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Erectile dysfunction (ED) and prostate cancer surgery: what to know

Two men walking holding hands and walking on cliff top

When your penis cannot become hard enough (or stay hard for long enough) to have sex, you have erectile dysfunction or ED. And every kind of prostate cancer treatment (including surgery) can cause changes to your sexual function.
We’ll cover why ED happens, how long it lasts, and what you can do about it.

Why does erectile dysfunction happen after prostate cancer surgery?

Most men experience erectile dysfunction for a time after prostate cancer surgery for one very simple reason: surgery to remove your prostate affects the nerves and blood supply around your penis. Your penis needs a healthy blood flow to get an erection. Without this, your penis will not become as hard as it did before surgery.

Although you may feel aroused and in the mood, these messages from your brain aren't able to make blood flow to the penis.

During surgery, your entire prostate is removed. The nerves that help create erections run down the left and right side of the prostate. Your surgeon can usually take out the prostate without causing permanent harm to the nerves on either side. But if your cancer is too close to the nerves, they may need to be cut out.

I’ve had ‘nerve-sparing’ surgery—can I still have erection problems?

Depending on where the cancer was within the prostate, your surgeon may have been able to avoid cutting the nerves—known as "nerve-sparing" surgery. However, even with nerve-sparing surgery you’ll likely have some trouble getting a hard erection right away after surgery. And some people may not get back their full erectile function. It is important to understand that surgeons cannot see the nerves during the surgery, so they use their knowledge of anatomy to attempt to avoid cutting nerves.

Sometimes the bundles of nerves on both sides of the prostate must come out (Non Nerve-Sparing Surgery). Damaged nerves can often recover; however, cut nerves cannot regrow. People who have this kind of surgery will not be able to have erections firm enough for penetration without an erectile aid—such as medications or devices.

How soon after surgery does erectile dysfunction start? When does it get better?

You’ll likely have trouble getting a hard erection immediately after surgery. It may take up to 3 years to improve.

    The level of function you get back depends on:

  • How strong your erections were before treatment

  • Your age

  • If you have other medical problems that affect sexual function, like heart disease or diabetes

  • Your lifestyle (smoking and not exercising will make erectile dysfunction worse)

  • Your medications (for example, beta-blockers can cause problems with erections)

  • Whether you had nerve-sparing surgery, which can reduce the likelihood and severity of ED after prostate surgery

  • Your willingness to work on penile rehabilitation (there are options)

Some are things you can work on—like exercise and keeping a healthy weight. Some are a bit more out of your control. All are things you can talk about with your doctor, and see what recommendations they have that can help.

What can you do about erectile dysfunction after prostate cancer?

Remember, you’ll still have sexual desire. You can still get pleasure from sexual intimacy.

If you're comfortable, you can:

Try medication and erectile aids to help get a firmer erection.

There are different types of sexual aids you can try, all with their own set of pros and cons. Every person is unique so you may need to try out a few options, a number of times and perhaps in combination to settle on the best solution for you. You can find out more here.

Try different positions during sex.

You might want to experiment with different sex positions that can help with blood flow to the penis. Depending on how you like to have sex, consider some of the examples below:

  • Partner on top, you lying down

  • Partner straddling, you sitting

  • Lying on your sides, facing each other

  • Spooning (lying down and cuddling with one person behind the other)

  • Any positions where you are not standing, on your knees, or on top of the partner

Adapt your role

Before surgery, you may have relied on erections as a way to initiate sex. Without spontaneous erections, think about who will initiate and how.

  • Your partner may need to be the one to get things started.

  • You could plan ahead when to have sex, so you look forward to it as a special date.

Expand your bedroom routine to cope with these changes.

After surgery, you may find that penetrative sex is difficult or impossible. It can help to explore different sex acts that give you both pleasure.

    For example:

  • Oral sex, or mutual oral sex (‘69’), which can also be done while laying on your sides if fatigue or weakness is an issue

  • Mutual masturbation (where you stimulate yourselves or each other) at the same time

  • Fingering or penetration with sex toys

Hear from someone who’s been there:

So far I have not been able to get my penis as hard as I want. I do feel angry at times and miss my old sex life. I’ve had to try new things, it’s a struggle.

Sam, 68 years

When can you have sex after prostate cancer surgery?

This will depend on what type of sex you’re having, and what your role is with your partner.

Straight men, and men who have sex with women

If you’re having sex with a partner who has a vagina, it’s safe to attempt intercourse as soon as your catheter is removed. This usually happens about two weeks after the surgery. It is unlikely, however, that you’ll be able to achieve erections so soon after your surgery.

Gay men, and men who have sex with men

If you are the ‘top’ partner, it’s physically safe to have sex and to attempt anal intercourse as soon as your catheter is removed. This usually happens about two weeks after the surgery. It is unlikely, however, that you will be able to achieve erections so soon after your surgery.

If you are the ‘bottom’ partner, it’s physically safe to engage in non-penetrative sex as soon as your catheter is removed. It’s suggested to avoid anal sex for a period of 6 weeks after surgery, to let your internal pelvic region heal. Importantly, it is wise to be cautious and talk to your surgical oncologist about when you can re-engage in sexual activity and anal sex.

Overall, a lot of men are not interested in sex when they are getting over the immediate effects of the surgery. However, there may be an increased need for physical affection for both you and your partner. At this early stage of recovery, you will most likely need to use injections to have erections firm enough for penetration.

As always, if you’ve got questions about erectile dysfunction (ED) and ways to improve, talk to your doctor or care team for support.

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