Prostate cancer is a scary prospect, but equally scary to many men is the prospect of a sudden and surgical loss of your sex life and healthy sexual function.
Prostatectomy — or prostate surgery — is one of the main prostate cancer treatments, but can result in side effects such as losing the ability to achieve and maintain erectile function, a condition known as erectile dysfunction (ED).
If you’re staring this possibility in the face after a prostate cancer diagnosis, you likely have a lot of questions like: can you still have an erection if your prostate is removed? How long does erectile dysfunction last after prostate surgery? And most importantly, how can I get hard after a prostatectomy?
We’ll provide answers to these questions and more to give you all the information you need on treating ED after prostate surgery.
Let’s start by backing up a little bit and explain why you would need to have your prostate removed in the first place.
One of the biggest reasons why prostate removal is necessary? Prostate cancer. According to the American Cancer Society, about one in eight men will be diagnosed with prostate cancer, with over 288,000 new cases estimated to be diagnosed in 2023.
Prostate cancer surgery is the main form of treatment if the cancer hasn’t spread outside the prostate gland. There are effectively two forms of prostate surgery: radical prostatectomy, in which the whole prostate is removed, and simple prostatectomy, where only the part of the prostate causing symptoms is removed.
There’s also an approach known as robotic prostatectomy, where laparoscopic surgery is done using a robotic system. While there are advantages to this approach, including less pain and recovery time, there isn’t much difference in side effects like erectile dysfunction.
So, let’s answer a question a lot of men may wonder: can you get an erection without a prostate?
A review discussing ED after prostate surgery found that there was a large inconsistency between studies in terms of how often men experienced erectile dysfunction after their surgery. However, several studies cited that as many as 85 percent of men had ED after radical prostatectomy.
Of course, every individual is different and will respond to and recover from surgery differently.
Whether or not you have an erection after radical or robotic prostatectomy can also depend on whether a nerve-sparing approach is used (if the nerves that run on either side of the prostate to control erections are removed).
In addition, when the cancer-affected prostate gland and the seminal vesicles are removed, the nerves and blood vessels that facilitate erectile function can be affected, causing issues.
So back to the question of whether you can still have an erection if your prostate is removed. Eventually, yes, but you may need some help in the meantime.
As annoying as this answer may be, how long you experience ED after prostate surgery depends on a lot of factors.
Erectile dysfunction from prostate cancer surgery can range in severity thanks to factors such as age and previous function, as well as the surgical techniques used.
The ability to have erections after surgery often returns slowly, taking anywhere from a few months to up to two years. You may not be able to have morning wood after prostatectomy for the first few months either.
But there are plenty of well-researched and effective ED treatment options you can try so that you can experience an erection after prostate removal.
There are several treatment options for achieving an erection after prostate surgery, from medications and devices to further surgical options and even penile implants.
Each treatment option has its own benefits and drawbacks, and different treatments may offer different results to different individuals.
Because of this, it’s best to consult with a healthcare professional to find the best treatment for you.
Here are some options that may be recommended.
Oral medications are often the go-to treatment for erectile dysfunction, and for good reason — they’ve been proven to be safe and effective, especially for those who underwent a prostatectomy.
Research has found that 75 percent of men suffering from prostate surgery-related ED successfully achieved erections after using oral medication.
ED medications like Viagra® (sildenafil), Cialis® (tadalafil), Levitra (vardenafil) and Stendra® (avanafil) work by improving blood flow to the erectile tissue of your penis, making it easier to get and maintain an erection.
You can learn more about these medications and their differences, side effects and more in this comprehensive guide.
It may seem like needles and erections should not go together (like, ever) but intracorporeal injections (or ED injections) can be used to promote the proper muscle relaxation needed for an erection.
These injections are a viable option for about 70 percent of men experiencing erectile dysfunction.
The most common type of these penile injections — Caverject injections, also known by their generic name, alprostadil injections — are vasodilators that expand blood vessels to increase blood flow. This allows more blood to flow into the penis, causing an erection.
While ED surgery after prostate surgery may seem excessive, this is the best option for some people’s sexual health if other treatments don’t work.
One of the most common surgical options for ED is a penile prosthesis, which is implanted in the penis to create an erection-like state.
While not technically a surgical treatment for ED, vacuum erection devices are another option. Vacuum pumps work by creating a seal around the penis in a tube, then creating a vacuum in the tube to draw blood into the penis.
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Along with treating the physical symptoms of ED after prostate surgery, it’s important to consider psychological treatments, including therapy.
Even after life-saving surgery, you may be experiencing one of several psychological causes of ED. Not to mention, ED can wreak havoc on self-confidence, relationships and be associated with a higher risk of depression, creating a vicious cycle of psychological and erection issues.
If you’re experiencing depression, anxiety or psychological distress associated with prostate cancer or the side effects of prostate cancer treatment, you should consider talking to a mental health professional either in-person or through online therapy.
Facing a prostate cancer diagnosis is one difficulty, and then dealing with erectile dysfunction after prostate surgery is yet another struggle on top of a life-changing medical treatment. But if you’re in this situation, know that it doesn’t have to be permanent.
Let’s recap some of the answers to your top questions on this topic.
Can you still have an erection if your prostate is removed? Eventually yes, although this can depend. Prostate surgery removes the prostate, and sometimes the nerves surrounding the prostate that control erections.
How long does erectile dysfunction last after prostate surgery? Many men experience sexual dysfunction such as ED after prostate surgery. However, the timeline in which men will regain erectile functioning varies — some will only have ED for a few months and others may experience it for up to two years.
How can I get hard after prostatectomy? Fortunately, several ED treatment options are effective in men who have had a prostatectomy. These options include oral medications, ED injections, penile surgery and psychotherapy.
Making it through a major cancer surgery is something to celebrate. But as exciting as that is, the surgery can wreak havoc on sexual intercourse and your quality of life. If you’re experiencing ED after prostate surgery, check out these erectile dysfunction treatments, and don’t forget to treat the physical symptoms of ED during sex after prostatectomy.
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Kate Hagerty is a board-certified Family Nurse Practitioner with over a decade of healthcare experience. She has worked in critical care, community health, and as a retail health provider.