Regaining Sexual Function After a Prostatectomy

Each year in the United States, about 90,000 radical prostatectomies are performed, often leaving men with some degree of erectile dysfunction. Here, we look at restoring sexual function.

Prostate cancer is the most commonly diagnosed cancer in men (outside skin cancer) — 1 in 8 men will receive a prostate cancer diagnosis. For more aggressive cases of prostate cancer, a radical prostatectomy is often the best course of action to prevent the disease from spreading.

While effective in containing prostate cancer, radical prostatectomies often leave patients with side effects afterward, such as erectile dysfunction (ED).

In this month’s blog post, board-certified urology specialist Dr. Robert J. Cornell takes a closer look at post-prostatectomy erectile dysfunction — why it occurs and what steps to take next.

Why a radical prostatectomy can lead to ED

When we perform a radical prostatectomy, our goal is to eradicate the cancer and prevent it from spreading. To do this, we not only remove your prostate, but we often also remove the seminal vesicles, which are primarily tasked with creating semen to carry and nourish your sperm.

Where complications arise is that this procedure can often impact the nerves involved in your erections. We want to point out that Dr. Cornell makes every effort to spare your nerves during a prostatectomy and uses advanced surgical technologies, including the daVinci® robotic surgical system, whenever possible.

Even with this higher level of accuracy, some nerve damage may be inevitable, which is one reason why 25% to 50% of men experience post-prostatectomy ED.

How long does post-prostatectomy ED last?

The good news is that nerves can regrow, and many men regain sexual function within a year of their prostatectomy. By the numbers, between 40% and 50% with post-operative ED return to pre-surgery erectile function at the one-year mark, and between 30% and 60% by the two-year mark.

As you can see, a good number of patients still struggle with ongoing ED after a prostatectomy. This can be for several reasons, starting with nerve damage, which we mentioned earlier. Other issues that can raise the risk of post-surgical ED include:

Age
Cardiovascular disease
Diabetes
Obesity

For example, if you have obesity and diabetes heading into the procedure, your risk factors for ED afterward are much higher than they are among healthier men. As well, post-prostatectomy ED rates are lower among younger men and much higher among older age groups of 75+.

So, even if Dr. Cornell is able to minimize nerve damage, pre-existing conditions can still lead to ED after your prostatectomy.

Restoring sexual health after your prostatectomy

Sexual health is an important piece of your overall wellness puzzle, so we don’t take this complication lightly. In fact, we recommend penile rehabilitation for almost all patients.

In many cases, we put men on low-dose ED medications that keep oxygenated blood flowing to the penis and the nerves that control it.

We might also recommend vacuum devices and/or penile injections to further encourage oxygen and blood into your penis.

There are some steps you can take, such as pelvic floor rehabilitation in the form of Kegel exercises, which can go a long way toward restoring healthy sexual function. And let’s not forget patience — nerves regrow, but slowly, so patience is key.

Overall, it’s difficult to say what your post-operative plan might look like because we tailor it to your individual needs and circumstances. To discuss your personal questions about post-prostatectomy ED and build your custom care plan, contact our Houston office today.