Erectile dysfunction (ED) is a common side effect for the first several months after a prostatectomy, the cancer surgery that removes some or all of the prostate.
After the surgery, the pelvic floor muscles responsible for getting and maintaining an erection may be weakened and lose function. While this condition usually goes away within a year, it can take some men two or more years to regain normal erectile function.
Penile rehabilitation refers to the treatment programs available for men with post-prostatectomy ED and includes medication, injections, implants, and sex therapy.
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What Is Post-Prostatectomy Erectile Dysfunction?
Erectile dysfunction, also known as ED, is the inability to get and maintain an erection hard enough to have intercourse. Up to 90% of men experience ED after having a prostatectomy, or surgery to remove part or all of the prostate gland.
The prostate is a walnut-sized gland right below the bladder in the male reproductive system. It surrounds the urethra, or tube through which urine and semen flow, creating extra fluid for ejaculation, and its muscles are critical for semen to leave the body during an orgasm.
The prostate has two parts — the outer part and the inner part. Depending on the type of prostate cancer or condition, one part or the entire gland may be removed.
What are the types of prostatectomies?
There are two types of prostatectomies:
Simple prostatectomy
During a simple prostatectomy, the inner part of the prostate is removed while the outer part remains. You still have some of your prostate, but not all of it. This procedure is usually done laparoscopically, or in a less invasive way that includes robotic arms.
Simple prostatectomies are typically reserved to treat severe urinary symptoms, enlarged benign prostate glands, and other conditions that may be impacting or obstructing the prostate. It is rarely used for prostate cancer removal.
Radical prostatectomy
In a radical prostatectomy, a surgeon removes the entire prostate gland and some surrounding tissue. This surgery can also be done laparoscopically or open.
A radical prostatectomy is most commonly performed to treat localized prostate cancer.
How common is post-prostatectomy ED?
Erectile dysfunction after prostate removal surgery is very common — up to 90% of men experience ED symptoms after the procedure. For some, ED goes away within a few months. For others, the condition remains for years.
What causes post-prostatectomy ED?
ED is a normal side effect of prostate removal. Post-prostatectomy ED doesn't seem to happen more often with one type of prostatectomy over another.
Prostatectomy tends to cause ED because the surgery weakens the pelvic floor, a part of the body that's vital to getting an erection. Located just under the bladder and behind the base of the penis, the pelvic floor contains many muscles, nerves, and blood vessels.
To get an erection, the brain needs to send signals through these nerves, the blood vessels must allow enough blood to flow into the penis, and pelvic floor muscles have to squeeze blood into the penis. If any of these parts are damaged during surgery, you may not be able to get or keep an erection.
Post-prostatectomy ED risk factors
The biggest risk for ED after a prostatectomy is age. After 50, the likelihood of developing ED after surgery increases significantly.
Men under 50 may avoid ED completely or recover faster.
Complications of post-prostatectomy ED
The biggest complication of ED after prostatectomy is the inability to get or maintain an erection.
What Are the Signs and Symptoms of Post-Prostatectomy Erectile Dysfunction?
Symptoms of post-prostatectomy ED are the same as symptoms for regular ED. These include:
- Having erections that aren't hard enough for intercourse.
- Having erections that don't last until orgasm.
- The inability to get an erection altogether.
Even though it's very common, ED can also cause some men to feel embarrassed. In addition, it might cause stress for you and your sexual partner(s).
When should I see a doctor about my post-prostatectomy ED symptoms?
If you are experiencing any of the above symptoms and have recently undergone a prostatectomy, it’s important to talk with your cancer care team. They can help create a personalized treatment plan for you.
How Do You Diagnose Post-Prostatectomy Erectile Dysfunction?
While ED is a known complication after prostate removal, your doctor will examine your genital area to confirm the cause of your ED. They may ask you to get blood tests to check your hormones and general health, and a urine test.
Tests to diagnose post-prostatectomy ED
Your doctor may request extra tests, including:
- Doppler ultrasound — Seeing ultrasound images of the penis, while both soft and erect, will allow your doctor to see how blood is flowing through it.
- Intracavernosal injection test — The doctor injects medicine into your penis that causes an erection, which they then measure.
- Nocturnal penile tumescence test — This test checks whether you have erections at night. If you do, the cause of the ED likely isn't physical.
How Do You Treat Post-Prostatectomy Erectile Dysfunction?
One of the most important components of treating ED is penile rehabilitation — using or exercising your penis to maintain its ability to become erect.
Rehabilitative treatments your doctor may recommend include:
- Injection — The doctor injects a muscle relaxant into the penis with a very small needle, allowing blood to flow into it.
- Oral medicine — Oral medicines for ED work as muscle relaxants. When the smooth muscle of the penis is relaxed, more blood can flow into it, which helps create an erection.
- Vacuum device — A tube is placed over the penis, forming a vacuum that pulls blood into it and makes it erect. Once the penis is erect, a band is placed around its base to hold the blood in the penis, allowing the blood vessels and muscles to stretch.
- Penile prosthetic device — Two types of prostheses make the penis erect: non-inflatable, or rigid, devices, and inflatable devices, which fill with liquid. Both types of devices are permanent and implanted through surgery.
Because ED can affect your relationship with your partner, sex therapy can also be helpful. In partner therapy sessions, you can work on methods for better communication, resolve anxiety, and find ways to make your physical relationship more satisfying.
