Impotence and Recovery After Prostate Surgery

Impotence and Recovery from Prostate Surgery: What to Expect

Prostate cancer

Prostate cancer affects an estimated 1 in 7 adult men. Fortunately, it’s a very treatable illness, especially if caught early.

Treatment can save lives, but it can also cause some serious side effects. One of the most common side effects is impotence, also known as erectile dysfunction (ED).

What is ED?

An erection is achieved when the brain sends sexual arousal signals to the nerves in the penis. The nerves then signal the blood vessels in the penis to expand. Blood flow to the penis increases, making it hard and erect.

ED is a condition that occurs when a man cannot achieve or maintain an erection long enough to engage in sexual intercourse or achieve orgasm. Problems with the nervous system, blood vessels, hormones, and even your emotions can lead to erectile dysfunction.

Surgery for prostate cancer and ED

Prostate cancer tends to be a slow-growing cancer and surgery may be a good option if your doctor believes the cancer is entirely contained within the prostate gland.

A radical prostatectomy involves the removal of the prostate gland. The prostate gland is a donut-shaped gland that surrounds the urethra just below the bladder. The urethra carries urine and semen out from the body through the penis.

There are some risks associated with surgery. Two small bundles of nerves on either side of the prostate are vulnerable to injury during the operation. A type of operation called “nerve sparing” surgery may be possible, depending on the exact size and location of the cancer.

If there’s a chance the cancer has invaded one or both sets of nerves, the operation may also include removal of the affected nerves. If both sets of nerves are removed, erections probably won’t be achievable without the assistance of medical devices.

The decision to operate is dependent on your age, overall health state, and other factors. You should discuss any concerns with your doctor.


You may experience impotence for a few weeks, a year, or even longer after the surgery. That’s because the operation can injure any of the numerous nerves, muscles, and blood vessels involved in getting an erection.

Outlook for Recovery
The Prostate Cancer Foundation reports that about half of men who undergo nerve-sparing surgery will regain their pre-surgery function within the first year after the operation.

There are a lot of factors that affect impotence recovery after surgery, so it’s difficult to predict how your own recovery will go. Injury to nerve tissue during a radical prostatectomy can contribute to a longer recovery. If you were experiencing erectile dysfunction before the surgery, it won’t be better afterward.

Improvements in prostate surgery techniques in recent years have led to much better outcomes for many men. Healthier erectile function prior to surgery can also help predict a better outcome.

Remember that other factors can affect your sexual health, including:

  • older age
  • cardiovascular disease
  • diabetes
  • smoking
  • obesity
  • excessive alcohol consumption
  • sedentary lifestyle

A healthy lifestyle can lead to a better recovery for erectile function and your overall well-being.

ED treatment

Impotence recovery after prostate surgery can be helped along with medications or devices for many men. Popular ED medications, such as sildenafil (Viagra) and tadalafil (Cialis) can be very effective. About 75 percent of men who undergo nerve-sparing radical prostatectomy can achieve successful erections with these drugs. If you have a heart condition, however, your doctor may recommend that you not use ED medications for fear of serious complications.

Men who can’t or don’t want to take medications for impotence may want to consider a vacuum constriction device, also known as a vacuum penile pump. A vacuum seal is placed around the penis to help force blood into the penis. A rubber ring placed at the base of the penis helps keep the seal tight. The device can be very effective for most users, but many men choose not to continue with it long-term.

A surgically implanted flexible tube is another option to treat ED. A small button is inserted into the testicles. This button is pressed from the outside to start a flow of liquid into the tube, creating an erection. This surgical solution is generally well tolerated and effective but health concerns may not make it right for every man.

Understanding your potential ED treatment options prior to surgery may help reduce some of the pre-surgery anxiety you may experience. A conversation with your doctor may be very reassuring. You may even want to reach out to other men in a prostate cancer support group.

Talk with your doctor

Talk with your doctor about all of your treatment options if you’ve been diagnosed with prostate cancer. Consider getting a second opinion that may either confirm your doctor’s recommendation or give you other options to consider. Prostate surgery can be a lifesaving and life-changing step. You shouldn’t feel self conscious or guilty by seeking other opinions. Your doctor will likely understand your interest in gathering more facts and perspectives.

While ridding your body of cancer is obviously the most important issue, you should have an open and honest conversation about returning to sexual activity after treatment. It can be an embarrassing and uncomfortable conversation for many men. Remember that you’re certainly not the first person to have these questions and concerns, nor will you be the last.

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