4 Ways to Treat Erectile Dysfunction After Prostate Surgery

How can I get hard after prostatectomy? You’re not the first guy to wonder this or type it into a Google search.

According to the American Cancer Society, about one in eight men will be diagnosed with prostate cancer, with an estimated 288,000 new cases in 2023 alone. Prostate cancer is a scary prospect, but equally scary to many men is a surgically induced loss of healthy sexual function.

A prostatectomy — or prostate surgery — is one of the main prostate cancer treatments. But it can result in side effects, like losing erectile function, a condition known as erectile dysfunction (ED).

Can you still have an erection if your prostate is removed? And if not, why does prostate removal cause impotence?

We’ll answer these questions (and more) below and provide helpful information and tips for treating ED after prostate surgery.

It’s unclear. A review discussing ED after prostate surgery found a large inconsistency between studies in terms of how often men experienced erectile dysfunction following the procedure.

But in several studies, as many as 85 percent of men had ED after radical prostatectomy.

Prostate cancer surgery is the main form of treatment if the cancer hasn’t spread outside the prostate gland.

There are two primary types of prostate surgery:

• Radical prostatectomy. With a radical prostatectomy, the whole prostate is removed.

• Simple prostatectomy. This procedure only removes the cancerous part of the prostate.

There’s also an approach known as robotic prostatectomy, where laparoscopic surgery (involving small incisions and a tiny camera) is done using a robotic system. 

Does Robotic Prostatectomy Have Better Outcomes for Erectile Function?

Though there are advantages to this approach, including less pain and a shorter recovery time, there isn’t much difference in side effects like erectile dysfunction.

Whether or not you can get erections after radical or robotic prostatectomy can also depend on whether a nerve-sparing approach is used.

What Is Nerve-Sparing Surgery for Prostate Cancer?

A nerve-sparing surgical approach means the nerves are spared, literally. The surgeon avoids cutting the nerves running on either side of the prostate — nerves that are essential to erections.

When the cancer-affected prostate gland and seminal vesicles (glands that produce and store semen) 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. Every individual will respond to and recover from surgery differently, but eventually, yes, function could return. 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 many factors, so it’s hard to give a timeline.

The ability to have erections after surgery often returns slowly, taking anywhere from a few months to two years. You may not get morning wood after prostatectomy for the first couple of months, either.

Erectile dysfunction from prostate cancer surgery can range in severity, thanks to factors like age, previous erectile function, and (as noted) the surgical techniques used.

But there are plenty of well-researched and effective ED treatment options you can try to help speed up the return of erections after prostate removal.

Experts aren’t totally sure why there’s such a delay in erection recovery after prostate surgery. Some think it’s possible that injured nerve tissues from the procedure take a while to heal. And the area may stay inflamed for a few months post-op.

Penile rehabilitation is possible after surgical interventions. But this occurs on a case-by-case basis best guided by the medical advice of a urologist or another healthcare provider.

There are several treatment options for achieving an erection after prostate surgery — from medications and devices to further surgical interventions 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 a healthcare professional to find the best treatment for you.

Here are some options that might be recommended.

ED Medications

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.

According to research, 75 percent of men suffering from prostate surgery-related ED successfully achieved erections after using oral medication.

PDE5 inhibitors like Viagra® (and the generic version sildenafil), Cialis® (and generic tadalafil), Levitra® (vardenafil), and Stendra® (avanafil) work by improving blood flow to the erectile tissue of your penis. This makes it easier to get and maintain an erection hard enough for sexual intercourse.

You can learn more about these medications, including their differences and side effects, in this comprehensive guide to ED pills for men.

Injections

It may seem like needles and erections shouldn’t go together — like, ever. But intracorporeal injections (or ED injections) can help promote increased blood flow needed for an erection.

These injections work for roughly 70 percent of men experiencing erectile dysfunction.

The most common type of penile injection is Caverject injections, also known by the generic name alprostadil. As vasodilators, these treatments expand blood vessels to increase blood flow. This allows more blood to flow into the penis, causing an erection.

Surgical Options and Implants

While ED surgery after prostate surgery may seem excessive, this is the best option for some men’s sexual health if other treatments don’t work.

One of the most common surgical options for ED is a penile prosthesis (implant). It’s implanted into the base of the penis and the shaft to create an erection-like state.

Vacuum Devices

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.

Psychological Treatment and Therapy

Along with treating the physical symptoms of ED after prostate surgery, you may want to consider psychological treatments, including therapy.

Even after life-saving surgery, you could be experiencing one of several psychological causes of ED. Not to mention, erectile dysfunction can wreak havoc on your self-confidence and relationships. It’s also 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, talking to a mental health professional might help — either in-person or through online therapy.

Facing a prostate cancer diagnosis is one difficulty. 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 it doesn’t have to be permanent.

Let’s recap answers to some of the most frequently asked questions on this topic:

• Can you still have an erection if your prostate is removed? Eventually, yes — but it might depend on how the procedure was performed. Prostate surgery removes the prostate and, sometimes, the nerves surrounding the prostate that control erections.

• How long does erectile dysfunction last after prostate surgery? The timeline for regaining erectile functioning varies. Some men will have ED for a few months, and others may experience sexual dysfunction 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. This includes oral medications, ED injections, penile surgery, and psychotherapy. Other options may include hormone therapy injections, exercises for the pelvic floor muscles (also known as Kegels), or sidestepping erections entirely to focus on the ejaculation part of sexual activity.

Making it through a major cancer surgery is something to celebrate. But as exciting as that is, the procedure can take a toll not just on your sex life but also your overall quality of life.

If you’re experiencing ED after prostate surgery, check out these erectile dysfunction treatments. Once things are up and running again, we’ve got guidance on sex after prostatectomy.