation can take time – sometimes up to four years. With patience and dedication, however, many men are able to again have erections suitable for sex.
What does a penile rehabilitation program (PRP) involve?
Penile rehabilitation programs vary from clinic to clinic and patient to patient, but some of the more common strategies include the following:
Oral medications. Phosphodiesterase type 5 inhibitors, such as Viagra®, Levitra®, and Cialis®, improve blood flow to the penis and help keep erectile tissue healthy.
Penile Injections. The patient is trained to inject medication into his penis to prompt an erection.
Suppositories (MUSE). Pellets of medicine are inserted into the urethra, the tube that allows urine and semen to exit the body.
Vacuum erection devices. A clear plastic cylinder is placed over the penis. The man then uses a pump to draw out the air, creating a vacuum. This leads to an erection.
How successful are penile rehabilitation programs (PRPs)?
Penile rehabilitation programs (PRPs) can help men restore their ability to have erections after prostatectomy (removal of the prostate gland). However, several factors affect the success rate of PRPs:
The man must consider how well he was able to have erections before surgery. Men who had good erectile function beforehand can often recover that good function after penile rehabilitation. Men who had poor function may not be as successful.
The man needs to be compliant with the program, following his doctor’s instructions. Men who stick with the program diligently tend to have greater success than men who are not as dedicated.
Nerve-sparing also plays a role in recovery. The prostate gland is surrounded by nerves that are important for erectile function. Surgeons try to preserve as many nerves as possible, but usually there is some degree of nerve damage. The success of penile rehabilitation may depend on how much nerve damage results from surgery.
Other factors to consider are age, weight, smoking status, and any medical conditions like diabetes. Having additional treatments for prostate cancer, such as radiation and/or hormonal therapy, can also affect the outcome of penile rehabilitation.
What is postcoital dysphoria (“post-sex blues”)?
Sometimes, people feel deep sadness or agitation after consensual sex. The medical term for these feelings is postcoital dysphoria (PCD), but some call it the “post-sex blues.”
In some cases, people become tearful or depressed after orgasm. In others, they become argumentative with their partner. These feelings occur even if the sexual encounter has been satisfying and enjoyable.
Not much is known about PCD, but research published in the journal Sexual Medicine in 2015 has revealed how common it is among women.
Researchers from the Queensland University of Technology (QUT) in Australia asked 230 female university students to participate in a survey about their experiences with PCD. The women ranged in age from 18 to 55 with an average age of 26 years.
Forty-six percent of the women said they’d experienced PCD in the past. About 5% said they’d had symptoms over the past month. And about 2% reported having PCD “always” or “most of the time.”
However, PCD was not linked to intimacy in close relationships, the researchers reported.
Experts aren’t sure why PCD happens. It may be that the bonding with a partner during sex is so intense that breaking the bond triggers sadness. Childhood sexual abuse may play a role as well.
The QUT researchers noted that their findings may not apply to other groups, as their participants were heterosexual, mostly Caucasian, and university students.
Additional studies with larger, more diverse groups may provide more clues. It is also uncertain to what extent postcoital dysphoria affects men.
People who are concerned about the post-sex blues are encouraged to talk to their doctor or a sex therapist.
A Man’s Penis Changes with Age
As we get older, it’s inevitable that our bodies change. Our hair might turn gray, our skin may become wrinkled, and we might put on a little weight. These are changes we can usually expect.
Some men might be surprised to learn that their penis and testicles change with age, too. Why does this happen? And should men be concerned? We’ll look at these questions today.
Men might be surprised to learn that their penis and testicles change with age
Testosterone Levels Gradually Fall
Testosterone is an important hormone for men’s health, as it gives them their masculine traits and contributes to sex drive.
As men get older, their testosterone levels naturally decline. Some experts call this process “andropause” or “male menopause” to compare it to female menopause, when estrogen levels drop. However, it is not the same. Once men are in their 40s, their testosterone levels decrease about 1% each year. For women, the hormonal drop is much more dramatic.
Still, it helps to understand this decline in testosterone and the role it plays in the aging man.
Changes in Penis Appearance
Men might notice that their penis starts to look different:
- It might change color. Good blood flow to the penis is important for genital health. But with age, atherosclerosis – hardening of the arteries – becomes more common. When this happens, the blood supply decreases and the tip of the penis becomes lighter in color.
- It might look smaller. Some older men worry that their penis is shrinking, but this can be an optical illusion. If a man has gained abdominal weight, the extra fat can hide part of the shaft, making the penis look shorter than it actually is.
- It might actually become smaller. Sometimes, the penis does actually shorten, due to reduced blood flow and testosterone levels. A buildup of scar tissue can also contribute to the problem. This “shrinkage” could be as much as an inch over time. Keep in mind that the change is gradual and that for many partners, penis size is not important.
- It might start to curve. Peyronie’s disease, a condition marked by a distinct bend in the penis, becomes more likely with age. In some cases, the curve becomes so great that intercourse is impossible. Men in this situation should see their urologist for treatment.
- Testicles may become smaller. Over time, the size of a man’s testicles may decrease by as much as a third.
- Pubic hair may diminish. As testosterone levels decrease, so might the amount of a man’s pubic hair.
Functional Changes in the Penis
Aging can affect the way a man’s penis performs, too:
- Men may need more time. With their testosterone levels falling, older men often need more stimulation to become sexually aroused, get an erection, and reach orgasm. They may also need more time before they can have sex again. It can be frustrating, but it’s normal. Keep in mind that female partners may need more time, too.
- Erectile dysfunction (ED) may develop. ED – being unable to get or keep an erection firm enough for sex – is quite common in aging men, especially if they have developed atherosclerosis in penile blood vessels. Fortunately, there are a variety of treatments for ED, including pills and vacuum devices. If you are having trouble with erections, be sure to see your doctor. ED can be a sign of other medical conditions, like heart disease or diabetes, so it’s important to have it checked out.
- Urinary problems may occur. Older men are likely to have an enlarged prostate, also called benign prostatic hyperplasia (BPH). When this occurs, the prostate gland grows inward. The urethra – the tube that carries semen and urine out of the body – runs right through this gland. When prostate tissue enlarges, it can squeeze the urethra, making it more difficult for men to urinate. Men with urinary problems are encouraged to see their doctors as well.
What Can Men Do?
While none of us can turn back the clock, there are a number of ways men can keep the penis healthy as they get older.
- See a doctor when you have concerns. It might be awkward to discuss your private parts and even more awkward to acknowledge that you’re having a problem. But talking to your doctor is the first step toward better penis health, better sexual health, and better overall health.
- Develop healthy habits. Ask your doctor about dietary changes and fitness plans that are right for you. You might consider having fruit for dessert instead of cake, going to the gym, or taking a walk around the block after dinner. Maintaining a healthy lifestyle can reduce your risk of heart disease and diabetes, which can contribute to erection problems. And losing some weight might bring back some of that penis length you “lost.”
- Communicate with your partner. If you’re worried about changes in your penis, be open with your partner. Most likely, he or she will be glad you brought it up, supportive in your search for answers, and understanding if your performance isn’t what it used to be. Your partner may also have ideas for adjustments the two of you can make in the bedroom.
By accepting the course of aging and maintaining healthy habits, you and your partner can still enjoy an active sex life for many more years.