Introduction
Prostate cancer affects many men, and some need surgery to remove their prostate gland. This surgery, called prostatectomy, saves lives but changes how your body works sexually. This guide will help you understand what happens to your sex life after surgery and how to adapt to these changes.
What is a Prostatectomy?
A prostatectomy removes all or part of the prostate gland. For prostate cancer, doctors often remove the entire prostate. This is called a radical prostatectomy.
Types of Surgery
Doctors can remove your prostate in several ways:
- Open Surgery: One large cut in your lower belly
- Laparoscopic Surgery: Several small cuts with special tools
- Robot-Assisted Surgery: Using a robot to help the surgeon work with more precision
- Nerve-Sparing Surgery: Careful work to avoid cutting the nerves that help with erections
The type of surgery you have affects how well you recover sexually. Nerve-sparing methods often lead to better results.
Sexual Changes Right After Surgery
Erection Problems
Almost all men have trouble getting erections right after surgery. About 85% of men face major erectile dysfunction (ED) in the weeks after surgery. This happens no matter what type of surgery you have.
Changes in Orgasm
Your orgasms will change after surgery:
- You’ll have “dry” orgasms with no fluid coming out
- The feeling may be different than before
- You might leak urine during orgasm
Pain During Sex
Some men feel pain during sexual activity early in recovery. This usually gets better within 3-6 months as you heal.
Timeline for Sexual Recovery
Each man’s recovery is different, but here’s what most men experience:
WhenWhat Happens0-3 monthsHealing from surgery; most men can't get erections yet3-6 monthsEarly signs of improvement; treatment is key6-12 monthsGradual improvement for many men1-2 yearsBest possible recovery of natural function
Your erections may keep getting better for up to 2 years after surgery. Be patient with your body.
What Affects Your Recovery
Before Surgery
- Age: Younger men often recover better
- Sexual function before surgery: If you had good erections before, you may have better results
- Other health issues: Diabetes or heart problems can slow recovery
During Surgery
- Saving nerves: Keeping nerve bundles intact helps recovery
- Surgeon’s experience: More skilled surgeons often get better results
- Surgery type: Robot-assisted surgery might offer slightly better results
After Surgery
- Starting treatment early: Beginning rehab soon after surgery helps
- Following your treatment plan: Using treatments as directed works best
- Mental outlook: Managing stress and having realistic hopes helps
Penis Rehabilitation Programs
What Is Penis Rehabilitation?
Penis rehab uses treatments to help your body recover natural erections. These treatments prevent damage to penis tissues during recovery.
What These Programs Include
Most programs use several approaches:
- ED pills (like Viagra or Cialis) taken regularly
- Vacuum pumps to increase blood flow
- Penis injections to deliver medicine directly
- Pelvic floor exercises to strengthen supporting muscles
Do These Programs Work?
Research shows men who follow structured rehab plans have better erection function at 12 months after surgery compared to those who don’t.
Treatment Options for Erection Problems
Pills
Common ED medications include:
- Sildenafil (Viagra)
- Tadalafil (Cialis)
- Vardenafil (Levitra)
- Avanafil (Stendra)
These pills work for many men but may not work as well after prostate surgery.
Vacuum Erection Devices
These devices use suction to pull blood into the penis. They offer:
- No need for drugs
- No drug side effects
- Can work even if you have nerve damage
Penis Injections
You inject medicine directly into your penis to cause an erection. Options include:
- Alprostadil
- Papaverine
- Phentolamine
- Trimix (a mix of medicines)
These work for 70-85% of men after prostate surgery, even with nerve damage.
Urethral Suppositories
Medicine (Alprostadil) can be placed into the opening of your penis. This method works less well than injections.
Penis Implants
If other treatments fail, a surgeon can place an implant in your penis. This offers a permanent solution with the highest satisfaction rates.
Beyond Erections: Complete Sexual Recovery
Rethinking Sex
After surgery, you may need to expand your view of sex beyond just intercourse.
Mental Impact
The emotional side of recovery includes:
- Managing hopes and expectations
- Dealing with feelings of loss
- Talking openly with your partner
- Building confidence with new sexual approaches
Getting Help
Working with a sex therapist or counselor can greatly improve your outcome. Research shows couples who get specialized help report better sex lives after prostate cancer treatment.
Partner Support
Impact on Partners
Your partner may face challenges too:
- Worry about hurting you during sex
- Not knowing how to help
- Adjusting to sexual changes
- Meeting their own sexual needs
How to Talk About It
Good communication is key:
- Talk openly about hopes and concerns
- Give clear feedback during sex
- Check in regularly about what works
- Make treatment decisions together
Creating New Intimacy
Successful couples develop new approaches:
- Try more types of sexual activities
- Focus on pleasure beyond the genitals
- Plan sex when ED treatments work best
- Use extra stimulation methods or aids
Other Sexual Options
Beyond Intercourse
Many couples find pleasure through:
- Extended foreplay and sensual touch
- Oral sex and hand stimulation
- Mutual masturbation
- Using vibrators and other sex toys
Adapting to Dry Orgasms
Try these tips to enhance orgasms:
- Extend foreplay
- Focus on multiple pleasure spots
- Practice mindfulness during sex
- Explore new erogenous zones
Special Situations
Gay and Bisexual Men
Gay and bisexual men may have unique concerns:
- Changes in sexual roles
- Different priorities in recovery
- Impact on sexual identity
- Need for specialized counseling
Dating After Surgery
If you’re single, these tips may help:
- Practice what to say to new partners
- Build confidence strategies
- Decide when to discuss surgical effects
Future Treatments
New Therapies Being Studied
Research is looking at:
- Sound wave therapy to help tissue regrow
- Stem cell treatments to restore nerve function
- Gene therapy to help nerves regrow
- Better medicine delivery systems
Better Surgical Methods
Surgeons are working on:
- Better ways to see nerves during surgery
- More precise robots
- Nerve grafting when nerves must be removed
- Targeted treatments that spare healthy tissue
Research Studies You Can Join
Current studies are looking at:
- New drug combinations for ED
- Regenerative medicine approaches
- Better rehab methods
- Quality of life treatments
Talk to your doctor about joining a study, or check ClinicalTrials.gov for options.
Common Questions
When can I have sex again after surgery? Most doctors suggest waiting 4-6 weeks after surgery. Get your doctor’s okay first.
Will I ever get natural erections again? Many men regain some natural function, especially if they had good erections before surgery and had nerve-sparing surgery. Recovery can take up to 2 years.
Can I have an orgasm without an erection? Yes! Orgasm and erection use different nerve pathways. Many men can climax without a full erection.
Will sex feel the same? Most men notice differences. You’ll have dry orgasms, and the feeling may change.
How can my partner help me recover? Partners can help by being patient, talking openly, going to doctor visits, and exploring new ways to be intimate.
Does insurance cover ED treatments? Coverage varies widely. Some treatments may be covered, especially for cancer-related ED. Many require prior approval or have limits.
Conclusion
Sex after prostate surgery presents challenges, but with the right treatments and approach, you can have a satisfying sex life again. Recovery takes time—up to two years—and may require trying new things.
The best results come from working with a team of doctors, including urologists, sex therapists, physical therapists, and counselors. By combining medical treatments with good communication and new intimacy approaches, many couples successfully adapt to these changes.