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Erections after Prostate Cancer Surgery

He felt a little awkward about another question: How would treatment affect his sex life?


ED is common after prostatectomy. May take two years for full function to return, if it does. (Click to tweet)


He knew that his focus should be on his health, survival, and family. But he and his wife had had a fulfilling, active sexual relationship spanning four decades. He didn’t want to give that up.

Karl’s oncologist recommended a prostatectomy – complete removal of the prostate. Nowadays, this surgery is often done laparoscopically, through small incisions. In many cases, the procedure is performed by a surgeon-controlled robot.

Karl’s doctor was honest with him. He might have problems with erections after surgery.

Indeed, erectile dysfunction (ED) is common after prostatectomy. It may take two years for full function to return, if it does. Research presented at the European Association of Urology Congress last March suggested that men’s erections are seldom as good after surgery as they were before surgery.

The situation isn’t as bleak as it sounds, though. Let’s talk a bit about why men develop ED after surgery, what might be done, and how to cope.


Why does prostatectomy affect a man’s erections?

The prostate is a small, walnut-sized gland located beneath the bladder. Its main job is to produce seminal fluid – the liquid that mixes with sperm when a man ejaculates.

Surrounding the prostate is a network of nerves that need to be in good working order for erections to occur. When a surgeon removes the prostate, he or she tries to preserve as many of these nerves as possible. (This is called nerve-sparing.)

But sometimes, nerve-sparing just isn’t possible. The nerves can be difficult to see. And size and location of the tumor might make it difficult to remove without damaging the nerves.

Whether the surgeon uses a nerve-sparing approach or not, most men have some degree of erectile dysfunction (ED) after surgery. It takes time for the area to heal.


Penile Rehabilitation

After surgery, Karl started a penile rehabilitation program (PRP). His doctor said it was similar to physical therapy. Karl thought the name sounded funny, as though he and his private parts would be going to the gym.

The goal of a PRP is to keep the penis healthy and strong by inducing erections. This may be achieved with medications, including pills like Viagra, Cialis, or Levitra. Other methods are penile self-injections, suppositories, and vacuum erection devices.

PRPs can be successful, but much depends on the patient and his cancer treatment. For example, if he had trouble with erections before surgery, he may still have trouble after rehabilitation. Any nerve damage during surgery will affect the results. Other forms of treatment, like radiation and hormonal therapy, can also play a role.

A man’s overall health status is important, too. If he is older or overweight, smokes, or has a medical condition that increases his risk for ED (like diabetes), he might have a poorer outcome.

Men must be committed to the program as well. Penile rehabilitation takes patience. It could take several years before erections come back. In the meantime, men need to continue with their exercises and follow their doctor’s instructions.

There were times when Karl felt like giving up. But his wife, and the memories of what they had shared, kept him going until they were enjoying intercourse again.


What can men do?

The uncertainty and anxiety associated with cancer is a lot to handle. Here are some things to keep in mind, as far as your sex life goes:

·         Having your prostate gland removed doesn’t have to mean the end of your sex life. But you and your partner may need to make some adjustments, at least for a while. Be prepared.

·         Remember that there is more to intimacy than a good erection. You and your partner can enjoy kissing, cuddling, touching, and oral sex. You might try having sex in a different location or experiment with some sex toys. Be creative and playful.

·         Talk to your partner about your feelings. Some men feel they are “less of a man” if they can’t have firm erections easily. Most likely, your partner will assure you that you are every bit as masculine as you were before surgery.

·         It’s normal to feel depressed when you’re coping with cancer. Try to get out with friends and continue with activities you enjoy, to the extent that you can. If you start to feel like it’s all too much, reach out to a trusted friend or family member. Talking to a counselor can help. Your doctor can suggest one.

·         You and your partner might consider seeing a therapist who specializes in sex after cancer treatment. The therapist may suggest new techniques to try in the bedroom and help you and your partner better communicate your feelings and needs.


Overall, remember that you’re not alone. Your oncology team and support network are there for you. Don’t be afraid to ask for help. Sexuality is a fundamental part of who we are and, just like any other aspect of our health, it deserves attention. While your sex life might not be the same as it was before surgery, you might find that it is still just as satisfying afterwards.

Print this article or view it as a PDF file here: Erections after Prostate Cancer Surgery


American Cancer Society

“Sexuality for the Man with Cancer”

(Last review: August 19, 2013)

Harvard Health Publications

“Penile rehabilitation after prostate cancer surgery”,N0111b

International Society for Sexual Medicine

“How successful are penile rehabilitation programs (PRPs)?”

“What does a penile rehabilitation program (PRP) involve?”

“What is a penile rehabilitation program (PRP)?”

Prostate Cancer Foundation

“About the Prostate”


“#EAU15 - Study shows regaining normal sexual functioning is ‘rare’ after prostate operations”

(March 21, 2015)