Can I Get an Erection After a Prostatectomy?

A simple prostatectomy removes part of your prostate and is performed for benign prostate enlargement, while a radical prostatectomy -- the procedure for prostate cancer -- removes the entire gland.

Not everyone with prostate cancer will need a prostatectomy. If your cancer is low-risk and thought to be slow-growing, active surveillance is usually recommended. This involves regular blood tests, digital rectal exams, biopsies, and imaging to monitor your cancer. If your cancer is higher-risk, treatment options could include radiation with or without medications, focal therapy, or a prostatectomy.

The pelvic region contains many important nerves that help with bladder control and sexual function. Because doctors have to go through the pelvic region to perform a prostatectomy, urinary incontinence -- trouble controlling your bladder -- and erectile dysfunction are the most common side effects

Yes, it is possible to regain erectile function after a prostatectomy if you had erections prior to surgery. “Our goal is by six to eight weeks post-op that all patients who want to be sexually active are sexually active,” said Dr. Morgan. However, in the early stages after surgery, this usually requires medications to achieve.

After your prostatectomy, you’ll participate in our penile rehabilitation program. The goal is to restore your sexual function within a few months of your surgery. During rehab, your doctor may prescribe medications, injections, or pumps to help you achieve an erection while your nerves recover, and you’ll attend regular checkups to assess your sexual function. You’ll also receive educational materials and perform at-home exercises, such as Kegel exercises. Pelvic floor physical therapy is also available. “As the months progress, patients need less assistance because the nerves we so carefully spared start to recover,” said Dr. Morgan.

Many major pelvic nerves and support structures are located in the space between your pubic bone and bladder, known as the “space of Retzius.” Whenever possible, Duke surgeons use imaging and robotic assistance to preserve this area by performing a highly specialized prostatectomy called a Retzius-sparing prostatectomy. Working within a smaller space in your pelvic area causes less damage to surrounding structures, spares more nerves, and speeds your recovery.

If you aren’t a candidate for a Retzius-sparing prostatectomy, Duke surgeons perform a traditional prostatectomy, taking care to move very slowly to preserve your nerve function. They focus on restoring the position of each structure to promote nerve recovery and faster healing. For example, Duke surgeons go beyond standard protocol after removing your prostate to place urethral suspension stitches to restore the urethra to its pre-surgical position. “It helps you have good control of urination very quickly after surgery, generally within the first few weeks to months,” said Dr. Morgan. Without the urethral suspension stitch, it can take up to a year to regain bladder control. “That's a really long time to be suffering through recovery.”

Duke’s goal is to cure cancer and help people recover faster so they feel they’ve been restored. What Duke does differently is “decrease the duration of recovery,” said Dr. Morgan.

No. During a radical prostatectomy, your prostate and seminal vesicles (which produce the fluid in semen) are removed, and your vas deferens (which brings sperm up from the testicles) is cut. However, you can still experience orgasms. These are typically called “dry orgasms,” because no seminal fluid is produced and no sperm reaches the urethra.