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Last updated May 5, 2020. 6 minute read

Erectile dysfunction and sex after prostatectomy

Some men are able to regain spontaneous erections in the months and years following prostatectomy through treatment strategies, and others are not. For some men, medications, devices, and other types of penile rehabilitation may be necessary.

17632058 10105404686002753 3934324734988674732 O Written by Michelle Konstantinovsky
Reviewed by Dr. Mike Bohl, MD, MPH

Surgery can be scary or uncomfortable for a lot of people, but if you’re told you have to have prostate surgery, you may experience an added element of discomfort or even embarrassment. You may have questions you feel awkward asking your doctor. For instance, when is it okay to have sex after prostatectomy?

Vitals

  • Prostate surgery can have a variety of sexual side effects, including erectile dysfunction.
  • Some men are able to regain spontaneous erections in the months and years following prostatectomy through treatment strategies, and others are not.
  • For some men, medications, devices, and other types of penile rehabilitation may be necessary.

What to expect from prostate surgery

Before understanding how prostate surgery can affect your sex life and sexual activity, it’s important to understand what prostate surgery is in the first place. Otherwise known as a prostatectomy, prostate surgery usually involves the removal of part of the prostate gland or the entire gland. Simple prostatectomy refers to the removal of just the inner part of the prostate gland. This surgery is usually a treatment for an enlarged prostate. Radical prostatectomy involves the removal of the entire prostate gland, and this surgery is a form of prostate cancer treatment (NIH, 2019).

Your healthcare team may recommend some form of prostate removal if you have problems emptying your bladder (urinary retention), frequent urinary tract infections, frequent prostate bleeding, bladder stones with prostate enlargement, very slow urination, or kidney damage (NIH, 2019).

Depending on the type of prostate surgery you have, you’ll likely need to remain in the hospital for 2 to 4 days after the procedure. Following the surgery, you’ll likely need to stay in bed until the next day, and once your healthcare team allows you to get up, they’ll ask you to move around as much as you can to keep your blood circulating. They may also teach you physical exercises and breathing techniques to repeat every few hours. After the surgery, you may need to use a breathing device to help keep your lungs clear, and you may also need to wear special compression stockings. After the surgery, you’ll have a catheter placed in your bladder. Full recovery usually takes about six weeks, and most men are able to urinate normally once they recover (NIH, 2019).

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Sex after prostate surgery

Like all surgeries, prostatectomy carries some potential risks and side effects like blood clots, infection, and more. The procedure can also have a few significant effects on your sex life. One possible risk of the surgery is erectile dysfunction (otherwise known as impotence). Some men also lose the ability for sperm to leave their body (this occurs in prostate cancer patients following radical prostatectomy because the organ that’s responsible for ejecting sperm is totally removed)—men who experience this, therefore, become infertile after surgery. Some men experience a condition called retrograde ejaculation, which involves passing ejaculate back up into the bladder instead of out through the urethra (NIH, 2019).

Recovery from prostate surgery and sexual function and sexual health post-prostatectomy can look different for every person. While some men report less satisfying and dry orgasms due to the lack of semen, others say they are able to adjust to their new baseline orgasm. These side effects may be permanent, particularly in the case of radical prostatectomy (ACS, 2020).

ED and prostate surgery

The most common side effect of prostate surgery is erectile dysfunction (ED): research has shown that as many as 85% of men who’ve had radical prostatectomy have problems with erections following the surgery (Emanu, 2016).

There are two tiny nerve bundles running along the side of the prostate that control erections. For some men, their surgeon may be able to use a “nerve-sparing approach” during the procedure to avoid injuring these nerves. But for some people with cancer that has grown very close to these nerves, a nerve-sparing approach isn’t an option. If both of these nerves have to be cut, you will no longer be able to have spontaneous erections. But some men are able to have erections again with the help of certain treatment strategies (described below). If you only have to have the nerves on one side of the prostate removed, you may still be able to get spontaneous erections, but it’s less likely than if neither nerve bundle was cut (ACS, 2019).

If neither of your nerve bundles are cut, you might eventually be able to experience spontaneous erections at some point following the procedure. But your ability to start having erections again depends on a few factors, including your age and your ability to get erections before the surgery. All men who have prostatectomy will have some decrease in their ability to have normal erections, but younger men are more likely to eventually recover this ability. Every person is different, and if you are able to regain spontaneous erections, it will probably happen slowly—it can take anywhere from a few months to two years. (ACS, 2019).

Treating ED after prostate surgery

There are a few treatment strategies that may help you regain the ability to have an erection following prostate surgery, as long as you have at least one nerve bundle intact.

Some doctors may recommend a treatment strategy known as penile rehabilitation or penis rehab. Many health experts believe that the sooner you’re able to get an erection after surgery, the more likely you’ll be able to gain better control of this side effect over time. Most doctors feel that regaining potency is helped along by trying to get an erection as soon as possible once the body has had a chance to heal (usually several weeks after the operation). The goal of penile rehabilitation (PR) is to preserve as much erectile function as possible through the use of medications and/or devices (Albaugh, 2019).

For some people, PR may involve the use of prescription medications. Oral medications known as PDE5 inhibitors are common treatments for erectile dysfunction. The most common one is sildenafil (brand name Viagra). Other PDE5 inhibitors include tadalafil (brand name Cialis), vardenafil (brand name Levitra), and avanafil (brand name Stendra) (Krzastek, 2019).

In some cases, a specific type of device may be helpful in restoring normal erections. Known as vacuum therapy (VT), this kind of treatment uses a vacuum pump to draw blood into the penis. Because a vacuum pump can lead to erections regardless of nerve disturbance, VT may be an important part of PR to help restore erections (Hecht, 2016).

Certain natural supplements, herbs, and vitamins may or may not have a beneficial impact on ED. A traditional Chinese herb called horny goat weed is often used to treat fatigue and low sex drive, and while animal and lab studies have shown it to be a mild PDE5 inhibitor (Dell’Agli, 2008), it’s unclear if these benefits translate to humans (Shindel, 2010). A 2015 review found that yohimbine, the active ingredient in yohimbe bark, may work better than a placebo to treat ED (Cui, 2015). Some research suggests that vitamin D deficiency may contribute to erectile dysfunction (Farag, 2016), and some research has shown vitamin B3 supplementation may be helpful in increasing blood flow to the penis (Ng, 2011). In general, research on natural supplements is limited, so it’s best to work with a doctor or other medical professional to treat ED.

Certain lifestyle modifications can also help treat ED. Because a lack of physical activity, obesity, an unhealthy diet, and cigarette smoking have all been shown to contribute to erectile dysfunction and sexual dysfunction, taking actions to modify these behaviors and conditions may improve symptoms of ED. Health issues like diabetes, cardiovascular disease, high blood pressure, and certain mental disorders can also contribute to ED, so working with a health professional to manage these conditions may be helpful (Krzastek, 2019).