By Dr Rhys Leeming

Here’s the list of chemicals, gadgets and actions that helped get my erections harder after prostatectomy surgery. They helped me go from about 70% hard to over 90%. You might find they help you too.

Restoration of a decent sex life with my wife took more than the actions below. While they all help ED in a functional way, the other major contributor was learning not to be disappointed at the status of my recovery at any given point. I had to unlearn all the previously hardwired responses coming from my penis and groin and focus on how the new “re-wired” version could give me pleasure.

Given time, many of the old pleasures have returned. But initially things like frantic hard and fast banging ramping up to orgasm had to be modified to a more sensuous “up to the hilt” grind so as not to fall out. Everyone is different –  so the main thing is be flexible and be happy with incremental improvements. More about adapting to changed bodies

Editor’s note: Nothing on this website is to be taken as professional medical advice. What you read here are ordinary people’s experiences and research. You should consult your doctor for professional advice.

Pro-erectile mechanisms that worked for me

The list is roughly ordered from what I found most to least help. But remember, each mechanism is cumulative, so the more things you pay attention to, the better your likely outcome.

PDE5i’s

Provide about a 10% boost to erectile hardness

Action: Inhibits PDE5, an enzyme that plays a crucial role in regulating smooth muscle relaxation and blood vessel function, particularly in the penis and other areas breaks down cGMP. This prolongs smooth muscle relaxation in the penis, enhancing blood flow and erection.

Examples:

  • Cialis – generic name tadalafil
  • Viagra – generic name sildenafil
  • Levitra – generic name vardenafil

Cock Rings

Provide a ±5-10% boost to erectile hardness

Action: Allow blood to enter the penis during arousal, then constrict the base to limit venous outflow of blood, helping maintain erection.

Notes: Stretch over top of penis and underneath and behind testicles forming a single compressed package for best results.

Arousal

Not something you can just wear or take, arousal requires some work to make it happen. But the benefits can be substantial to both erection performance and overall enjoyment. Solid arousal gives a good 5% boost.

Action: Triggers nerve signals—primarily via the cavernous nerve—that release nitric oxide, starting a biochemical cascade leading to increased blood flow and erection.

Notes: The cavernous nerve is essential to erections and it is the one most commonly damaged or disturbed by prostate surgery. But multiple systems—neurological, hormonal, and muscular—work together to achieve and maintain an erection. These include the pudendal nerve (somatic input and motor control), testosterone (libido and nitric oxide support), and the central nervous system (processing arousal and triggering signals).

All the mechanisms further below provide small ⩬1% performance enhancement, but combined can make a significant difference.

Visual Arousal

Action: Actions like watching your partner undress, self-pleasure, or viewing pornography stimulate sexual interest and increase arousal.

Notes: Visual cues enhance arousal and amplify erectile responses. The brain’s limbic system plays a key role in processing these stimuli and modulating sexual excitement.

Fantasy Arousal

Action: Imagining sexual scenarios or desires stimulates brain pathways that enhance sexual interest and increase physiological arousal.

Notes: Mental fantasies can increase psychological excitement, boost libido, and help trigger erections. Fantasies can be very useful in maintaining an erection when physical stimulation fluctuates or wanes during sex.

Morning Sex

What could be more natural than employing the power of morning wood?

Action: Morning erections are triggered by a natural peak in testosterone levels and REM sleep cycles that promote parasympathetic activity and penile blood flow.

Notes:

1. Testosterone levels peak in early morning, boosting libido and erection.
2. REM sleep cycles promote physiological conditions favoring erections.
3. Melatonin levels decrease upon waking, enhancing arousal.

Oxytocin

Plenty of skin-on-skin will increase oxytocin for both of you.

Action: Produced in the hypothalamus; boosts arousal and erectile reflexes via brain and spinal cord.

Notes: Promotes emotional closeness, trust, and intimacy, which can enhance psychological arousal and improve erection quality and sexual satisfaction.

Dopamine

Action: Enhances sexual desire and arousal; stimulates erection via central nervous system pathways.

Notes: Enhanced by

• Physical exercise
• Healthy diet
• Music and sensory stimulation
• Mental anticipation & visualization
• Reduce stress
• Adequate sleep
• Limit Dopamine blocker medication

Testosterone

(natural)

Action: Increases libido, supports nitric oxide production, and maintains penile tissue health.

Notes: As for dopamine, plus vitamin D, zinc, and magnesium can be useful to support testosterone levels.

Serotonin

Action: Regulates mood and sexual behavior; can modulate sexual satisfaction and delay ejaculation.

Notes: As above, plus
• Get sunlight exposure
• Manage stress
• Avoid excessive alcohol and drugs
• Be careful with medications
• Mental stimulation and positive sexual experiences

Prostaglandins

Action: Locally produced lipids that relax smooth muscle in penile blood vessels, increasing blood flow and supporting erection.

Notes: Prostaglandin E1 (PGE1) is used therapeutically in ED treatments like alprostadil injections or suppositories.
• Eat foods rich in essential fatty acids
• Maintain a healthy balance of inflammation
• Avoid excessive NSAIDs (like ibuprofen)
• Support healthy circulation and tissue health

Body posture

Action: Body position affects blood flow to the penis by altering pressure gradients and muscle engagement.

Notes: Erections are typically stronger when the heart is above the penis (e.g. kneeling or standing) than when lying flat. Upright positions enhance arterial inflow. Engaging core and pelvic muscles also supports erectile rigidity via pudendal nerve activation.

I’ve written more about many aspects of my journey with prostate cancer starting right back in the days directly after my 2020 surgery. And here’s a piece about how we managed sex on vacation when all those toys and gadgets were left behind.

Next: Anti-erectile mechanisms


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Published On: June 9th, 2025Last Updated: June 9th, 2025

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