Updated: Jun 1, 2020
All five of the main components of erectile dysfunction (ED) can be affected by your prostate cancer treatment:
Libido (sex drive) is most commonly affected by hormone therapy or treatment that decreases your testosterone. You can have a low libido and still obtain an erection, but it is usually more difficult if you have have less interest in sex. Normally your interest in sex will return once your testosterone levels get back to normal after you complete your hormone therapy. Low libido can be a big problem for some men and/or their partners. Note: If low libido is causing stress in your relationship then couples counselling should be considered.
Mechanical ability is the ability to achieve a firm erection. Even though during surgery, everything is normally done to avoid damaging the nerves and blood vessels that surround your prostate and seminal vesicles, trauma of some kind is almost inevitable. Since these are the nerves and blood vessels that control a man's ability to get an erection it is not surprising that post-surgery ED is a common problem.
Orgasm/climax can be more difficult after treatment, especially if your libido is low and / or your erections are not as firm as they used to be. There can be some discomfort initially after treatment when you climax. This is usually transient and will resolve itself. It is important to distinguish orgasm from ejaculation, as men will continue to have the pleasure sensation of orgasm without ejaculation.
No ejaculation. The prostate and seminal vesicles which function to produce seminal fluid are removed and/or irradiated during treatment, so it is common not to ejaculate afterwards. Although you may be able to have an erection and reach an orgasm, nothing may come out.
Male incontinence during sex. When a man has an erection, the sphincter at the base of his bladder closes so urine can’t pass into his urethra. This means that most men can’t urinate during sex. Men who’ve had their prostate removed surgically to treat prostate cancer very often experience incontinence, which can include incontinence during sex. They’re most likely to have leakage either during foreplay or when they climax.
How long do these post-surgery problems last? If you've had a radical prostatectomy your seminal vesicles have been removed and your dry orgasm is permanent. Everything else, including urinary leakage, normally gets better with time. Your body needs to heal. Most men see significant improvement in their situation after 12months.
That said there are no hard and fast rules. For those who still find themselves having problems help is available.
First, the pills: Almost everybody I have spoken to about the realities of life after prostate surgery has told me that their doctor prescribed them a course of Viagra when they raised concerns about sex post-surgery. For some, pills like Viagra are a silver bullet solving the problem of ED for others it can be just another soul-crushing failure. Whatever your initial experience, the advice from the experts appears to be don't give up. It often takes three or four attempts with Viagra before you see its true effects and even then this doesn't usually occur within the first couple of months after surgery. Most men see the most meaningful recovery around 9 to 12 months after surgery. Note: Don’t be discouraged if the first time you use Viagra after surgery the the results are not great.
Hear me when I say YOUR COCK STILL WORKS. The blood supply should still be good. So basically, your penis is like a car that needs a jump-start to get it going. Your body is going to continue to recover, things will get better. It just means that at least right now, you might need a little help.
The Injections: So you've persevered with the tablets but things still aren't working the way you'd like. The next step is injections. I know what you're going to say. Injections, in my cock! Before I have sex! WTF are you talking about?
It seems drastic I know but holdup! Check this out:
"I just started with Trimix injections. My only question to myself is why on earth did I wait so long to do injections? Once one gets the routine down it is a quick and easy extra step in the process. Orgasms are marvellous. I think fear of sticking myself with the needle was the stopper but it turned out to be a big non-issue. Plus, the erection lasts about an hour so a second round can be had."
Sounds interesting! So what's involved:
The injection works by increasing the blood flow into your penis. The more blood that flows through your penis, following a nerve-sparing radical prostatectomy, either with a pill like Viagra or with an injection of a pharmacological agent, the better the chances of regaining erections.
Johns Hopkins urologist Trinity Bivalacqua, M.D., Ph.D.explains: “If you don’t have enough blood flow within the penis after surgery, it becomes ischaemic (restriction of blood supply); it does not get the nutrients it needs to stay healthy.”
Let’s take a moment to think about rehabilitation – say, after a road accident you need to learn to walk again. You're likely to be pretty disappointed if all you do is sit around and hope something is going to happen. Everybody knows the best chance you'll have to walk again is to go to rehab and work at it. It's the same with your penis. After prostate surgery, you have to rehab your penis. When I had my shoulder replaced I had to do exercises every day to get the blood flowing through the new joint and get my mobility back. It's the same with your cock after prostate surgery. Increasing the oxygenated blood flow to your penis, whether by pill or an injection, will help you preserve the erectile bodies (called the corpora cavernosa; these are chambers where blood flows to provide a rigid erection), so they will respond once those nerves start to work again.”
How well does it work? Pretty well; the success rate is between 70 and 80 per cent. The main cause of failure is poor blood flow to the penis, Bivalacqua says. “Sometimes, although the shot produces an initial erection, it doesn’t last because the veins in the penis are damaged,” Heart disease, diabetes, or other health problems are normally the reason for this.
The Vacuum Erection Device (VED) and penis-stretching:
One fact about the penis: It needs activity. The nerves in those neurovascular bundles are also responsible for night time erections (in your sleep), and those are responsible for penile health and strength. Think of tiny push-ups happening in your sleep. After surgery even if your nerve bundles have been spared there is likely to be a period when you will be unable to obtain a full erection. When any part of the body is injured, a scar forms. This is because as it heals, the tissue gets fibrosis (it hardens; this is the more rigid tissue that makes up a scar). There is extra collagen in there, and this contracts over time. This contraction can shrink the penis by as much as half an inch. Now, before you say, “That’s it! I’d rather have cancer!” or make any hasty decisions, please read this next sentence: “The good news is that there is a way to prevent the loss of length in the penis: using a vacuum erection device,”
Please note this important point: We’re focusing on stretching, not shrinking.
This is a great video that runs through pretty much all of the different kinds of VED's available on the market
I checked out how easy it is to obtain a VED and it seems pretty straightforward. I approached the Love Honey website ( an adult toy online shop) about this and they have a full range of penis pumps as they call them from £19.99 up to £129.99. For the more medical grade options I found the Vacurect on Ebay for £229. For the other medical grade products it might be worth discussing it with your GP.
I'm not a doctor and I'm not an expert on sex. I do have a prostate cancer diagnosis and everything I have written here is based on conversations I have had with men
who have survived prostate surgery and research I have done online. If you're suffering from ED post prostate surgery and this article gives you hints and tips on what to do, fantastic. But if you have a problem, talk about it. Talk to your doctor, talk to your partner. You are not alone and I hope you can see from what I've written, there are things you can do. You are not broken, but you have been hurt. Recovery is possible. Good luck JG.