Sexual performance, endurance, and libido are important to some degree for most guys, regardless of their age. So it’s natural for men to question their ability to recover sexual function after prostate cancer surgery (prostatectomy). After all, prostatectomy is a radical surgery that can have a major impact on a man’s sexual identity, physically and psychologically, as it commonly leads to erectile dysfunction (ED), at least temporarily. Overall, about 77 percent of men who undergo radical prostatectomy experience ED associated with nerve damage or blood flow issues.
Causes of erectile dysfunction
Erectile dysfunction can have a wide variety of causes, including but not limited to prostatectomy. In fact, some men who have a prostatectomy also have other factors or health issues that can complicate or compound the side effects of the surgery. Men who have type 2 diabetes, for example, are about four times more likely to have ED because they typically experience poor blood flow and nerve function in the penis. Even when surgeons perform nerve-sparing prostatectomy (which is designed to spare the nerves in the penis), there can be some residual damage to the nerves, which in turn contributes to ED.
Other causes of ED can include use of certain medications (e.g., beta-blockers), high cholesterol, high blood pressure, smoking, Peyronie’s disease, obesity, lack of exercise, poor diet, and psychological issues, such as divorce, guilt, and performance anxiety. Some experts even believe that use of ED oral medications, such as Viagra and Cialis, make the condition worse rather than better.
Ways to recover sexual function after prostate cancer surgery
Treatment options for ED after prostate cancer surgery run the gamut from oral medications (e.g., Viagra, Cialis, Levitra, Stendra) to lifestyle modifications, penis pumps, testosterone therapy, suppositories (MUSE), penile injections (intracavernosal injections of papaverine hydrochloride, phentolamine, prostaglandin E-1), penile revascularization, and penile prostheses.
Some men also try penile rehabilitation, which is a treatment program that involves practicing several different approaches to restore penile function. Part of the approach is to get men “back in the saddle” as soon as possible after surgery so they don’t lose muscle power in their penis and promote scarring. Penile rehab also may include sex therapy for men and their sexual partner because it is more successful if couples are treated together.
Several new and experimental treatment options are in the pipeline for ED. Stem cell therapy is being investigated as a way to reverse ED. Stem cells are harvested from a man’s own fat, specially treated, and then injected into the patient’s penile tissue. Another approach is low intensity extracorporeal shockwave therapy. This noninvasive method delivers shockwaves to the penile tissues, which revascularizes it and thus improves blood flow. Gene therapy, as well as a number of potential new drugs, are being groomed for possible treatment of ED.
Read more in our Prostate Cancer Health Center.
Esposito K et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA 2004; 291:2978-84.
Sopko NA, Burnett AL. Erection rehabilitation following prostatectomy–current strategies and future directions. National Reviews of Urology 2016; 13:216-25.