Learn more about: Erectile Dysfunction (penis not getting as hard)

Why does erectile dysfunction happen after prostate cancer surgery?

Surgery to remove your prostate affects the nerves and blood supply around your penis that are responsible for erections. This creates an issue, as your penis needs a healthy blood flow to get an erection. Without a good blood supply, 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. The nerves that send a signal to your penis to open the blood vessels and allow blood to flow in do work or do not work well after surgery, even if your surgeon spared them. It will take time for them to recover. When the nerves do not work and blood cannot flow into the penis, it is known as erectile dysfunction, or ED.

How soon after surgery does this start? When does it get better?

You’ll likely have trouble getting a hard erection immediately after surgery. It may take 2 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

  • your willingness to work on penile rehabilitation

What can you do

Remember, you’ll still have sexual desire and can get pleasure from sexual intimacy. If you're comfortable, you can:

Try medication and erectile aids to help get firmer erections

You can find out more about this when you get to Second Base.

Try different positions

You might want to experiment with different sex positions that can help with blood flow to the penis.

For example:

  • partner on top, man lying down

  • partner straddling, man sitting

  • lying on your sides, facing each other

  • 'spooning' — lying down with one person behind the other

  • any position you can create together

Think about your sexual roles

Some men lose confidence in their ability to initiate sexual activity without being able to have an erection. This is especially true if the man was the one to be the usual initiator. Even without spontaneous erections, this role does not have to change if you and your partner prefer it.

  • Remember, if you have desire for sex, you can still initiate.

  • This is also an opportunity for your partner to be the one to get sex started.

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

Expand your routine in the bedroom to cope with these changes

Explore different sexual activities that give you both pleasure.

For example:

  • sex or mutual oral sex ('69') — which can also be done lying on your sides if fatigue or weakness is an issue

  • mutual masturbation

  • sensual touching

  • fingering or penetration with sex toys, or stimulation with vibrators

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