Managing Erectile Dysfunction After Prostate Surgery

Erectile dysfunction is a common concern for men following prostate surgery and can have a significant impact on confidence, relationships and quality of life. Although surgery is often necessary to treat prostate cancer or manage benign prostate conditions, changes in sexual function may occur during recovery. When erectile dysfunction develops after surgery, patients often worry about its permanence and severity.

Fortunately, there are a variety of evidence-based treatments and strategies that may be applied to achieve an improvement in this condition.

How Prostate Surgery Can Affect Erectile Function

An erection depends on a complex interaction between nerves, blood flow, and hormones, which all must function in tandem. Prostate surgery can affect one or more of these systems, which may lead to changes in erectile function.

Potential causes after surgery include:

• Nerve-Related Factors

  : The nerves responsible for starting and maintaining an erection, known as the cavernous nerves, run very close to the sides of the prostate. Even with careful surgical technique, these nerves may be temporarily stunned, stretched, or affected during the removal or reshaping of prostate tissue. Recovery varies from person to person and depends largely on the extent of nerve disruption during surgery.

• Blood Flow Changes

  : Surgical manipulation within the pelvic region can compromise the minute tissues and arteries responsible for supplying the penis. This reduced blood flow is a major factor that contributes to impaired erectile capacity during the immediate post-operative phase and subsequent rehabilitation.

What Types of Surgery Contribute to Erectile Dysfunction?

There are two primary types of prostate surgery that may result in erectile dysfunction:

• Radical Prostatectomy: This procedure, typically for prostate cancer, involves removing the entire gland and seminal vesicles. Due to the anatomical constraints, this carries a higher risk of post-operative ED.
• Procedures for Benign Prostate Enlargement (BPH): Urinary blockages are cleared using less invasive methods like transurethral resection of the prostate (TURP) or various laser techniques. While generally sparing the nerves, they can still lead to changes in function depending on the extent of tissue removal and the closeness of the work to critical neurovascular bundles.

Men who have had erectile difficulties before surgery may also notice that these issues become more pronounced afterwards. Long-term erectile function also depends on factors such as age, overall vascular health, and the presence of medical conditions like high blood pressure or diabetes.

Management Options for Erectile Dysfunction After Prostate Surgery

A variety of evidence-based treatments are available to manage ED during and after recovery. The suitability of these strategies is always determined following a thorough clinical evaluation.

Oral Medications (PDE5 Inhibitors)

These medicines are typically the first line of medical treatment. They work by relaxing smooth muscle, which allows more blood to flow to the penis in response to sexual stimulation. Assessment by a physician is required to confirm suitability, particularly in patients with underlying cardiovascular conditions.

Vacuum Erection Devices (VEDs)

This non-invasive approach uses negative pressure to draw blood into the penile shaft. A vacuum device can assist in achieving an erection suitable for intercourse and may also be used as part of penile rehabilitation, with the aim of helping maintain penile tissue health.

Penile Injections (Intracavernosal Injections)

Medications injected directly into the penis induce an erection by relaxing the cavernous smooth muscle and increasing local blood flow. Patients receive detailed training to ensure correct technique and safe self-administration.

Penile Implants

For men who do not achieve a satisfactory result from the above non-surgical options, penile implants provide a reliable and definitive internal solution. The decision to proceed is based on the patient's overall health, treatment expectations, and history of recovery.

Pelvic Floor Muscle Therapy

Targeted exercises, often guided by a specialised physiotherapist, focus on strengthening the pelvic floor muscles. This therapy is known to improve both urinary continence and, in some cases, sexual function by enhancing penile rigidity.

Counselling and Psychological Support

The emotional impact of prostate cancer treatment and ED can affect self-esteem and relationships. Professional counselling can offer immense benefits for men and their partners dealing with anxiety, relationship concerns or performance-related stress.

When Should I See a Urologist for Post-Surgery Erectile Dysfunction?

Men are advised to consult a urologist if they experience any of the following:

• Persistent difficulty achieving or maintaining an erection beyond the expected recovery period
• Ongoing concerns about nerve function or a slower-than-anticipated recovery
• Pain or discomfort during sexual activity
• Psychological or emotional distress related to changes in sexual function
• Uncertainty about the correct use of prescribed medication or medical devices

Early consultation allows appropriate assessment and timely adjustment of management strategies. A urologist can evaluate potential underlying causes and recommend a personalised treatment approach based on individual health factors and recovery goals.

If erectile difficulties persist, you can seek professional advice without delay from our urology clinic. Our urologist, Dr Jonathan Teo, can help identify suitable support options and protect long-term quality of life. Contact us today to book an appointment.

FAQs on Post-surgery Erectile Dysfunction