Sexual Function after Prostate Surgery

Options for men with erectile dysfunction following prostate cancer treatment
Friday, December 5, 2014 - 11:15am

Nearly all men will experience difficulty getting an erection (erectile dysfunction, or ED for short) for a period of time after undergoing robotic radical prostatectomy. The nerves responsible for an erection (the cavernous nerves) travel very close to the prostate gland and may be injured during removal of the prostate. However, most men recover with time. 

Recovery

The degree of recovery for ED depends on multiple factors, including the type of operation you had (one, both, or no nerves spared), your age and your erectile function before surgery.

It is important to understand that time may be the most important factor in the recovery process. We know from studies of thousands of men who have had nerve-sparing prostate surgery (open or robotic) that the natural healing process often takes 18 to 24 months or more. This is due in part to the length of time it takes for nerve tissue to heal after surgery.

Rehabilitation

There is some evidence that early rehabilitation designed to increase blood flow to the penis, starting about six weeks after surgery, may speed up the ability to resume sexual activity. There are various methods available, depending on your particular case, your level of motivation and the judgment of your surgeon. It is also very common to need medications after surgery to assist with erectile function.

Here are some therapies to discuss with your oncologist before and after prostate cancer treatment: 

Treatments for Impotence

Type of Therapy Pros Cons
Oral Medication (Viagra®, Levitra® or Cialis®)
  • Pills taken by mouth
  • Effective in many men
  • Not effective unless nerve-sparing approach used
  • Side effects, including headache. Viagra® and Levitra® may cause blurry vision. Cialis® may cause joint or back pain.
  • Should not be used in some patients.
  • 30-60 minute wait for response
  • Cannot be taken with some medications
Intra-Urethral Suppository (MUSE)
  • Small pellet placed in the urethra without needles
  • Few systemic side effects
  • Effective in 43-62 percent of men
  • Can cause penile or urethral pain
  • Requires simple training
  • Refrigeration required
  • May require tension ring placed at base of penis for best effects
  • Side effects include (rarely) painful & prolonged erection (more than six hours), fainting, dizziness
Penile Injection
  • Highly effective
  • Few systemic side effects
  • Works in three to five minutes
  • Some medications require refrigeration
  • Requires injection
  • Requires office training
  • Can cause penile pain
  • Can cause prolonged erection and penile fibrosis or scarring
Vacuum Device
  • Least expensive
  • No systemic side effects
  • Effective in 66-71 percent of patients
  • May cause numbness or bruising
  • Less natural erection
  • Some find it awkward to use
Penile Prosthesis
  • Highly effective
  • For men who have failed or are not satisfied with medical treatment of impotence
  • Small risk of infection
  • Requires anesthesia and surgery
  • May require replacement after many years of use

Resources for Support

Roswell Park's Psychosocial Department offers counseling for couples struggling with sexual function after prostate cancer treatment. If you are considering surgery, meet with one of our counselors to discuss the potential impact on your relationship and ways to overcome any intimacy issues. 

 Here are some addiational tools to help you adjust to life after prostate surgery:

Books

  • The Lovin’ Ain’t Over: The Couple’s Guide to Better Sex after Prostate Disease, by Ralph and Barbara Alterowitz 
  • Our Journey Through Prostate Cancer, by Jim and Julia Miller 
  • Couples Confronting Cancer: Keeping your Relationship Strong, by Joy L. Fincannon and Katherine V. Bruss 

    Websites