Erectile Dysfunction After Prostate Surgery: 4 Ways to Improve Recovery
Most men will experience erectile dysfunction after a radial prostatectomy, at least temporarily. Men who have had natural erections pre-surgery are likely to regain erectile function with a dedicated recovery plan, while men who had pre-existing erectile dysfunction, had a non-nerve-sparing procedure, or who have had long periods of disuse may have more difficulty with erectile function after surgery. To improve erectile function, treatments like medications (Cialis, Viagra, Levitra), vacuum erection devices (VED), and pelvic floor muscle training can all be effective. Plus, finding ways to maintain or improve intimacy even without an erection can be a huge part of maintaining connection and fun while you recover.
Erectile Function After Prostate Surgery
Prostate cancer can be a life or death issue, and when we are choosing life aren’t we hoping to choose all that life has to offer? Sexual health and performance is part of life and is just as valid as PSA numbers, pain, or any of that other important stuff. The truth is, 80-90% of men will wake up from prostate removal surgery (prostatectomy) and will be completely unable to achieve an erection. Now, for the first 7-10 days they are likely pretty happy with that - having an erection with a catheter in place is not a fun experience! But what about after that? The good news is that most men that were able to have erections before surgery will end up being able to have them post-surgery if they have a good plan in place for optimal results.
The Science: Why ED after Prostate Surgery?
Surgeons are awesome and the technology available these days is incredible. But even with all the skill and technology, there is a lot of disruption when we are entering the body, removing, and reattaching things. No matter how careful and precise the surgeon and/or robot is, the tiny nerves that are critical for erections get disturbed. Think of this disruption as more of a strain or bruise vs a cut or killed. While these nerves are injured, the brain is not able to transmit all the necessary signals to penile structures to facilitate an erection and keep tissues healthy.
How to Improve Erections After Prostate Surgery
Regaining sexual function after surgery doesn’t have to be a wait and see game. We can use what we know about physiology and sexual health to our advantage and make a roadmap for recovery. So what do we know? First and foremost, blood flow is king! Not only does the penis need blood flow to stand up, but it needs blood flow to
Keep skin, muscles, and connective tissue healthy
Heal nerves
Keep the spongy tissue pliable
The truth is, without regular and consistent blood flow the penile tissue can shrink (atrophy) and make it more difficult for the future-self to ever get erections. Therefore, we need to get the blood pumping as soon as possible to get erectile function and organ health back on track.
Here are 4 things you can do for erectile function after prostatectomy:
Medication: Pills like tadalafil (Cialis) , sildenafil (Viagra), and vardenafil (Levitra) are all PDE5 inhibitors, which help blood vessels relax and open wide to increase blood flow. I most commonly see daily tadalafil prescribed around the time your catheter is removed and continuing as long as needed. Your surgical team will be the ones to prescribe these medications if they are safe for you.
Vacuum Erection Device (VED): The medical name sounds fancy, but it’s a penis pump. While these devices help increase blood flow, they also can ensure that blood enters the spongy erectile tissue to help keep it flexible. They can also be used for sexual activity before natural erections return!!
Pelvic Floor Muscle Training (PFMT): Smart training will improve blood flow to promote healing and increase satisfaction with sexual activity. Your pelvic floor also needs to be strong enough to keep the blood in the penis. Unfortunately, there isn’t a strong link showing that pelvic floor muscle training increases the chance or speed or returning erections, but it can still be an important piece of the picture.
Playfulness & Communication: “Excuse me, what?” I know this doesn’t help with blood flow, but hear me out: If we set our expectations super high, look at erection recovery as a job/chore, or “hide” and wait to engage until things are perfect, we are going to miss out! Does anyone perform their best under pressure, especially sexually? No. Our partners are supportive, understanding, and accommodating. Please, don’t pull away from them and rehab alone in the corner. Have fun, try new things, and try to stay cool (maybe even laugh) if things don’t go as expected right away.
Why Erections May Not Return After A Prostatectomy
Another hard truth: there are times where natural, unassisted erections might not return. The most common circumstances where erectile dysfunction is likely to persist are:
Non-Nerve-Sparing: If, during surgery, the Cavernous Nerves were unable to be spared or became severely injured, it is unlikely that natural erectile function will resume.
Pre-Existing Erectile Dysfunction: Many things can cause ED, but if ED was due to physiological factors (i.e. diabetic neuropathy, blood vessel plaques, known nerve/blood vessel injury) and/or present for multiple years pre-op - it is less likely that natural erections return.
Prolonged Disuse/Atrophy: I guess this is the “use it or lose it” principle in action. If the spongy tissues aren’t exercised to keep pliable or if the pelvic floor muscles that help keep blood in the tissues are not strong enough/have enough endurance, it can make spontaneous erections more difficult to achieve.
Despite these bits of downer news, it should be noted that the language used in this section is intentional: “less likely,” “more difficult” are used because we can never say never with humans. With diligent work, focus, and intention it could be possible for you. Plus, sexual activity can still happen and be pleasurable without erections. Again, “Excuse me, what?” YEP! Most men can orgasm without an erection (just because one hasn’t tried, doesn’t mean one can’t). There are lots of options out there for intimacy and sexual activity that don’t involve penetrative sex or even orgasm too (this is the year 2026+ after all).
The Bottom Line
Having prostate surgery does not mean you will have erectile dysfunction forever. For most men, erectile function returns, and for men that don’t regain spontaneous erections, there are other options to have enjoyable intimacy and sexual activity if desired.
Resolving erectile dysfunction after a radical prostatectomy does take time, a sequence of smart steps, and a bunch of patience. Work closely with your medical team, talk openly with them and your partner, and don’t be afraid to lean on a dedicated pelvic coach to build your custom plan. You’ve got this.
