FAQ: Erections After Prostate Surgery
1. Q: Is the treatment of prostate cancer going to destroy a man's sex life?
A: Some of the current treatments for prostate cancer can affect the sex life, but if the cancer is detected early and patients are treated by an experienced surgeon using nerve-sparing techniques, then for the vast majority, their sex lives will return after surgery – usually beginning within three to six months and then having continued improvement for two to three years. Other treatments such as radiation therapy and hormonal therapy can have a negative impact on sex life, but they do not uniformly destroy sex life. Also, sexual function can be restored in a lot of different ways now with medications, vacuum erection devices and certain types of injections. The potential is there for a negative impact on sex life, but many men are successfully treated for prostate cancer and have satisfactory sex lives afterwards.
2. Q: What is nerve sparing surgery?
A: Preservation of the cavernous nerves – the so-called nerve-sparing technique – offers many men opportunities to regain erectile function. These nerves course along the sides of the prostate and rectum providing nerve connections to the base of the penis in the deep pelvis. The severing of the cavernous nerves (during surgery) was and is the common basis for erectile dysfunction. The final decision to perform nerve-sparing surgery is usually made at the time of surgery.
3. Q: When will erections return after a nerve-sparing prostatectomy?
A: Erections usually begin to return as partial erections 3 to 6 months after surgery and then continue to improve for about 36 months after surgery, as the nerves recover from the trauma of surgery. Despite expert application of the nerve-sparing prostatectomy technique, early recovery of natural erectile function is uncommon. Even when the nerve-sparing surgery is performed with meticulous technique, patients do not recover erectile function as quickly as they do urinary continence. In fact, the cavernous nerves are typically functionally inactive, at least partially, for as long as 2 years after surgery, even when nerve-sparing technique is used.
Q: Why does it take so long to recover potency?
A: A number of explanations have been proposed for this phenomenon of delayed recovery, including mechanically induced nerve stretching that may occur (during the operation), thermal damage to nerve tissue caused by cauterization during surgical dissection, injury to nerve tissue amid attempts to control surgical bleeding, and local inflammatory affects associated with surgical trauma.
5. Q: Why don't all men recover erectile function after nerve-sparing surgery?
A: The most obvious determinant of postoperative erectile function is potency before the operation. Some men may experience a decline in erectile function over time, as an age-dependent process. Furthermore, postoperative erectile dysfunction is compounded in some patients by preexisting risk factors that include: older age, cardiovascular disease, diabetes, cigarette smoking, physical inactivity and taking of some medications such as anti-hypertensive drugs or psychotropic medications. The impact of these risk factors on patients’ eventual outcomes has led to the acknowledgment that rating erection recovery potential after surgery should involve relevant risk factors.
6. Q: What is available for Erection Rehabilitation After an RRP?
A: Men who have undergone nerve-sparing technique should be offered therapies that are not expected to interfere with the potential recovery of spontaneous, natural erectile function. The relatively new strategy of rehabilitation in clinical management after an RRP comes from the idea that early-induced sexual stimulation and blood flow in the penis may facilitate the return of natural erectile function and resumption of medically unassisted sexual activity. Some experts in erectile dysfunction now believe that taking agents such as Viagra, Levitra, or Cialis will hasten the return of erections. Alternatively, vacuum erection devices, MUSE suppositories, or injections of blood vessel dilating drugs into the side of the penis can produce good erections in some patients. The basis for this belief is that, normally, men have erections every day; therefore, the normal situation for the penis is to receive an infusion of well-oxygenated blood every day. This infusion helps to keep the intricate anatomical structures in the penis healthy.
7. Q: What is the effect on potency of radiation therapy after an RRP?
A: In about 70% of these cases, radiation does damage the cavernosal nerves and erections begin to fade about one year after treatment.
8. Q: Can I have sex with prostate cancer and is the cancer contagious?
A: Yes, you may. As far as we know, prostate cancer is not contagious.
9. Q: When is it safe for a man to resume sexual activity after an RRP. Is it normal to have pain with return of sexual activity?
A: Sexual activity can be resumed within a month after a radical prostatectomy. We tell our patients to resume sexual activity as soon as they feel an interest and when their urinary control is adequate for sexual activity. Usually, erections do not begin to return spontaneously until 3 to 6 months, and they may continue to improve for up to 36 month after surgery. We encourage patients to induce erections sooner in the following ways:
1. with Viagra-like medications. (We recommend Cialis 20 mg/day because it has a longer lasting effect, but this drug causes some men to have muscle cramps and they have to switch to another.
There have been reports that these drugs might cause blindness in some men. This occurrence is rare and has not been causally linked to the drugs. Most of the patients who developed blindness had pre-existing eye problems or very abnormal blood lipids. To be safe, a patient should consult an ophthalmologist to see if there is any worry about taking these drugs that are called phosphodiesterase type 5 inhibitors.
2. with a vacuum erection device
3. with a MUSE suppository
4. with injection therapy. Some experts in male sexual dysfunction believe that initiating erections in these ways improves the blood flow to the penis and hastens the return of spontaneous erection. Normally, men have one or more erections daily. The normal physiology of the penis is to have an infusion of well-oxygenated blood several times each day. It is probably not good for men to go for months without having any erections. Some experts suggest that lack of erections can cause atrophy of important structures such as the valves that trap blood in the penis during erection and can cause fibrosis (scarring) of the penile tissues. It is not uncommon to have pain with orgasm after a radical prostatectomy. This pain occurs because the deep pelvic muscles have not completely recovered from the trauma of surgery. Often, some discomfort persists for a long time; however, in most patients it resolves completely with time.
10. Q:I have used caverject impulse penis injections but they give me severe pain in my penis during and after use. Is there any of type of injection medication that can be used that doesn't cause so much pain?
A: In our experience, many patients find a mixture of 3 drugs called Tri-Mix considerably less painful than Caverject and equally or more effective. We actually prefer caverject alone because scar tissue may be lower and thus preferred.
11. Q: I am a 57 year old man who had an RRP 6 months ago. I currently have sex 2-3 times per week using prostaglandin injections and Viagra. Can you give me an estimate as to when most men see a substantial and noticeable improvement in erectile function?. Also, are there any foods or supplements that can promote the nerve regeneration process and are there foods to avoid that might help the healing process?
A: In our experience, erections usually begin to return as partial erections 3 to 6 months after surgery and then continue to improve for about 36 months after surgery, as the nerves recover from the trauma of surgery. It is currently believed by some that taking agents such as Viagra, Levitra, or Cialis will hasten the return of erections. The basis for this belief is that, normally, men have erections every day. Therefore, the normal situation for the penis is to receive an infusion of well-oxygenated blood every day. This infusion helps to keep the intricate anatomical structures in the penis healthy. We don’t know of any evidence to suggest that diet helps in this matter.
Important factors are to take the erection enhancing medications on an empty stomach to allow them to become completely absorbed, to avoid smoking, alcohol, and, if possible, other medications that can interfere with erections.