Radical prostatectomy is surgery to remove the prostate gland. This surgery is most often done to treat prostate cancer. The success rates are good if the cancer has not spread beyond the prostate. There are risks with this surgery, though. One such risk is erectile dysfunction (ED).
The reason why radical prostatectomy carries this risk is that two tiny cavernous nerves are located along the sides of the walnut-sized prostate. Normally, these cavernous nerves carry signals to the penis to fill with blood and become erect. But, during surgery, the doctor may need to remove one or both nerves if they are too close to the cancer. Also, even if the nerves are not removed, they can still be damaged during the surgery. This trauma to the cavernous nerves is one of the main causes of ED after prostate surgery.
If you have been diagnosed with prostate cancer and need surgery, you may want to know what options are available to restore your sexual function after surgery. First, it is important that you talk openly with your doctor about:
You should also talk to your doctor about your overall risk of developing ED. For example, if you are older, have a chronic condition like diabetes, and already have sexual function problems, then you are more likely to develop ED after the surgery.
While it can be difficult to discuss sensitive topics like sex, remember that your sexual health is a part of your overall health and well-being, and it is definitely worth talking about. If you have a partner, be sure to involve this important person in your recovery since your sexual function affects you both.
Since ED is a common complication after prostate surgery, it is a good idea to learn about your treatment options. It is also important to understand that while ED affects most men after prostate surgery, many men regain the ability to have erections within two years of nerve-sparing surgery. This is not as common, though, if the nerves were removed.
Your doctor may prescribe medicines like sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis) after your surgery. These medicines work by increasing blood flow to the penis, which causes an erection.
Injecting medicine directly into the penis is another option. While this is not as convenient as taking a pill, this option can help produce an erection.
A vacuum device is also available. This involves placing a mechanical pump over the penis. This pump creates vacuum pressure, which triggers an erection by causing blood to flow into the penis. To maintain the erection, a small band is placed around the shaft of the penis.
Surgery can also be done to treat ED, as various devices exist that can be implanted into the penis to help you achieve an erection. With one type, there is a small pump implanted under the skin of the scrotum. When you want to have sex, you squeeze the pump and fluid is sent to cylinders that are implanted in the penis. The fluid helps create an erection.
Pelvic floor muscle exercises offer yet another option. These exercises have been found to improve erectile function in men with ED from other causes. Your doctor may recommend that you do pelvic floor muscle exercises after surgery to help with urinary control and possibly for restoring your sexual function.
Since there are many treatments to try, there is a good chance that you will find one that fits your lifestyle.
There may be other sexual problems, though, beyond the ability to have an erection. For example, you may experience difficulty having an orgasm. For men who can have an orgasm after prostate surgery, they will still have a pleasurable experience. But, they will not ejaculate semen due to the removal of the prostate.
Facing a cancer diagnosis and the impending treatment is a life-changing event. It may be too overwhelming for you to think about how prostate surgery will affect your sex life.
But remember that there are doctors and mental health professionals who have a lot of experience in dealing with ED. Therapists understand how sexual problems can affect your feelings of self-worth and your relationships. If you have a partner, you may want your partner to attend therapy with you. You can both express your fears and concerns, learn coping strategies, and find new ways to develop intimacy during your recovery. There are also support groups available to provide further encouragement and hope.
While ED is very common right after prostate surgery, you may regain sexual function after some time. This may range from several months to two years. Also, remember that ED can be treated. By working with your doctor, you will be able to recover from prostate surgery and find an effective ED treatment that is right for you.
Canadian Cancer Society
Prostate Cancer Canada
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Prostate cancer and impotence. St. Joseph’s Prostate Cancer Center website. Available at: http://www.gaprostatecancer.org/prostate-cancer-and-impotence. Updated July 31, 2012. Accessed March 18, 2013.
Radical prostatectomy: erectile dysfunction. Sex Health Matters website. Available at: http://www.sexhealthmatters.org/erectile-dysfunction/radical-prostatectomy-erectile-dysfunction. Accessed March 18, 2013.
Sex problems vex men long after prostate surgery. Prostate Cancer Foundation website. Available at: http://www.pcf.org/site/c.leJRIROrEpH/b.6281715/k.E76C/Sex_Problems_Vex_Men_Long_After_Prostate_Surgery.htm. Accessed March 18, 2013.
Sexual function after prostate surgery. Roswell Park Cancer Institute website. Available at: http://www.roswellpark.org/patients/living-cancer/side-effects/impotence. Accessed March 18, 2013.
Sexual side effects. Michigan Cancer Consortium website. Available at: http://www.michigancancer.org/PDFs/MDCHFactSheets/MCCProstCaSymptoms/SexualSideEffects-Sept09.pdf. Published September 2009. Accessed March 18, 2013.
Sexuality for the man with cancer: Is there a way to restore erections if the nerves or blood supply of the penis has been damaged? American Cancer Society website. Available at: http://www.cancer.org/Treatment/TreatmentsandSideEffects/PhysicalSideEffects/SexualSideEffectsinMen/SexualityfortheMan/sexuality-for-men-with-cancer-nerve-or-blood-supply-damage. Updated October 28, 2011. Accessed March 18, 2013.
Sexuality for the man with cancer: Methods to help with erections. American Cancer Society website. Available at: http://www.cancer.org/Treatment/TreatmentsandSideEffects/PhysicalSideEffects/SexualSideEffectsinMen/SexualityfortheMan/sexuality-for-men-with-cancer-methods-to-help-with-erections. Updated October 28, 2011. Accessed March 18, 2013.
Last reviewed March 2013 by Brian Randall, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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