Thank you for downloading this ebook so you can find out how to take control of your penile health. This ebook is designed to give you an overview of penile rehabilitation and why it is an important part of your health.
Please remember I am not a cancer specialist, urologist, prostate cancer specialist, nor a continence expert, BUT I am a penis specialist.
This ebook will show you why exercising your penis (penile rehabilitation) is required and briefly outline the steps involved in the process. Nothing in this ebook is new, it is a collation of the information publicly available on penile rehabilitation for men with prostate cancer or other penile function issues. I have created this ebook to provide a resource that translates the available research and recommendations into patient-friendly language.
If you like what you learn here I encourage you to take the next step and sign up for one of our programs. These programs provide you with all the information and a roadmap to follow to achieve optimal function. They are all individually tailored by me, a qualified Nurse Practitioner and Sexologist.
Melissa is a Nurse Practitioner and Sexologist who was trained at Curtin University and has continued studying since her initial qualification in 1995. She has worked in private practice since 2012 and was previously employed as a Remote Area Nurse/Midwife and Emergency Nurse for many years. Her career also includes working as an academic in teaching and research roles for both Curtin University and The WA Centre for Rural Health (formerly CUCRH) and The University of Western Australia.
Her professional areas of interest include male and female sexuality and wholistic wellness; she enjoys public speaking and is passionate about imparting knowledge to both the public and health professionals.
She is the Director and Lead Clinician of the Restorative Health Clinic (RHC) in Western Australia which services both metropolitan and rural/remote patients, and Restore Men's Intimate Health (RMIH), an online resource for men's health worldwide. Melissa treats all genders, and has extensive experience in male sexual dysfunction, in particular penile pre/rehabilitation for prostate cancer treatments.
She is also the co-founder and presenter of The Penis Project Podcast which covers everything you have always wanted to know about Men’s Health but were too embarrassed to ask!
THE CONNECTION BETWEEN ERECTILE DYSFUNCTION AND PROSTATE CANCER
As techniques to treat cancer have improved, the incidence of side effects has lessened substantially. Unfortunately, serious effects on a penis owners’ sexual function, particularly his ability to get an erection, remains an almost universal problem. However as penile rehabilitation is more widely accepted, more penis owners return to their pre-treatment function
Penises exercise themselves!
Yes, you heard right, a penis naturally has 3-5 erections each night, whilst its owner is sleeping peacefully. This is the body's way of taking the penis to the gym. All muscles need exercise and the penile muscles are no different. With absent erections, the health of the penile tissues is adversely affected. Lack of tissue stretching, and low oxygenation leads to damage to the smooth muscle cells and the development of fibrosis. Such changes may cause permanent ED, penile shortening and Peyronie’s disease (change in shape).
Solutions are Available
There is now good evidence that early use of medication and/or exercises to restore erections after prostate cancer treatment and other pelvic problems that cause ED, can improve the chances of recovery of erectile function; this is known as “penile rehabilitation.”
Shortening of the penis is thought to be due to retraction with tissue fibrosis during the healing phase. Regular erection or use of a vacuum pump can be useful in preventing this.
It is not all bad news though as many penis owners report orgasm being more intense following prostate cancer treatment and it is possible to have an orgasm with a flaccid (non-erect) penis.
What is important to know is that many men now return to pre-treatment function with rehabilitation It really is a case of “if you don’t use it you lose it!” Melissa
Erectile dysfunction after treatment
Erectile dysfunction (ED) is a common problem for men after prostate and bladder cancer treatments, as the erection nerves are closely related to the prostate gland. Sexual function after treatment is determined by three things: the first is pre-treatment function, the second is the degree of nerve damage and the third is the rehabilitation. Nerve sparing is not always possible, especially if the cancer is invading the nerves. Those most at risk of losing erections have impaired function pre-op or have more advanced disease. Your individual situation should be clearly discussed.
Sexual function after radical prostatectomy
Radical prostatectomy is performed with increasing frequency as the most common treatment for prostate cancer Prostate cancer is the commonest cancer in men and is often diagnosed in men in their 50’s and 60’s otherwise in the “prime of life” As surgical techniques and expertise have improved, the incidence of side effects has lessened substantially.
Sexual Function
Unfortunately, serious effects on a man’s sexual function, particularly his ability to get an erection remains an almost universal problem, however as surgical techniques improve and penile rehabilitation is more widely accepted, more penis owners return to their pre-op function.
Radical Prostatectomy
In radical prostatectomy the prostate gland along with the seminal vesicles and a length of urethra are removed. Nerves supplying the erectile “message” pass closely around the prostate gland like a spider’s web and are often damaged even when nerve-sparing techniques are used As a result, a man will normally lose the capacity to have erections immediately after the operation, however with time and a penile rehabilitation program, there is usually some or total return of erections.
