Prostate Removal and Erectile Dysfunction: What to Expect and How to Recover
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Prostate removal (radical prostatectomy) is a common treatment for prostate cancer, but one of its most concerning side effects is erectile dysfunction (ED). Many men worry that losing their prostate means losing their sex life forever—but that’s not always the case.
In this post, we’ll cover:
✔ Why prostate removal causes ED
✔ How long ED typically lasts after surgery
✔ Proven ways to regain erectile function
✔ What to do if traditional treatments fail
Whether you’re preparing for surgery or recovering, this guide will help you navigate the journey back to sexual health.
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Why Does Prostate Removal Cause ED?
The prostate sits near nerves, blood vessels, and muscles critical for erections. During surgery, these structures can be damaged, leading to temporary or permanent ED. The risk depends on:
1. Type of Surgery
- Nerve-Sparing Prostatectomy: If the surgeon preserves the cavernous nerves (which control erections), recovery is more likely.
- Non-Nerve-Sparing: Higher ED risk, but sometimes necessary if cancer is aggressive.
2. Surgeon Skill & Technique
- Robotic-assisted surgery often has better nerve preservation rates.
- Experienced surgeons report higher success rates for post-op erectile function.
3. Pre-Surgery Erectile Health
- Men with strong pre-surgery erections recover faster.
- Existing conditions (diabetes, heart disease) make recovery harder.
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How Long Does ED Last After Prostate Removal?
Recovery follows a general timeline, but individual results vary:
First 3–6 Months
- Most men have no spontaneous erections.
- Penile shrinkage and numbness may occur due to lack of blood flow.
6–12 Months
- Gradual nerve healing begins.
- Some men regain partial erections, especially with nerve-sparing surgery.
12–24 Months
- Maximum recovery period—further improvement is unlikely after this.
- 50–80% of men with nerve-sparing surgery regain some function.
Key Insight: Even if erections don’t return fully, many men can still have satisfying sex with treatment.
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How to Regain Erections After Prostate Surgery
1. Penile Rehabilitation (Start Early!)
- PDE5 Inhibitors (Viagra, Cialis):
- Not just for sex—daily low-dose Cialis (5mg) improves blood flow and prevents tissue damage.
- Works best when started immediately after catheter removal.
- Vacuum Erection Devices (VEDs):
- Pump + constriction ring forces blood into the penis, preventing atrophy.
- Use 3–5 times per week, even without sex.
2. Testosterone Replacement (If Low)
- Prostate cancer survivors often develop low testosterone due to surgery or hormone therapy.
- Testosterone therapy (if cancer is hormone-independent) can boost libido and erectile recovery.
3. Shockwave Therapy (Emerging Option)
- Low-intensity shockwaves stimulate blood vessel growth and nerve repair.
- Studies show 60–70% of men improve with this treatment.
4. Penile Injections or Implants
- Alprostadil injections: Bypass nerve damage by directly causing erections.
- Inflatable penile implants: A permanent solution if other treatments fail.
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What If Nothing Works?
Some men never regain natural erections, but that doesn’t mean the end of their sex life. Options include:
✔ Oral meds + VED combo – Enhances rigidity.
✔ Urethral suppositories (MUSE) – Less invasive than injections.
✔ Focus on non-penetrative intimacy – Oral sex, toys, and sensual touch keep relationships strong.
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Success Story: John’s Recovery After Prostatectomy
- Surgery: Nerve-sparing robotic prostatectomy at 58.
- Rehab Plan: Daily Cialis + VED 3x/week.
- Result: At 12 months, he regained 70% function; at 18 months, near-normal erections.
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Final Thoughts: Patience & Proactivity Pay Off
Prostate surgery doesn’t have to mean the end of your sex life. The keys to recovery are:
1. Start rehab immediately (don’t wait for erections to return on their own).
2. Combine treatments (e.g., pills + VED + shockwave).
3. Communicate with your partner – ED is easier to manage with support.
Your Next Steps:
- If pre-surgery, ask your surgeon about nerve-sparing techniques.
- If post-surgery, begin penile rehab ASAP.
- If struggling, see a urologist specializing in sexual medicine.
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Have you experienced ED after prostate surgery? Share your recovery tips below!