Managing ED After a Prostatectomy

Erectile dysfunction (ED) is a common side effect of prostatectomy. Up to 85% of men who undergo a prostatectomy experience temporary ED, resulting in additional emotional stress. After your diagnosis of prostate cancer, your health is top priority. However, erectile dysfunction is a real struggle for many men as well, and it deserves equal understanding and acknowledgement.

In this post, we’ll explore why so many men have ED due to prostate cancer and explore potential treatment options.

What You Need to Know About Prostate Cancer

The prostate is a walnut-shaped gland in males that produces semen and helps transport sperm. Prostate cancer is the number-one cancer diagnosed in men with over 288,000 men diagnosed every year.

While it has a high survival rate, cancer is cancer. Living with the disease takes a drastic toll on your physical, emotional, and mental health. Early detection is vital to minimizing side effects.

Symptoms of prostate cancer include:

●      Increased difficulty urinating

●      More frequent urination, especially at night

●      Blood in the urine or semen

●      Erectile dysfunction

●      Numbness or weakness in the hands or legs, or loss of bladder and bowel control (advanced states)

If you experience any change to urination, sexual performance, or discomfort, schedule an appointment with a urologist.

Erectile Dysfunction After a Prostatectomy

A prostatectomy is the leading treatment for prostate cancer. During the procedure, the surgeon partially or completely removes your prostate. If you have a radical prostatectomy, you will not be able to produce children through sexual intercourse. The thought of becoming infertile is a scary thought for many men, especially if you have yet to even begin planning a family. For this reason, your doctor may suggest collecting sperm ahead of your procedure.

Men who have had a radical prostatectomy can still produce sperm, and they may be able to be extracted directly from the testicles. Sperm banking is a potential option for men with prostate cancer that want to have a child in the future.

Fertility rates are extremely low, if not non-existent, after a prostatectomy. The accompanying erectile dysfunction can be devastating. ED is not usually permanent after treatment, but it can take time to return as your body heals.

Why Does Prostatectomy Cause Erectile Dysfunction?

The main cause of erectile dysfunction after a prostatectomy is nerve damage. The procedure removes some if not all of your prostate as well as surrounding seminal vessels and affected tissue.

Because of the invasive nature of the procedure, the sensitive area around the prostate is also affected. Whether or not you have ED after surgery also largely depends on whether you have a full or partial prostatectomy.

Radical prostatectomy patients are more likely to experience ED. Impotence is among the leading side effects of prostate removal. Research shows that men can suffer from erectile dysfunction up to a year or more after their radical prostatectomy.

Your doctor may be able to perform nerve-sparing surgery, which aims to minimize tissue damage and preserve normal erectile function and urination after treatment. Nerve-sparing prostatectomies are minimally invasive and take three to four hours to complete.

Some men still experience ED after nerve-sparing prostate surgery; although the procedure carries a lower risk of erectile dysfunction, it can still happen. In other types of prostate surgery, the bundles of nerves on either side of the gland have to come out. Unfortunately, the nerves cannot regrow once they’re cut, which means men have to use medication or assistive devices to get a firm erection after surgery.

How Long Does Ed Last After a Prostatectomy?

The exact answer is unclear as there are various factors that can influence your erectile dysfunction post-surgery. Men who are overweight and smoke are more likely to have ongoing issues with impotence.

The truth is that everyone’s body is different and heals at its own pace. ED isn’t a sign of failure; it’s just a natural side effect of an important surgery that you needed. Saving your life from prostate cancer that spreads is a wonderful thing — it’s important to remember the positives even when you’re struggling with post-surgical ED.

Men in their 20s and 30s are more likely to recover faster than older adults. Recovery can range from a few months to around 2 years depending on factors like your age, weight, whether you smoke or not, and the surgical procedure used to perform your prostatectomy.

What Is The Treatment For ED After a Prostatectomy?

Treatment options include prescription medication and lifestyle changes. Men with a high BMI or who smoke may be encouraged to start a weight loss and exercise program and quit tobacco. Those who do not may speak to a urologist or their primary care physician about trying a prescription medicine approved to treat erectile dysfunction.

Another option is vacuum erectile devices (VED)s, or ED pumps. These work like a vacuum, drawing blood into the penis. Once erect, you can place a construction band around the penis to maintain the erection during sexual activity.

For cases that do not respond to other forms of treatment, penile surgery is an option. However, this is generally considered a last resort due to its invasive nature and high cost.

How Can I Improve My ED After Prostate Surgery?

The best thing you can do is follow a healthy lifestyle, treat stress and anxiety, and talk to a doctor about medication options. The most effective treatment for ED after prostate surgery is prescription medication.

There are a variety of medications to choose from, and your doctor can help you determine the best fit for your body. Johns Hopkins reports up to 75% of men who take oral medication for ED after prostate surgery are able to get an erection. However, men who suffer from angina, have heart problems, or take alpha-blockers may not be able to take these drugs.

The most well-known ED medication is Viagra®, or sildenafil. Other options include:

●      Cialis® (tadalafil)

●      Levitra (vardenafil)

●      Stendra® (avanafil)

You should explore all your options with your doctor to make sure that you get the best medication for you.

Can You Get a Hard-On Without a Prostate?

Yes, men without prostates can still achieve and maintain an erection. Nearly all men with prostate surgery experience ED, but within a year, many see a major improvement in their sexual performance.

It’s important to note that everyone is different, so avoid placing yourself on a timeline to recover. What matters most is that you prioritize your health. Speaking with your doctor, and even a mental health counselor, can help you process the struggles you’re facing as you explore other treatment options.

How Is Erectile Dysfunction Treated?

When it comes to ED, prescription medications are the most effective treatments. They have a high success rate among men without a prostate, and they can be an easy solution to your problem.

In other cases, you may need to explore surgical solutions. It sounds extreme, we know, but ED surgery could be necessary if you do not see improvement with oral drugs. Erectile dysfunction surgery is generally a penile prosthesis, or penis implant. These can be malleable or inflatable.

A malleable implant is made from two rods inserted at the base of the penis. Malleable implants are always firm, but you can bend the rods in them to make them less apparent in clothing. But the thought of having a detectable erection most of the time makes many men hesitant to choose this option. As an alternative, they may consider inflatable penile implants.

The inflatable implant procedure includes two inflatable cylinders placed at the base of the penis, along with a pump unit in the scrotum. The cylinders are inflated for sexual activity and then deflated.

Penile implant surgery takes 30-minutes to 2 hours and recovery lasts for several weeks. Many men are happy with their sex lives after surgery, but it is important to explore other options before going the surgical route.

The cost of penile prosthesis surgery can range from $10,000 to $20,000 without insurance. Many insurance providers are unlikely to cover this type of surgery as it is not deemed medically necessary.

Recovering From ED After Prostate Surgery

Having erectile dysfunction can take a major toll on your self-confidence, but you do not have to suffer alone. Although it can be embarrassing to bring up, the only way to get help for ED is to discuss your struggles with a qualified medical provider.

Doctors are professionals who understand the underlying causes and possible treatments for ED. They can hear your concerns, understand your experience, and offer potential solutions that could restore sexual function after prostatectomy.

Sources:

1. https://www.cancer.org/cancer/types/prostate-cancer/about/key-statistics.html
2. https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/signs-symptoms.html
3. https://www.cancercenter.com/community/blog/2023/06/sex-after-prostate-cancer
4. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/fertility-after-prostate-cancer-treatment
5. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/radical-prostatectomy