Key Facts
- Erectile dysfunction (ED) is a very common—and expected—side effect of nearly all prostate cancer treatments, including surgery and radiation.
- ED happens because the delicate nerves and blood vessels controlling erections are located right next to the prostate and are often affected by treatment.
- This is not a sign of failure. It is a predictable part of the healing and recovery process.
- Recovery of natural erectile function is a slow marathon, not a sprint, often taking 18 months or more.
- You have many excellent treatment options, from pills to injections to devices, to help you be sexually active during and after this recovery period.
On This Page:
The Tough but Hopeful Reality
You’ve done it. You’ve been through the diagnosis, you’ve made the hard decisions, and you’ve completed your prostate cancer treatment, whether it was surgery (a prostatectomy) or radiation. You’ve won the battle against cancer. But now, in the quiet aftermath, you’re facing a new challenge: your sex life is not what it used to be. Erections are difficult, or maybe they’re not happening at all.
I want to start by saying this is the most normal thing in the world. As a urologist, I see this as an expected chapter in the story of prostate cancer recovery. The goal was to save your life. Now, our next goal is to help you reclaim your quality of life. And a healthy, intimate sex life is a huge part of that. There is hope, and there is a plan.
Why This Happens: An Unavoidable Consequence
It’s important to understand that this is not your fault. It’s a matter of anatomy. The tiny, delicate nerve bundles that send the “go” signal for an erection are stretched like fine spiderwebs right over the surface of the prostate. When we remove the prostate surgically, those nerves are inevitably bruised, stretched, or sometimes have to be cut. When we treat it with radiation, those nerves and the small blood vessels they supply can be damaged by the energy beams. For a deeper dive, you can read my guide on prostate cancer treatment side effects.
Think of it like a power line that’s been knocked down in a storm. The power plant (your brain’s desire) is still working, and the house (your penis) is still there, but the connection between them has been disrupted. Our job now is to get that connection working again.
The Rehab Plan: Actively Reclaiming Your Function
“Penile rehabilitation” is a term we use for this process. It’s not a passive, “wait-and-see” approach. It’s an active plan to encourage blood flow and stimulate the erectile tissues to keep them healthy while the nerves slowly heal. The principle is simple: “use it or lose it.” Tissues that don’t get regular, oxygen-rich blood flow can weaken over time. So, we want to actively bring blood into the penis, even before your natural erections have returned.
Your Toolkit for Sexual Recovery
We don’t have to wait for the nerves to fully wake up to help you be sexually active. We have a fantastic toolkit to bridge the gap.
| The Tool | How It Works | When It’s Used |
|---|---|---|
| Oral Pills (PDE5 Inhibitors) | Medications like Cialis or Viagra help the damaged nerves work more efficiently. They amplify the weak signal that might be getting through. | This is often the first thing we try. We might even have you take a low dose regularly to promote blood flow for rehab. |
| Vacuum Erection Device (VED) | A plastic cylinder and pump that physically draws blood into the penis to create an erection. A band at the base holds it there. | An excellent, non-invasive tool for both rehabilitation (daily use without the band) and for intercourse. |
| Penile Injections | A tiny, painless injection of a powerful medication like Trimix directly into the penis. | This is the go-to when pills aren’t strong enough. It bypasses the nerves completely and creates a very reliable, firm erection. |
| Penile Implant | A surgical device placed inside the penis that allows you to have an erection on demand. | This is the permanent “gold standard” solution for men when other treatments have failed or are not desired. The satisfaction rate is incredibly high. |
A Final Word on Patience
I tell all my prostate cancer survivors the same thing: this is a marathon. The nerves can take up to two years, sometimes even longer, to heal as much as they are going to. There will be progress, and there will be plateaus. The most important thing is not to get discouraged and not to give up on your sex life.
Work with your partner. Communicate. And work with your urologist. We have the tools and the experience to help you navigate this new chapter. You’ve already beaten the cancer. Now let’s work on getting you back to being you.
