Erection changes are one of the most common effects of prostate cancer treatment, and they can be worrying. This guide explains why they happen after surgery and radiotherapy, what nerve-sparing surgery means, how recovery usually unfolds, the main types of treatment used in penile rehabilitation, changes in orgasm, and when to speak to a doctor. It is general information, not a personal treatment plan.
Medically reviewed by Prof. Dr. Samir Ahmed Al-Samarrai, consultant urologist. Last reviewed: · Last updated:
Why erection problems happen after prostate cancer treatment
An erection needs healthy nerves, good blood flow into the penis and a healthy mind and hormone balance. The nerves that control erections run in two thin bundles along the back and sides of the prostate. During a radical prostatectomy these nerves are stretched, handled or sometimes removed. According to Cancer Research UK, almost all men have problems getting an erection after this surgery, at least at first.
The American Cancer Society explains that radiotherapy can damage both the nerves and the blood vessels that supply the penis, and scar tissue can stop the vessels from stretching as they should. It adds that hormone therapy, which lowers testosterone, can cause low sex drive and problems with erections and orgasm.
Nerve-sparing surgery
When the size and position of the cancer allow it, surgeons try to keep the nerve bundles (nerve-sparing surgery). According to the American Cancer Society, more men recover erections after nerve-sparing surgery, and the chance is higher when the nerves on both sides are kept. If the cancer is close to or inside the nerves, one or both bundles may need to be removed to treat the cancer. The American Cancer Society notes that when both bundles are removed, natural erections are not expected and tablets will not work, but other aids can still help.
What recovery looks like over time
Recovery is usually slow. Prostate Cancer UK says erections can take a few months to a few years to return and may not be as firm as before. The American Cancer Society says nerve healing can take up to 2 years, and that men under 60, especially under 50, are more likely to recover. Strong erections before surgery help, while diabetes, high blood pressure, heart disease, smoking and depression can slow recovery.
After radiotherapy the pattern is different. Prostate Cancer UK says problems can take up to two years to appear and may get worse over time. The American Cancer Society reports that, about 4 years after either surgery or radiotherapy, the share of men reporting erection problems is about the same.
Penile rehabilitation: treatment options by type
Penile rehabilitation means using treatments early, often in the weeks after surgery and before a man feels ready for sex, to keep blood and oxygen flowing to the tissue of the penis. Prostate Cancer UK compares it to physiotherapy after an injury. The type, timing and combination of treatment are decided by the doctor.
| Type | How it works | Points to know |
|---|---|---|
| Tablets | Increase blood flow to the penis; sexual arousal is still needed | Need some working nerves; not suitable with certain heart medicines |
| Vacuum device | A cylinder draws blood into the penis; a ring can hold the erection | Does not depend on the nerves; Prostate Cancer UK says it can usually start about four to six weeks after surgery, once the catheter is out |
| Injections, pellets or cream | A medicine placed in or on the penis widens the blood vessels directly | Training from a nurse or doctor; can work even when nerves are affected |
| Penile implant | A device placed inside the penis during an operation | Usually considered when other treatments have not worked |
You can read more about erectile dysfunction medicines and the penile implant. Prostate Cancer UK notes that men who try more than one treatment, or combine them, are more likely to find something that works, and that a treatment that fails early may be worth trying again months later as the nerves recover. It reports that about 3 in 100 men with an implant get an infection.
Orgasm and ejaculation changes
The prostate and seminal vesicles make most of the fluid in semen. After their removal, the American Cancer Society explains that there is no ejaculation, so orgasm is “dry”. Orgasm should still feel pleasurable, though some men find it less intense and a few have pain. Prostate Cancer UK suggests asking your care team about sperm storage before treatment if you may want children in the future. After radiotherapy, Prostate Cancer UK says men may notice less semen or a dry orgasm. Some men also notice the penis looks shorter after surgery; the American Cancer Society says this may improve somewhat over the next year.
Feelings, relationships and partners
Changes in sexual function can affect mood, confidence and relationships. Cancer Research UK encourages open conversation with a partner and says counselling or sex therapy can help alongside medical treatment. Prostate Cancer UK suggests partners can come to appointments to learn how treatments work.
How the problem is assessed
The doctor asks about erections before and after treatment, desire, relationships, general health, smoking and medicines. The NHS describes basic checks such as blood pressure and an examination of the genitals. Hormone levels or other conditions may be checked, depending on the case. See also our guide to erectile dysfunction.
When to see a doctor or seek urgent help
- Emergency: Prostate Cancer UK advises going to the emergency department straight away if an erection lasts more than four hours (priapism).
- Signs of infection after implant surgery, such as fever, increasing pain, redness or swelling.
- Erections not improving as expected, or a treatment causing side effects.
- If you have a heart condition or take heart medicines, before starting any treatment, as some are not suitable.
- Low mood, anxiety or relationship strain linked to sexual changes.
Avoid buying erection products online or using herbal remedies without speaking to your doctor first.
Frequently asked questions
Will my erections come back after radical prostatectomy?
Many men regain erections, but it takes time. Prostate Cancer UK says it can take a few months to a few years, and erections may be less firm than before. Age, erections before surgery, general health and whether the nerves were spared all affect recovery.
Can I have an orgasm without an erection?
Yes. Orgasm and erection are controlled differently, so orgasm is still possible without a full erection. After prostatectomy the orgasm is dry because no semen is released. According to the American Cancer Society it should still be pleasurable, though some men find it less intense.
When should penile rehabilitation start?
Prostate Cancer UK says rehabilitation can start in the weeks after surgery, even before you feel ready for sex. Your doctor decides the right time and method for you, based on your surgery, catheter removal and general health.
Do the tablets work if my nerves were removed?
According to the American Cancer Society, tablets do not work if both nerve bundles were removed, because they rely on nerve signals. Vacuum devices, injections and implants work in other ways, so options remain. Your doctor will explain what suits your situation.
Does radiotherapy cause erection problems straight away?
Usually not. Prostate Cancer UK says problems can take up to two years to appear and may get worse over time. Prostate Cancer UK notes that treatment for erection problems is often more effective if started soon after radiotherapy; your doctor can review this at follow-up visits.
Should my partner be involved?
It often helps. Prostate Cancer UK suggests partners can come to appointments to learn how treatments work, and some couples include treatments in foreplay. Counselling or sex therapy can support both of you through the changes.
Sources
- Sex and erection problems after treatment for prostate cancer | Cancer Research UK
- Treatments for erection problems | Prostate Cancer UK
- Side effects of external beam radiotherapy | Prostate Cancer UK
- How Cancer Can Affect Erections | American Cancer Society
- Surgery for Prostate Cancer | American Cancer Society
- Erectile dysfunction (impotence) | NHS
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Prof. Samir Al-Samarrai and Dr. Amer Mousa assess urological conditions at Prof. Al-Samarrai Medical Center, Dubai Healthcare City, and discuss the options that suit your case. Medical consultations are confidential.
Read more: Urologist in Dubai: doctors, services, insurance and booking
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