ERECTION REHABILITATION POST PROSTATE SURGERY

What can I do to regain some form of sexual function - or should I wait the 18 to 24 months, which I believe might result in some recovery of nerves to allow this?

As well as penile rehabilitation of some form (which you are doing with the pump) there are other lifestyle and mindset adjustments you could consider to maximise your chances of regaining function. 

One of the main ones that I feel is often not stressed strongly enough, and I've seen clients benefit from more than we expected, is overall cardio exercise for the body. This webinar with Tom (male physiotherapist) sheds more light on that with some specific suggestions on getting started : 

https://www.atouchysubject.com/exercise-and-ed

Other ideas are around understanding stress and engaging with sexual pleasure in other forms. 

VACUUM PUMPS

I use a vacuum pump because I'm told this is important for penile health, is this right?

The reason we believe the pump plays an important role in penile health is to do with the concept of replacing nocturnal erection activity. Before the erection nerves were traumatised during prostate surgery, most men would have spontaneous erections 3-6 times a night during REM (the deep sleep cycle). The pump is a way of replacing that blood flow and stretching action. Keeping the penile tissue and skin stretched using an erection aid like the pump (or injections) helps to prevent shortening, it is also believed that moving oxygenated blood into the penis tissue helps to prevent deformities such as Peyronie's Disease and venous leakage. 

I have to see 'also believed' during this simply because the large sample size, long term research trials where men comply to using a pump regularly vs not at all still need to be carried out. We have smaller trials that strongly suggest using a pump helps prevent damage, and that men using a pump tend to have better long term sexual function outcomes. The underlying message across penile rehab studies that look at any erection creation method (devices/pills/injections) is that doing something to keep the penile tissue active during ED after surgery is much better than doing nothing.

However, we must also keep in mind that an erection is a complex puzzle... 

The erection begins in the mind, relies on a healthy cardiovascular system, as well as a hormonal basis, and then of course there are the erection nerves. So there's a lot going into the ultimate question of 'when or will spontaneous function return?' The part the pump plays is like a penis-maintenance-tool while erectile dysfunction without nocturnal erections is happening: keeping everything within the penis in the best possible structural condition. 

-- as a side note : I also wonder if there is a psychologically good reason for pumping too. Simply practising creating an erection regularly so the brain registers the visual look, the feel and the satisfactory feedback from seeing an erection might help with nerve regeneration from a neuroplasticity perspective (this is where I get a bit theoretical though and it's just my theory for now, the concept has been positively trialled with people recovering other forms of physical function after strokes however so maybe in the future this will be researched within penile rehabilitation).

How long should I persist with pumping for rehab?

That's a really tricky one to answer. The hope is that nocturnal erections return or arousal-created erections begin to return, therefore this then is doing the 'job' of the pump essentially so using the pump for that stretching and maintenance can lessen. There is no way for a person to tell what their journey will be with ED after surgery however, it's why I feel so strongly that more research and conversation needs to happen in this area. It is in this sense an uncertain journey. Focus on what you can control - we all need to exercise every part of the body and mind in some for throughout life to prevent problems and keep ourselves in top condition. By using erection aids to keep blood flow and the mind active, you are giving yourself the best possible chances of functional recovery, but I cannot put any time frame on that... and my next answer will hopefully fill in some more blanks...

I already have a vacuum pump. Would the pump you promote be helpful?

Honestly, if you are finding the electronic pump you use now easy to operate and it creates a good erection in the cylinder for rehab, then that's great and I would encourage you to continue using it. It can take time to get used to any vacuum device, even the one I sell, so if you like what you've got and it fits your needs that's perfect.

In case it's not quite fitting all your needs, here are the main reasons some pump users post surgery find the one I offer more helpful: 

- The Vacurect comes with five different ring sizes and the ring system is a two-step process fitted into the device. This makes it the most effective VED system I have found for keeping the erection up after the cylinder is removed. Most pumps can be operated for rehab (blood moving in, then moves out when cylinder removed), but often men have told me that the constriction system is too fiddly, or lets out air so is ineffective. The Vacurect therefore can be great for men who want to keep the erection around after pumping up.

- The Vacurect is not electronic and only has two parts to it, the cylinder that slides up and down to release air, and the ring system. Therefore it's easy to travel with, can be used in the shower or bath, and it's very lightweight. Some men therefore prefer it just because it's easier to use regularly or in their busy lifestyle.

(This video playlist explains how it works)