In part, the return of erection depends on the degree of nerve sparing achieved during surgery To use nervesparing surgery or not is a choice that the surgeon is only able to make at the time of surgery, since to spare the nerves but leave cancer behind would defeat the purpose of the operation. Blood vessel damage can also occur. Some people may also require the use of radiotherapy which may further damage the nerves and blood vessels and such damage can get worse over a number of years with late scarring
Hormone Ablative Therapy
Hormone ablative therapy will cause a sudden drop in testosterone giving the man an artificial “male menopause ” This will profoundly affect a man’s interest in sex and can make the penis less responsive With absent erections, the health of the penile tissues is adversely affected Lack of tissue stretching, and low oxygenation leads to damage to the smooth muscle cells and the development of fibrosis. Such changes may cause permanent ED and penile shortening.
Recovery & Penile Rehabilitation
There is now good evidence that early use of medication and/or exercises to restore erections after surgery can improve the chances of recovery of erectile function; this is known as “penile rehabilitation”.
After radical prostatectomy, whilst the penis may not be as responsive to visual stimulation, more direct stimulation of the penis may be helpful It is possible to have vaginal intercourse with a partial erection and stimulation within the vagina may encourage further and better-quality erections. Some people find the erection is stronger when standing up.
Because most of the ejaculatory fluid is made by the prostate and seminal vesicles, a man will not ejaculate after radical prostatectomy; he can however reach orgasm even without an erection Such an orgasm is “dry” but just as pleasurable and less messy!
Most men experience a change in the sensation, but this can be an increase rather than a decrease in sensation. Some men experience leakage of urine or pain with orgasm, but this is usually a temporary problem Shortening of the penis is thought to be due to retraction with tissue fibrosis during the healing phase Regular erection or use of a vacuum pump or traction device can be useful in preventing this. Sexual function after other prostate/ bladder cancer treatments (i.e. radiation, chemotherapy, hormone treatments)
There is a varying degree of erectile issues after radiation, chemotherapy and hormone treatments Each person needs to be assessed individually to determine the degree of the problem and possible solutions. In general, the same treatment regime applies to men who have had these treatments as those who have had surgery. It is a matter of “if you don’t use it, you may lose it” so the aim is to keep the penis exercising with assistance
Radiotherapy
The use of radiotherapy may damage the nerves and blood vessels and such damage can get worse over a number of years with late scarring Hormone ablative therapy will cause a sudden drop in testosterone giving the man an artificial “male menopause ”
This will profoundly affect a man’s interest in sex and can make the penis less responsive. With absent erections, the health of the penile tissues is adversely affected. Lack of tissue stretching, and low oxygenation leads to damage to the smooth muscle cells and the development of fibrosis Such changes may cause permanent ED and penile shortening
Recovery
There is now good evidence that early use of medication and/or exercises to restore erections after prostate cancer treatment can improve the chances of recovery of erectile function; this is known as “penile rehabilitation.”
Shortening of the penis is thought to be due to retraction with tissue fibrosis during the healing phase. Regular erection or use of a vacuum pump can be useful in preventing this
SO WHY IS PENILE REHABILITATION IMPORTANT?
Following prostate cancer treatment, you most likely will have a period of time when your penis doesn’t want to play the game and become erect. This can happen for lots of reasons such as diabetes, age, spinal injury, and any other pelvic surgery. The penis is made up of smooth muscle and like all muscles if it doesn’t get exercise the muscle atrophies (a fancy name for withering away). Imagine if you stopped walking… your quadriceps muscles would reduce in size, and you would need to exercise them again to build them up. If you stopped using your legs for an extended period, the muscles would never return to normal.
Your penis is no different, it needs exercise. In a healthy functioning body, the penis has nocturnal erections whilst you are sleeping, approx. 3 to 5 per night. This is the body's way of taking the penis to the gym. Unfortunately, when things aren’t working as they should, the penis health deteriorates. Thus, it is important to manually exercise the penis to maintain length and girth. It is a common misconception that prostate cancer treatments cause this loss of size however it is not the treatment itself that does this, it is the loss of exercise, which is why other illnesses and age also cause this problem. This is good news, if you keep moving your old buddy, he can maintain his girth and length give or take 1cm/ ½”.
I AM NOT SEXUALLY ACTIVE, DO I NEED TO WORRY ABOUT PENILE REHAB?
Yes, Penile Rehab is not just about getting your penis back in action for sex. Imagine trying to stand up to pass urine with a buried penis!
SCARY, ISN’T IT?
Now I am not saying that this will happen to every man who doesn’t do Penile Rehab, but it is a very real possibility. I have seen many men with this problem. Starting rehab when this has occurred can help, but prevention is much better than cure.
The other problem that can occur if the penis is left dormant, and is not exercised, is the development of Peyronie’s disease.
This is when the shaft develops a bend...
