One of a man’s biggest fears: what if I can’t get an erection? Few health concerns provoke as much anxiety for men. It’s an especially valid concern when discussing prostate removal, and one that is tactfully addressed in the clinic setting both before and after a prostate removal procedure.
Especially when you’re already processing a cancer diagnosis or another serious prostate condition, the information can feel overwhelming, technical, or rushed.
While no blog will ever take the place of the conversations you have with your doctor about your particular health situation, we thought a little background on a sensitive subject may help turn down the anxiety amperage.
Why is the Prostate Removed in the First Place?
The most common reason for prostate removal is the treatment of prostate cancer. Surgery is not always the first or only option; treatment decisions depend on several factors, including the cancer’s aggressiveness, location, size, and whether it has spread beyond the prostate. For men with low-risk prostate cancer, doctors may recommend active surveillance rather than immediate treatment.
Closely monitoring the cancer delays the potential side effects of surgery or radiation while keeping a careful eye on it. The goal isn’t to “wait and see” passively, but to avoid overtreatment. Many prostate cancers never become dangerous, and early treatment can permanently affect urinary and sexual function. Active surveillance allows men to maintain their quality of life while remaining safe. With frequent check-ups and ongoing communication with your practitioner, any signs of progression can be identified and treated early.
Some men with intermediate-risk prostate cancer may be candidates for focal therapy, also called partial prostate ablation. This technique uses targeted energy (such as heat, cold, sound, or electricity) to destroy only the cancerous portion of the prostate, potentially allowing men to stay on active surveillance longer while minimizing side effects.
For men with higher-risk prostate cancer, however, surgical removal may be the most effective means of controlling the disease, as long as the cancer is confined to the prostate and has not spread to surrounding tissues or organs.
Radical prostatectomy, the most common surgical approach, involves removing the entire prostate gland along with some surrounding tissue. It’s considered a complex operation. Because the prostate sits in a crowded and sensitive area of the body, it has potential risks and requires experienced technical precision. Surgeons take into account the tumor’s location, size, and relationship to nearby nerves when planning the operation. Because of the local anatomy and the uniqueness of each surgery, even the most exacting procedure still comes with risks, including problems with urinary control, erectile dysfunction, injury to the rectum, and scarring.
How Does Prostate Removal Affect the Penis?
The most direct answer is this: the prostate sits directly next to the nerves and blood vessels that control erections and urinary function. Tampering with the prostate includes the potential to disrupt the surrounding communication pathways. These structures are delicate, and even when surgeons use advanced nerve-sparing techniques, they can be temporarily (or sometimes even permanently) affected during surgery.
The nerves responsible for erections run immediately alongside the prostate, and a tumor can show up anywhere. When cancer is located close to or has extended beyond these nerves, preserving them may not be medically safe; prioritizing complete cancer removal can mean sacrificing some nerve tissue to avoid leaving cancer behind.
Recovery of erectile function after prostatectomy varies widely, in large part due to the anatomical location of the tumor and the surrounding structures it (or surgery) has affected. Other factors that help determine post-operative erectile function include how strong a man’s erections were before surgery and the skill and experience of the surgeon performing the operation.
Let’s go ahead and get this out: changes in erectile function are physical as well as emotional. Research shows that erectile dysfunction after prostate cancer treatment leads to significant psychological distress in men¹ – feelings of frustration, avoidance, embarrassment, or grief are common, and they can affect relationships, self-esteem, and overall quality of life. As part of your recovery, we want to restore optimal blood flow and nerve signaling, but we also want to help you rebuild confidence, intimacy, and a sense of normalcy. Both the physical mechanics and the emotional impact of these changes are critical parts of healing.
Most men experience some degree of urinary leakage and erectile dysfunction immediately after radical prostatectomy. For many, these effects are temporary and improve over time, but they are common in the early recovery period.
Erectile dysfunction after prostate removal does not automatically mean permanent loss of function. Nerves heal slowly, and recovery can take months or even more than a year; it just takes time. Some additional support along the way, including different treatments, rehabilitation strategies, and better management of other health conditions, can help bring men closer to their pre-surgery performance baseline.
What Can You Do?
Recovery is not passive. Even though tumor location, surgical factors, and other parts of the process feel out of your control, you still exercise quite a bit of influence when it comes to healing and improving your outcome.
Support Your Recovery Through Lifestyle Participation
Erections are fundamentally a vascular event. Hence, adequate blood flow is paramount. Habits that support cardiovascular health also support penile health.
Maintaining a healthy weight, staying physically active, and managing conditions like high blood pressure or diabetes improve circulation and hormone balance, and, therefore, libido and erectile function. Nutrient-dense diets support stamina and energy levels, while appropriate weight loss recalibrates hormonal disruptions that interfere with sexual function.
Being mindful of your overall health absolutely influences how well the body responds to rehabilitation and treatment.
Pelvic Floor Muscle Training
Pelvic floor muscles are also part of the intricate prostate neighborhood, supporting both urinary control and erectile function. After prostate surgery, these muscles can become weak or lose coordination.
Consistently performed Kegel exercises (that are also done correctly) are the easiest, most accessible practice you can adopt on the road to recovery. These movements help strengthen weak sphincters involved in post-surgical urinary incontinence, and they promote erectile rigidity via improved blood trapping in the penis.
Pelvic floor training is simple, noninvasive, and an important foundation of recovery, especially in the early months after surgery.
Medical Therapies to Support Erectile Function While Nerves Heal
The nerves usually take the longest to heal, taking many months or longer to “come back online.” In the meantime, many men benefit from therapies that help maintain erections during the healing process rather than waiting for spontaneous function to return.
Oral medications, such as daily tadalafil (Cialis) with sildenafil (Viagra) used early on in recovery and as needed, help improve blood flow and may support long-term outcomes, even if they do not immediately produce erections suitable for intercourse.
Intracavernosal Injection Therapy (ICI) is another great option. ICI uses injectable forms of medications similar to Viagra or Cialis that are delivered directly into the penis, bypassing the nerves – this can be especially effective while nerve tissue continues to heal.
Vacuum Erection Devices (VEDs) are another useful tool. By drawing blood into the penis, VEDs help maintain tissue health and allow for sexual activity during recovery. To preserve the erection VEDs can produce, many men use a constriction band (for no more than 30 minutes at a time).
Any combination of these methods can be utilized as part of a structured rehabilitation plan.
When More Support Is Needed
Recovery isn’t always linear, and progress can be uneven: sometimes it can feel like two steps forward and one step back. If early therapies are not providing the desired results, further evaluation and ongoing discussions with your practitioner will guide the next steps. Conversations and unique circumstances may drive the approach toward additional imaging, such as a penile Doppler ultrasound, or even surgical interventions.
For men with persistent erectile dysfunction despite rehabilitation, penile implants can be a reliable and highly effective long-term solution. Modern implants are discreet, safe, and designed to closely mimic natural erections.
Staying Positive and Moving Forward
You arrived at prostate removal due to a serious health condition – that wasn’t easy. And it’s normal to grieve the changes that come along with that course of action. The field of urologic care has come a long way, and Dr. Kapadia is here to help you find solutions. Advances in surgical techniques, rehabilitation strategies, and erectile dysfunction treatments mean that most men have options and real hope for restoration and recovery.
If you’re navigating sexual or urinary changes after prostate surgery, work with a specialist who understands the full recovery process. Dr. Kapadia and the team at Georgia Urology focus on individualized, stepwise care to regain function, confidence, intimacy, and quality of life at every stage of recovery.
Resource:
- Emanu, J. C., Avildsen, I. K., & Nelson, C. J. (2016). Erectile dysfunction after radical prostatectomy: prevalence, medical treatments, and psychosocial interventions. Current opinion in supportive and palliative care, 10(1), 102–107. https://doi.org/10.1097/SPC.0000000000000195.
