Sexual Function After Prostate Surgery

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You may have heard that prostate surgery can cause some problems with sexual function. But it doesn’t have to mean an end to your sex life. For many men, the condition improves with time. Even if you have lasting problems, there are many treatments that can help. 

Types of Problems

There are a few types of sexual problems you can have after surgery:

  • A change in your orgasms. Depending on the type of surgery you have, you may not ejaculate much when you orgasm. You may also find your orgasms painful or less intense. In some cases, you may not be able to have an orgasm.

  • Erectile dysfunction (ED). This means not being able to get or keep an erection. ED is the most common problem men report after prostate surgery.

  • Loss of fertility. In cases of hormone-sensitive advanced prostate cancer, surgical removal of the testes may occur. If that happens, you will no longer be able to father a child through sex. This will not change with time. If this is a concern for you, talk with your doctor about your options for preserving sperm before your surgery.

What to Expect

Most men can expect to have ED for at least a few months after prostate surgery. This is because surgery can damage the tissues and nerves that make erections possible. Within a year or two after surgery, many men will have the same sexual function as before surgery. How well you recover your sexual function depends on a few factors:

  • The type of surgery. If you have surgery for an enlarged prostate, you are likely to fully regain your sexual function with time. If you have prostate cancer surgery, you may have more lasting ED. This depends on the specific type of surgery you have. For example, if the doctor has to cut the nerves around your prostate, you’re more likely to have ED.

     

  • Your age. The younger you are, the less likely you are to have ED after surgery.

  • Your sexual function before surgery. If you had strong erections before surgery, you are less likely to have problems after surgery.

Keep in mind that every man is different. If you are concerned about your sex life, talk with your doctor about your own risks before your surgery. 

Ways to Help

There are many different treatments for ED including:

  • Medicines. These include sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). Depending on your type of surgery, these pills may not work until six months to two years after your surgery. You may need to use another treatment first.

  • Penile implants. This is an inflatable pump placed inside the penis. When you want to have sex, you squeeze the pump to have an erection. Implants work well, but since they require surgery, most men try other treatments first.

  • Penile injections. These are medicines you inject into your penis with a thin needle to help you get an erection. Penile injections are one of the most reliable types of treatment for ED, but can cause some side effects. The most alarming one is an erection that does not go away. A sustained erection requires emergency treatment.

  • Urethral pellets. This is a tiny pellet you place into the tip of your penis. It contains medicine that gives you an erection. Although easy to use, pellets can have some side effects, such as dizziness. It’s also possible for the pellets to enter your partner during sex. This can lead to burning and itching.

  • Vacuum constriction devices. This is a plastic device you place over your penis that creates suction to draw blood into the penis.

The specific type of treatment you choose for ED depends on your personal preference and whether you have co-existing conditions. For example, you may not be able to take pills for ED if you also take certain medicines, such as nitroglycerine for heart disease. Be candid with your doctor, including listing every medicine, herbal remedy, and vitamin you take. Talk with your doctor about the type of treatment that will work best for you.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Aug 4
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