Impotence and Recovery from Prostate Surgery: What to Expect

Medically reviewed by Daniel Murrell, MD on November 20, 2017Written by James Roland

Prostate cancer

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

Treatment can save lives, but it can also cause 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 blood vessels in the penis to expand. Blood flow to the penis increases and makes it erect.

ED is a condition that occurs when a man cannot achieve an erection or maintain an erection long enough to have sexual intercourse or achieve orgasm. Emotions and problems with the nervous system, blood vessels, and hormones can cause ED.

Surgery for prostate cancer and ED

Prostate cancer tends to be a slow-growing cancer. Surgery may be a good option if your doctor believes the cancer is contained in the prostate gland. Surgery is also dependent on age, overall health, and other factors.

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. This depends on the size and location of the cancer.

Surgery may require removal of some nerves if there’s a chance the cancer has invaded one or both sets of nerves. If both sets of nerves are removed, you may not be able to achieve an erection without the assistance of medical devices.

Recovery

After the surgery, you may experience ED for a few weeks, a year, or longer. That’s because surgery can injure any of the nerves, muscles, and blood vessels involved in getting an erection.

There are also other factors that affect ED during recovery. So, it’s difficult to predict your own recovery. Injury to nerve tissue during a radical prostatectomy can cause a longer recovery. If you were experiencing ED before the surgery, it won’t be resolved after surgery.

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

Other factors can also 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

Medications or devices can help ED recovery after surgery. Popular ED medications, such as sildenafil (Viagra) and tadalafil (Cialis) can be 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, your doctor may not recommend the use of ED medications because of the risk for serious complications.

Men who can’t or don’t want to take medications for ED may 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 is effective for most users.

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

Understanding your ED treatment options before surgery may help reduce some pre-surgery anxiety. Talking with your doctor may be reassuring. You may also want to reach out to other men in a prostate cancer support group.

Talk with your doctor

Prostate surgery can be a lifesaving. Talk with your doctor about all your treatment options if you’ve been diagnosed with prostate cancer. Also, consider getting a second opinion that may either confirm your doctor’s recommendation or give you other options. Your doctor will likely understand your interest in gathering more facts and perspectives.

Getting rid of the cancer is most important. But you should have a conversation with your doctor about returning to sexual activity after treatment.

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