Erectile Dysfunction (ED) and Rectal Cancer

Hi there, Dr. Abram McBride, the Men's MD here!

Today, I'd like to talk to you about a situation for some men with erectile dysfunction, and that's the relationship between erectile dysfunction and pelvic surgery. Specifically, pelvic surgery performed on men who had rectal or anal cancer.

We know that there are many patients who experience erectile dysfunction and that there are many potential causes of this condition. For 6% of patients, complications from pelvic surgery or trauma are the primary cause of their erectile dysfunction (1).

Whether it's surgery, chemotherapy, radiation, or, in some cases, all three of those treatment modalities, the interventions used to address their cancer can have significant side effects (2). These therapies can cause nerve damage that slows or stops the transmission of the appropriate nerve signals from the spinal cord down to the pelvis and from the pelvis to the posterior part of the prostate, and around to the base of the penis (3). These nerve signals control the blood flow into and out of the penis required for a normal erection and also control the transmission of sensory signals that are necessary to experience physical sensation.

Like men who have prostate cancer and have their prostates removed surgically or radiated for prostate cancer, those nerves can get damaged. We see the same process that can cause erectile dysfunction in those men who have surgery or radiation therapy to treat their rectal or anal cancer.

In patients who have erectile dysfunction from radiation or surgery related to their rectal cancer or anal cancer, it is appropriate to consider the same treatment options as for any other man with erectile dysfunction (understand that each patient’s situation may be different and certain treatment options may not be an option). 

Treatment options to consider include pills, vacuum devices, injections that deliver medicine directly into the penis, and of course, the penile implant. Some physicians may say that a patient with a history of rectal cancer or anal cancer who's had surgery and radiation therapy on the pelvis is not a candidate for a penile implant procedure – specifically that those patients shouldn’t undergo an additional procedure.

In my opinion, that is not the case.  In my view, men who have had surgery or radiation therapy for rectal or anal cancer are just as much of a candidate for a penile implant procedure as anyone else. Treatment for anal and rectal cancer is similar to that received by a patient who's had prostate cancer and undergone surgery or radiation therapy. While there are side effects associated with treating their cancer and unique considerations to make for these patients, I have performed penile implant procedures safely and efficiently with satisfying results for both prostate cancer survivors and anal and rectal cancer survivors.

I think a lot of people, including many healthcare professionals, don’t know about the relationship between rectal cancer, anal cancer, and erectile dysfunction. Unfortunately, even when healthcare professionals are aware of the association, many think that the penile implant procedure is not a suitable option for those patients.  I think that the penile implant procedure is an option that providers should consider for those patients.

For any patient population undergoing a penile implant procedure, the procedure has risks, such as infection and device failure. If re-operation is required due to infection, erosion, or device failure, 93% had successful reoperation, providing a functional penile implant (4). In general, we know that there's a high satisfaction rate in patients and partners to treat erectile dysfunction (5).

If you take away a few things from today, I want you to remember that:

1. Patients who underwent surgery or radiation therapy to treat their rectal or anal cancer can and often do experience erectile dysfunction.
2. The same treatment options should be considered for those patients as patients who haven’t had prior surgeries or radiation for rectal or anal cancer.
3. The penile implant procedure can be an excellent treatment option for patients who have erectile dysfunction as a result of surgery or radiation therapy for rectal or anal cancer.

If you'd like to learn more about erectile dysfunction and commonly associated conditions, please visit www.edcure.org  or www.themensmd.com.

References

1. Shabsigh R, Lue TF. A Clinician’s Guide to ED Management. New York: Haymarket Media Inc.; 2006.
2. Oblak I, Petric P, Anderluh F, Velenik V, Fras PA. Long term outcome after combined modality treatment for anal cancer. Radiol Oncol. 2012 Jun;46(2):145-52. doi: 10.2478/v10019-012-0022-2. Epub 2012 Apr 11. PMID: 23077451; PMCID: PMC3472931.
3. National Cancer Institute. Sexual Issues in Men with Cancer. 2022. https://www.cancer.gov/about-cancer/treatment/side-effects/sexuality-men#:~:text=External%2Dbeam%20radiation%20therapy%20to,this%20is%20called%20erectile%20dysfunction. Accessed February 27, 2024
4. Salonia A, Bettocchi C, Carvalho J, et al. EAU guidelines on sexual health and reproductive health. Edn. presented at the EAU Annual Congress, Milan 2021. ISBN 978-94-92671-13-4.
5. Burnett AL, Nehra A, Breau RH, et al. Erectile dysfunction: AUA guideline. [published correction appears in J Urol. 2022;207:743]. J Urol. 2018;200:633–641.

EDCure.org is a website owned by Boston Scientific.

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1. Abram McBride, MD is a paid consultant of Boston Scientific.

The information provided in this article is based on the experiences and opinions of Dr. McBride. It does not represent the opinion or recommendation of Boston Scientific.

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