Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 1/24/2021
Prostate cancer is a scary prospect, but equally scary to many men is the sudden and surgical loss of your sex life and healthy sexual function.
As one of the main treatment options for prostate cancer in men, prostatectomy is a simple surgery, but the side effects can scare men away from treatment, for fear of losing the ability to achieve and maintain erectile function.
If you’re staring this possibility in the face after a prostate cancer diagnosis, you likely have a lot of questions about whether your normal function will ever be the same — or return at all.
Thankfully, many men who undergo prostate surgery recover sexual function over time, depending on the procedure. And there are treatments that can help in the recovery process and boost function even while you’re on the healing path.
There are several treatment options available to help with erectile dysfunction symptoms after prostate surgery, which we’ve laid out below. But first, it’s important to understand what undergoing prostate surgery means.
Prostate cancer surgery involves removing cancer-affected areas of the gland, but the nerves and blood vessels that facilitate erectile function can become affected.
There are effectively two forms of prostate surgery: radical prostatectomy, in which the whole prostate is removed, and simple prostatectomy, where only the part of the prostate causing urinary symptoms is removed.
These surgeries are typically designed to be nerve-sparing when possible, but regardless of nerve damage according to Johns Hopkins, nearly all men will experience some ED within the first months after treatment.
Erectile dysfunction from prostate cancer surgery can range in severity because a number of factors — your age and previous function, the surgical techniques used — and a 2015 paper showed wide variation from patient to patient.
But there’s good news despite the high rate of symptoms. The same data shows that as many as half of men affected will have returned to their normal, pre-treatment function within a year, and up to 60 percent after two years.
It’s important to note that one of the key indicators of potential to return to normal function is normal function prior to surgery; previous or existing ED could mean a longer road to recovery.
Recovery rates are still dependent on a multitude of factors, but there are a variety of treatments to help in recovery, regardless of the severity of sexual dysfunction post surgery.
There are several treatment options for ED after radical prostatectomy, from medications and devices to further surgical options and even penile implants.
Each treatment option carries with it its own benefits and drawbacks, and different treatments may offer different results from one individual to another.
It’s best to consult with a medical professional before beginning a series of treatments, to find the best treatment for you.
Here are some options that may be recommended.
A paper in the Journal of Medicine and Life in 2017 called ED medications the first line of treatment for post-prostatectomy ED.
There’s a simple reason: they’ve been proven effective and safe. And 75 percent of men suffering from prostate surgery ED successfully achieved erections after using an oral medication.
However, they may not be right for men who take medications for angina (or other heart problems), or men who take alpha-blockers.
Drugs like Viagra® (sildenafil or generic Viagra), Cialis® (tadalafil), Levitra (vardenafil) and Stendra® (avanafil) work by improving blood flow to the erectile tissue of your penis, making it easier to get and maintain an erection.
They’re considered on-demand medications, as they should be taken before sexual activity.
Within these drugs there are variations that make them slightly different. Cialis is long-lasting while Viagra works for just a few hours. A more comprehensive review of the differences in these medications including side effects is available here.
Most medical professionals will suggest oral drugs as a first treatment to ED, but intracorporeal injections can be employed to directly promote the proper muscle relaxation to cause an erection.
Different studies have seen results ranging from 20 percent success up to 90 percent, after oral medications failed.
Vacuum devices — penis pumps — work by creating a seal around the penis in a tube, and then creating a vacuum in that tube, which will draw blood into the penis. The device was popularized in the ‘60s, but it’s been known to be effective and safe (and affordable) for decades.
It can also be used in combination with other treatments, making it a first line option for many. There can be some discomfort from the constriction band, though.
Surgical options for penile rehabilitation present a more severe approach to ED symptoms, once again sending the patient under the knife for results.
The implant consists of an inflatable device inserted into the penis, a balloon-like structure filled with fluid in the abdominal wall, and a release button. The release button allows fluid to enter the tube, straightening the penis and creating an erection.
Penile prosthesis and inflatable devices should largely be considered a last option after other treatments have failed, as risks can include infection and erosion. But assuming they’re working properly, they are 100 percent effective.
Along with treating the physical symptoms of ED during sex after prostatectomy, it’s important to consider psychological treatments as well, including therapy.
Even after life-saving surgery, ED can wreak havoc on self confidence, relationships, and ED can be associated with a higher risk of depression.
Men suffering from ED avoid seeking medical help. Studies have shown that more than half of men could not accept that they had ED, and that the median time to pursue treatment was two years.
A study of men with and without prostate cancer found that only half of men were interested in seeking treatment, and it’s estimated that 50 percent to 80 percent of men discontinue treatment within a year.
If you’re experiencing depression, anxiety or psychological distress associated with prostate cancer or the side effects of prostate cancer treatment, you should consider talking to a mental health professional.
If you’re suffering from ED after prostate surgery, there are plenty of treatments available to help you get back to previous sexual activity.
A medical professional will most likely start you on an oral medication designed to assist you in achieving and erection.
They will take a detailed history, including other medical conditions you may have as well as any other medications you might be taking. Based on this evaluation, they can provide a recommendation for treatment.
And remember: ED is a treatable condition, but after surgery, recovery and results may take time. It may be a while before results of treatment begin to show, so don’t get discouraged if you’re struggling to see results immediately.
And while there’s one symptom in particular that you may be focused on, don’t forget to treat the psychological symptoms as well.
Make sure to get help if you begin to feel sad, down, or low for extended periods of time, of if your sex drive is lowered, as these can also be symptoms of depression.
If you’re having depressive thoughts, talk to a mental health professional or your healthcare provider and get help.