Sex After Prostatectomy

Prostate health issues such as benign prostatic hyperplasia (prostate enlargement) and prostate cancer affect hundreds of thousands of men in the United States every year. 

If you’ve been diagnosed with a serious prostate issue, your healthcare provider may suggest a prostatectomy — a surgical procedure in which your part or all of your prostate gland is surgically removed from your body.

Prostate removal surgery is usually highly effective at treating cancer and prostate enlargement (when the cancer is found early enough), but it can potentially lead to complications.

These include some sexual performance issues, such as erectile dysfunction (ED) and difficulty ejaculating normally.

Although these effects can change your sexual experience, many men are still able to enjoy a fulfilling, satisfying sex life after prostate surgery by making certain lifestyle changes and using medication. 

Below, we’ve talked about what to expect if you’re scheduled to undergo a prostatectomy and want to maintain an active sex life after surgery. 

We’ve also explained how you can have a healthy sex life after a partial or complete prostate removal, whether through exercises to improve sexual functioning, medications, devices or a combination of different approaches.

Prostatectomy Surgery & Your Sex Life: The Basics

• Your prostate gland plays a key role in your sexual and urinary function. If your prostate is surgically removed, you’ll likely experience changes to your ability to have sex.
• Several different methods are used to remove part or all of the prostate gland. The type of technique that’s used for your prostatectomy may have an effect on your sex life and sexual performance after surgery.
• Because your prostate plays a key role in producing and secreting semen, you may not be able to ejaculate normally after it’s surgically removed.
• It’s normal to experience erectile dysfunction after prostate surgery. Although most men regain the ability to get an erection in the months and years after surgery, some develop persistent erectile dysfunction that doesn’t improve over time.
• Medications like sildenafil (the active ingredient in Viagra®), tadalafil (Cialis) and others can often help to improve your sexual performance after prostate removal.
• When these aren’t effective, other treatments, such as injectable medications or penile prosthesis, may help you to enjoy a healthy sex life.

What Is a Prostatectomy?

A prostatectomy is a surgical procedure in which part or all of your prostate gland is surgically removed from your body. It’s usually carried out to treat advanced benign prostatic hyperplasia (prostate enlargement) or prostate cancer.

Your prostate is a small gland that’s located between your penis and your rectum. It’s roughly the same size as a ping-pong ball and plays a key role in your reproductive health by creating the semen that mixes with your sperm before you ejaculate. 

Prostatectomy surgery is generally described as simple or radical. In a simple prostatectomy, the inner part of the prostate gland is removed through an incision that’s made in your lower abdomen. This type of procedure is usually performed to treat prostate enlargement.

In a radical prostatectomy, your entire prostate gland and some of the surrounding tissue may be removed. This type of procedure is usually performed to treat prostate cancer.

Prostatectomy and Sexual Issues

As a man, your prostate gland plays several important roles in your body’s sexual and urinary function. 

During sex, your prostate gland is responsible for releasing seminal fluid, or semen, into your urethra. As you reach orgasm and ejaculate, the muscle tissue of your prostate forces semen and sperm out from your penis.

The nerves that surround your prostate also play an important role in allowing blood to flow to the erectile tissue of your penis when you’re sexually aroused.

Because prostate surgery involves removing the prostate gland, it’s normal to lose some parts of your normal sexual function after the surgery.

For example, radical prostatectomy involves cutting the connection between your urethra and your testicles. This means that sperm is no longer able to flow down your urethra and out the tip of your penis during sex.

As a result of this, men who undergo radical prostatectomy surgery can still reach orgasm, but aren’t able to ejaculate. 

Several different approaches are used to remove your prostate gland during surgery. Some of these approaches — particularly those used to treat prostate cancer — may result in damage to the nerves that surround your prostate gland, testicles and penis.

Nerve damage caused by prostatectomy surgery may affect your erectile health. If your nerves need to be cut during the procedure (for example, to remove cancerous tissue), you may find it difficult or impossible to get and/or maintain an erection after surgery.

Because recovery from prostate surgery is usually a slow, gradual process, it may take several months to find out how much your sexual function has been affected by prostate removal.

How to Maintain Your Sex Life After Prostate Surgery

Although prostate surgery can affect your sexual experience and performance, getting surgery to remove part or all of your prostate doesn’t mean that you can no longer have sex or enjoy a satisfying sexual life. 

However, it does mean that you may need to make some changes to how you and your partner have sex. These may include using ED medications, erection-promoting devices or engaging in penile rehabilitation exercises to keep your penis stimulated and healthy. 

If you’ve recently had prostate surgery, it’s important to talk to your healthcare provider before you make any changes to your health habits. They’ll be able to inform you about what you can do to restore and improve your sexual function after surgery. 

Oral ED Medications

It’s common and normal to experience some degree of erectile dysfunction after undergoing a prostatectomy. In fact, some research shows that 85 percent of men experience some level of ED following radical prostatectomy.

ED caused by prostate surgery can sometimes be permanent. However, for many men, it’s a temporary issue that improves as your body recovers from the procedure.

Following a nerve-sparing prostatectomy, about 40 percent to 50 percent of men who develop ED will return to their normal level of sexual function within one year. Two years after surgery, about 30 percent to 60 percent of men should experience a return to normal sexual function.

After prostate surgery, ED is often treatable using medications like sildenafil (Viagra), tadalafil (Cialis) and others.

These medications work by improving blood flow to your penis. About 75 percent of men who undergo nerve-sparing prostatectomy surgery are able to successfully achieve an erection by using ED medications.

Our guide to the most common ED treatments lists the four most popular medications for ED and explains more about how they work. 

Other Medications and Devices

Although medications like sildenafil(generic Viagra) and tadalafil are effective for many men with post-surgery erectile dysfunction, they aren’t the best choice for everyone.

If your prostatectomy causes damage to the nerves near your penis, or if you take medication for hypertension, angina or other health conditions, using an oral ED medication may not be a suitable option for you. 

In this case, your healthcare provider may recommend a different type of medication or a device to help you achieve an erection. Your options may include:

• Penile injection therapy. This involves using injectable medications to stimulate blood flow and improve your erections. These medications are typically administered using a very small needle (5/16th inches in length) to minimize discomfort.
  Although this treatment method may sound unpleasant, it’s relatively simple to use and has a success rate of 70 percent to 80 percent.
• Vacuum constriction devices (VCDs). Also known as a penis pump, a VCD works by creating a vacuum around your penis. This draws blood into your penis and allows it to become erect.

Habits and Lifestyle Changes

Your healthcare provider may recommend making certain changes to your habits and lifestyle to promote blood flow and improve your erectile health. These may include:

• Treating any underlying health issues
• Changing your eating habits to maintain a healthy weight
• Exercising regularly to improve your cardiovascular health
• If you smoke, quitting smoking and nicotine products
• Limiting your consumption of alcohol

We’ve talked more about the effects of good habits and lifestyle changes on ED in our guide to naturally protecting your erection.

Although these changes are unlikely to treat prostatectomy-related erectile dysfunction on their own, they can contribute to an increase in blood flow, better overall health and improved sexual function.

In Conclusion

Prostate surgery can affect your sex life in several ways, from preventing ejaculation to causing issues such as erectile dysfunction.

Following a prostatectomy, your sexual performance may gradually improve and issues such as ED may become less severe. If you have persistent ED after a prostatectomy, medications such as sildenafil and others can often make it easier to get and sustain an erection.

If you’re about to undergo prostate surgery, or have recently had a prostatectomy, keep in touch with your healthcare provider. They’ll be able to keep you informed about the recovery process, including how you can maintain your sex life after surgery.