This can occur at any time in a man’s life but is much more prevalent postprostate cancer treatment or other illnesses.
Men who have a history of Dupuytren's contracture (abnormal thickening of the skin) in their hands are even more at risk.
Penile rehabilitation keeps the penis tissue healthy and the blood flowing whilst the prostatic nerves that are damaged due to prostate cancer treatments or other surgeries and treatments, heal in their own time.
Following surgery the nerves heal, if they are going to, over 2-4 years.
Following radiation treatment, the time depends on more factors which are individual. Either way penile rehab is important if you want to improve your chances of returning to spontaneous erection and prevent deterioration of the penile tissues.
3 CORE COMPONENTS TO PENILE HEALTH
This diagram shows the 3 important factors to be considered to keep the penis healthy.
Having a healthy body is the KEY.
A healthy body is one that is exercised regularly and is in a healthy weight range. This type of body provides the penis with adequate blood flow (fat bellies reduce blood flow to the pelvis). Exercise increases the nitric oxide (NO) gas production in the penis and NO is fuel for erectile function. Healthy mind!
3 CORE COMPONENTS TO PENILE HEALTH
PDE 5 medications are the group of medications that include Sildenafil (Viagra), Avanafil(Spedra), Tadalafil(Cialis), Vardenafil(Levitra and Spontan).
There are 4 main pills that can be used to assist erectile function. They all vary slightly in the dose, the time they take to work and duration they work for. The tables below outline these differences. The main thing is to try them all and use the one that best agrees with your body, lifestyle, and effect. If more than one works well, you can use them both as long as not at the same time. For example, if Viagra works well and so does Spedra, you may choose to use Spedra when you don’t have much lead up time as it only takes 15 minutes to work, however if you are on notice and can have at least 60 minutes lead up, then Viagra is a cheaper option. Now there is a new one (only available in australia at present) called Spontan a nasal delivery version of vardenafil which works in 15 mins!
For Penile Health
It is good to take a small daily dose of one of these medications to improve blood flow to the penile tissues. Think of this as a vitamin pill for your penis!
3 CORE COMPONENTS TO PENILE HEALTH
Vacuum pumps have been commercially available since 1985, and consist of a clear plastic cylinder and a hand or battery-operated pump.
They have been often considered a sex toy, but are now being used increasingly because they are cheap, non-invasive and an easy way to exercise the penis, and for some couples a useful device to keep the penis engorged for sexual intercourse.
Studies suggest that early usage of this device decreases the loss of stretched penile length after radical prostatectomy and increases the chance of early erectile recovery sufficient for vaginal intercourse. (Wang R. Penile rehabilitation after radical prostatectomy: where do we stand and where are we going? J Sex Med. 2007;4(4 Pt 2):1085-1097.)
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WANT AN INDICATION OF YOUR PENILE HEALTH?
MEASURING PENILE HEALTH WITH THE FIRMTECH TECHRING
The FirmTech TechRing is a revolutionary cock ring.
Not sure how your penile health is tracking? We have the answer. The Firmtech cock ring. Wear this at night and you will know with no doubt what is happening whilst you are seeping and then create a plan to keep your penis healthy. The TechRing can be used for pleasure during sexual activity, or worn overnight to track and count your nocturnal erections, gaining objective data about your sexual health, sent right to the FirmTech phone app via Bluetooth.
With the help of built-in sensors, it tracks and monitors vital signs of penile fitnesssuch as firmness and duration of erections, giving you a clear understanding of your sexual health. Whether you’re experiencing Erectile Dysfunction or want to maintain sexual performance, this medical-grade, adjustable elastomer ring is the perfect solution.
The TechRing has a unique design, making it comfortable whilst maintaining light pressure on the urethra, designed to intensify orgasms. The penoscrotal design wraps around the shaft and scrotum with a hook and latch, the feature designed to keep blood in the penis, prolonging erections.
The cock ring’s comfortable design allows it to be worn for hours, with a runtime of 810hrs. It’s also USB rechargeable and comes with a satisfaction guarantee. It is waterresistant, and is compatible with water-based lubricants.
Experience the advancements of this innovative men’s health ring today. chase the Urologist-approved TechRing here: https://myfirmtech.com
WHEN SHOULD YOU START PENILE REHAB?
Penile rehabilitation should be initiated as soon as you notice a decline in nocturnal erections or reactivity when you stimulate your penis or become aroused.
Doing Penile Rehabilitation won’t guarantee return to spontaneous function but if you keep doing what you have always done, you will get what you have always got.
Prior Preparation Prevents a Piss Poor Performance.
Thanks for taking the time to read this book. I hope to see you on the path to penile perfection soon!
Melissa
WANT TO KNOW MORE?
If you would like more detail on prostate cancer penile rehabilitation, erectile dysfunction, Peyronie's disease or premature ejaculation, check out my online programs:
