Introduction
Prostatectomy is the surgical removal of all or part of the prostate gland. It’s one of the most common treatments for prostate cancer and other prostate conditions. While this surgery can save lives, it often changes a man’s sexual function and intimate relationships. Understanding these changes helps both patients and their partners.
“The physical and emotional aspects of returning to sexual activity after prostatectomy are challenging for many men,” says Dr. Michael Benson, a urological surgeon at Northwestern Memorial Hospital. “But with proper expectations, patience, and the right help, most men can enjoy intimate relationships again, though sometimes in different ways.”
This guide explores sex after prostatectomy. We’ll address common concerns, look at proven solutions, and offer practical advice for recovery.
How Prostatectomy Affects Sexual Function
Effects on Erections
The prostate sits below the bladder and surrounds the urethra. During surgery, especially radical prostatectomy (complete removal), nerves and blood vessels that control erections can be damaged.
Dr. Sarah Chen, Director of Sexual Medicine at University Medical Center, explains: “Tiny nerves run alongside the prostate and trigger erections. Even with nerve-sparing techniques, these delicate nerves may still be affected, causing erectile dysfunction (ED) to varying degrees.”
The physical impacts on erections include:
- Nerve Damage: Even careful surgery can cause temporary or permanent damage to these nerves.
- Reduced Blood Flow: Changes to blood vessels near the surgery site can limit blood flow needed for erections.
- Venous Leakage: Some men have trouble keeping erections due to changes in the penile veins after surgery.
“Recovery of erectile function is usually gradual,” says Dr. Chen. “The timeline varies between men, with improvements continuing for up to two years after surgery.”
Other Sexual Changes
Beyond erections, several other aspects of sexual function may change:
- No More Ejaculation: During radical prostatectomy, the seminal vesicles and part of the vas deferens are removed with the prostate. Men will no longer produce semen or ejaculate during orgasm.
- Different Orgasms: Men can still have orgasms after surgery, but they may feel different. Some men report less intense orgasms, while others say they feel similar to before.
- Urine Leakage: Some men leak urine during orgasm, a condition called climacturia.
- Size Changes: Some men notice a decrease in penis length or girth after surgery.
- Reduced Sex Drive: Hormone therapy, often used with prostatectomy for some prostate cancers, can greatly reduce sexual desire.
Dr. James Wilson, a psychosexual therapist, notes: “These changes require big adjustments for many men, especially those who linked their sexuality with ejaculation or specific feelings. But with support and new thinking, men can adapt and maintain fulfilling intimate relationships.”
Recovery Timeline
First 3 Months
The first weeks and months focus mainly on physical healing:
- No sex for 4-6 weeks to allow proper healing.
- ED is very common and expected during this time.
- Urinary leakage may make intimacy and sex difficult.
Dr. Benson says, “Setting realistic expectations during this period is crucial. The early phase is about healing, so don’t be discouraged by sexual difficulties now.”
3-12 Months
As physical healing progresses:
- Some men start having spontaneous erections, especially those who had good erectile function before surgery and had nerve-sparing procedures.
- ED treatments (medications, devices) typically work better during this period.
- Men begin adapting to new sexual realities.
1-2+ Years
Research suggests erectile function may improve for up to two years after surgery. Dr. Chen notes: “Recovery times vary greatly between men. Age, function before surgery, surgical technique, and commitment to rehabilitation all affect long-term sexual outcomes.”
A 2021 analysis found that about:
- 40-50% of men regain enough erectile function for penetrative sex within 12 months
- Another 10-20% see improvements between 12-24 months
- Recovery rates are much higher for younger men and those who had nerve-sparing procedures
Sexual Rehabilitation
Many urologists now recommend active sexual rehabilitation to help recover erectile function.
“Penile rehabilitation keeps tissues healthy through increased blood flow while nerves heal,” explains Dr. Robert Kang, Associate Professor of Urology. “Regular blood flow to erectile tissues helps prevent damage that could permanently harm future function.”
Treatment Options
Oral Medications
Medications like sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra) enhance nitric oxide effects. This relaxes muscles in the penis and increases blood flow.
“These pills are often the first treatment for post-surgery ED,” states Dr. Kang. “They may not work well right after surgery due to nerve trauma. But they can still help rehabilitation and may work better as nerve function improves.”
Treatment often includes:
- Regular scheduled doses (not just as-needed)
- Starting within weeks or months after catheter removal
- Sometimes using higher doses than typical ED treatment
Vacuum Erection Devices (VEDs)
VEDs are pumps that create a vacuum around the penis, drawing blood into the tissues. A ring placed at the base of the penis helps keep the erection.
“VEDs work regardless of nerve damage, making them valuable early in recovery,” explains Dr. Chen. “Regular use may help preserve penis length and maintain tissue health while nerves recover.”
Injections
This involves injecting medication directly into the side of the penis to create an erection. Medications like alprostadil, papaverine, and phentolamine relax smooth muscles and increase blood flow.
“Injections bypass the need for nerve signals, making them effective even with significant nerve damage,” notes Dr. Kang. “Many men find the idea scary at first, but with proper teaching, most can use them safely.”
Penile Implants
For men with persistent ED that doesn’t respond to other treatments, penile implants offer a permanent solution.
Dr. Wilson explains: “Penile implants have among the highest satisfaction rates of all ED treatments. Modern devices are reliable, hidden, and allow for spontaneity that other treatments may not provide.”
Common types include:
- Inflatable implants: Fluid-filled cylinders in the penis, connected to a pump in the scrotum
- Semi-rigid rods: Bendable rods that maintain a permanent degree of firmness
A 2022 survey found that over 85% of men and their partners were satisfied with penile implants after prostatectomy.
Adapting to a New Sexual Normal
Redefining Sex and Intimacy
“One of the most important aspects of successful adaptation is expanding the definition of sex beyond penetrative intercourse,” emphasizes Dr. Wilson. “Couples who see this challenge as an opportunity to explore new ways of experiencing intimacy often adjust well.”
Helpful approaches include:
- Try non-penetrative activities: Expand your sexual experiences to include more mutual touching, oral sex, and other pleasures that don’t require firm erections.
- Focus on intimacy: Maintain physical closeness through cuddling, massage, and skin-to-skin contact.
- Talk openly: Discuss desires, concerns, and reactions honestly.
- Experiment with timing: Many men find sexual function varies throughout the day, with better erectile function in the morning.
Research shows that couples who talk openly about sexual changes after prostatectomy report higher relationship satisfaction regardless of erectile recovery.
Mental and Emotional Aspects
The psychological impact of prostatectomy on sexuality can be significant:
- Loss and grief: Mourning changes to sexual function
- Self-image changes: Adapting to new perceptions of masculinity
- Performance anxiety: Worry about pleasing a partner
- Depression: Affects about 15-20% of men after prostatectomy
“The psychological aspects of recovery are just as important as the physical ones,” Dr. Wilson emphasizes. “Men who get proper psychological support tend to report better quality of life and sexual satisfaction, regardless of their level of erectile recovery.”
Support options include:
- Individual counseling
- Couples therapy focusing on intimacy
- Support groups for prostate cancer survivors
- Sexual therapy with specialists experienced in cancer-related sexual challenges
Partner Support
Partners of men undergoing prostatectomy face their own adjustment process. Research shows that partners often experience significant stress but may hesitate to express concerns to avoid burdening the recovering patient.
Dr. Elena Martinez, a relationship therapist, notes: “Partners need support too. They often become caregivers while adjusting to changes in their intimate relationship. Creating space for their needs is crucial for the couple’s overall well-being.”
Key advice for partners:
- Learn about the changes: Understanding the physical changes and expected recovery can reduce anxiety.
- Talk openly: Express your own needs while being sensitive to your partner’s recovery.
- Join the recovery process: Attend medical appointments to feel more connected and in control.
- Be patient but active: Recovery takes time, but participating in rehabilitation shows commitment to shared intimacy.
- Get support: Consider joining groups specifically for partners or couples affected by prostate cancer.
“The most successful couples approach this challenge as a team,” emphasizes Dr. Martinez. “When both partners view sexual recovery as a shared journey rather than the patient’s individual problem, they navigate the changes more successfully.”
Talking to Your Healthcare Team
Despite the importance of sexual function to quality of life, many healthcare professionals don’t address these concerns without prompting.
A 2020 survey found that while 87% of prostate cancer patients considered sexual function discussions important, only 48% reported having thorough discussions with their healthcare providers about post-treatment sexual expectations and options.
Dr. Chen recommends: “Be proactive about discussing sexual concerns with your healthcare team. Don’t wait to be asked, and don’t hesitate to request a referral to a sexual medicine specialist if your primary provider seems uncomfortable or unknowledgeable about these issues.”
Important questions to ask your healthcare team:
- What specific sexual changes should I expect after my procedure?
- How might my age, health, and surgical approach affect my recovery of sexual function?
- What rehabilitation strategies do you recommend, and when should I start them?
- What resources are available if I need support for relationship challenges?
- When should we consider more advanced treatments if initial approaches don’t work?
“Sexual health is a legitimate medical concern and an important part of quality of life,” emphasizes Dr. Benson. “Patients deserve complete information and support throughout recovery.”
Future Developments
Research into improving sexual outcomes after prostatectomy continues to evolve. Promising areas include:
- Better surgical techniques: Refinement of nerve-sparing approaches and robotic surgery
- Nerve regeneration therapies: Research into growth factors that may speed nerve healing
- Gene therapy: Experimental approaches to enhance production of compounds crucial for erections
- Tissue engineering: Early research into developing replacement erectile tissues
- Improved rehabilitation: Optimizing timing and combination of existing treatments
Dr. Kang notes: “While we’ve made significant progress in preserving sexual function after prostatectomy, further improvements are needed. Current research aims not only to prevent damage during surgery but also to enhance recovery through biological approaches.”
Frequently Asked Questions
How long after prostatectomy can I resume sexual activity?
Most surgeons recommend waiting 4-6 weeks after surgery before resuming sexual activity. This allows for proper healing. Your doctor may give you specific guidance based on your recovery.
Will I be able to have an erection after prostatectomy?
Many men experience ED after prostatectomy, especially in the first few months. Recovery depends on several factors including age, function before surgery, surgical technique, and rehabilitation efforts. About 40-50% of men regain erections good enough for intercourse within the first year. Improvement can continue for up to two years.
Why can’t I ejaculate after radical prostatectomy?
During radical prostatectomy, the prostate gland and seminal vesicles are removed. These organs produce most of the fluid in semen. The connections between the testes and urethra are also cut. This results in “dry orgasms” without ejaculation. This change is permanent but doesn’t prevent orgasm or pleasure.
Can I still have an orgasm after prostatectomy?
Yes, most men can still have orgasms after prostatectomy. The nerves responsible for orgasm are different from those controlling erections and usually aren’t affected by surgery. However, some men say their orgasms feel different—sometimes less intense or more diffuse. These sensations typically improve over time.
How effective are medications like Viagra after prostatectomy?
ED medications often work less well right after prostatectomy compared to typical ED. Their effectiveness largely depends on whether the nerves controlling erections were preserved during surgery. About 30-40% of men respond well to these medications in the first year after surgery, with better response rates as nerve function recovers.
What can I do if ED medications don’t work after prostatectomy?
If pills don’t work, several alternatives are available:
- Vacuum erection devices (VEDs)
- Penile injections
- Intraurethral suppositories (MUSE)
- Penile implants (for long-term solutions)
A specialist in sexual medicine can help determine the best option for you.
Will I experience urinary leakage during sex after prostatectomy?
Some men leak urine during orgasm after prostatectomy. This is more common early in recovery but may persist long-term for some. Practical strategies include emptying your bladder before sex, using a condom, or discussing medical options with your doctor for persistent cases.
How can my partner and I maintain intimacy during recovery?
Maintaining intimacy during recovery involves:
- Talking openly about feelings and concerns
- Exploring non-penetrative forms of physical affection and sexual activity
- Setting realistic expectations and being patient
- Focusing on pleasure and connection rather than performance
- Considering counseling or therapy if adjustment is difficult
Is penile shrinkage after prostatectomy permanent?
Some men notice a decrease in penis length after prostatectomy. This can result from nerve damage, reduced blood flow, and scar tissue formation. Early penile rehabilitation, including regular use of vacuum devices, may help minimize these changes. Some—but not all—men experience partial return of previous dimensions as recovery progresses.
Conclusion
Sex after prostatectomy involves significant adjustments, but satisfying intimacy remains possible for most men and their partners. The journey requires patience, open communication, appropriate medical treatments, and often a willingness to redefine what makes a fulfilling sexual experience.
As Dr. Wilson emphasizes, “Recovery of sexual function after prostatectomy isn’t just about regaining erections—it’s about maintaining intimacy, pleasure, and connection in relationships. With appropriate expectations, medical support, and communication, couples can successfully navigate these changes.”
By understanding what to expect, actively participating in rehabilitation, communicating openly with partners, and using available medical and psychological resources, men who have undergone prostatectomy can maintain sexual wellbeing as an important part of their overall quality of life.