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CION Cancer Clinics
Sex and erections after a cystectomy in men | CION Cancer Clinics
A radical cystectomy in men removes the prostate along with the bladder, so ejaculation stops and erections are usually weaker or absent, at least for a time. Orgasm and desire are usually kept. Whether erections return depends on whether the nerves beside the prostate could be spared, and there are effective treatments if they do not. This page says what to expect and what to ask before the operation. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What happens to sexual function after a cystectomy in men?
- What exactly changes, and what stays?
- When does recovery happen, if it happens?
- What can be done if erections do not come back?
- Questions worth asking your surgeon
- Four things men tell us, and what is actually true
- What this page cannot tell you
- Common questions about sex after cystectomy in men
The short answer
What happens to sexual function after a cystectomy in men?
For most men, a radical cystectomy changes sex in three ways. Erections become weaker or stop, at least for a time. Ejaculation stops altogether, because the prostate and the glands that make semen are removed with the bladder. Orgasm, the feeling itself, usually remains possible.
Why the operation affects erections
The nerves that trigger an erection run in two thin bundles along the sides of the prostate, pressed against the bladder. A standard radical cystectomy removes the bladder and prostate together, and those bundles are often cut or damaged. In selected men a surgeon can leave one or both behind, which is called nerve-sparing. Whether that is safe depends on where the cancer sits, and it is a decision for your surgical team.
What does not change
Desire, sensation in the skin of the penis, and the ability to reach orgasm come from different nerves and are usually kept. Many men are surprised that a dry orgasm can feel much the same as before. Closeness to your partner is not removed with the bladder, though it may need time and help to settle.
This page is about men. The changes after cystectomy in women are different and have their own page.One by one
What exactly changes, and what stays?
Families rarely ask the surgeon about this, and men rarely ask afterwards. Here is what to expect, in plain words.
Erections
Usually weaker or absent straight after surgery, even when nerves were spared. Bruised nerves can recover, but slowly. If both bundles were removed, natural erections are unlikely to return and help of another kind is needed.
Ejaculation and fertility
There is no semen after the prostate and seminal vesicles are removed, so you cannot father a child by natural means. If having children later matters to you, sperm can be stored before the operation. Ask before surgery, because afterwards it is too late.
Orgasm
Still possible for most men, with or without an erection, though it is dry and can feel different. Some men notice a small leak of urine at orgasm, more often with a neobladder. Emptying beforehand helps.
Desire and confidence
Tiredness, a stoma, a scar and the fear of leaking can all reduce interest for months. This is common, is not a sign the nerves have failed, and usually improves as recovery does.
Often helped by
- Talking to your partner early, before the first attempt
- A stoma cover or a snug vest during sex
- A counsellor who has seen this before
Not sure whether this applies to you?
Ask an oncologistOver the first year
When does recovery happen, if it happens?
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Before the operation
Ask the surgeon whether nerve-sparing is possible for your cancer, and what it would mean for the safety of the operation. Ask about sperm storage if that matters. This conversation cannot be had afterwards.
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The first weeks
Nothing is expected. The wound is healing, a catheter or a stoma is new, and the body has had a large operation. Erections at this stage are rare and their absence tells you nothing about the future.
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The first months
If nerves were spared, some surgeons start tablets or a vacuum device early, to keep blood flowing into the penis while the nerves heal. This is often called penile rehabilitation. It is a plan set by your urologist or surgeon, not something to start on your own.
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A year on and beyond
Nerve recovery is slow and can continue well into the second year. If natural erections have not returned by then, the options below still work, and many men move to them sooner rather than waiting.
Help that exists
What can be done if erections do not come back?
Your urologist chooses with you, usually starting with the simplest. None of them is a mark of failure.
Tablets
Sildenafil and tadalafil are the common ones in India. They help only if some nerve signal is getting through, so they work better after nerve-sparing. They are not safe with certain heart tablets, so never buy them without telling your doctor.
Vacuum device
A clear tube placed over the penis draws blood in, and a soft ring at the base holds the erection. It works whether or not nerves were spared, costs nothing to run after purchase, and takes practice.
Injections
A tiny injection of a medicine such as alprostadil into the side of the penis produces an erection without needing the nerves at all. Most men are taught to do it themselves. It sounds worse than it feels.
An implant
A further operation places a device inside the penis that can be made firm when wanted. It is usually kept for men where nothing else has worked. Ask your centre whether it is offered and what it costs.
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Questions worth asking your surgeon
- Is nerve-sparing possible with where my cancer sits, and what does it risk?
- Will the prostate be removed, and is there any option to keep part of it?
- Should I store sperm before the operation?
- Who will look after erection problems afterwards, and when should I raise them?
- Does the type of diversion I am having change any of this?
- Can my partner be part of the conversation now?
Commonly believed
Four things men tell us, and what is actually true
"At my age it does not matter, so I will not ask."
Many men in their sixties and seventies are sexually active and would like to stay so. Not asking means the surgeon plans without knowing what matters to you. Say it once, before the operation.
"Sex could make the cancer come back or spread."
It cannot. Once the wound has healed and your surgeon has said it is fine, sex has no effect on whether the cancer returns. A partner cannot catch cancer, and a stoma bag is not harmed by closeness.
"If nothing happens in the first months, nothing ever will."
Nerve recovery is measured in many months, sometimes longer, and the early period tells you very little. Even when natural erections never return, the devices and medicines above work for most men who try them properly.
"The tablets are the same as the ones sold outside the chemist."
Unbranded tablets sold without a prescription may contain the wrong medicine or the wrong amount, and the real medicine is dangerous alongside some heart drugs. Ask your doctor for a prescription and buy from a licensed pharmacy.
Being straight with you
What this page cannot tell you
This page cannot tell you whether your own erections will return. That depends on whether the nerves could be spared, on your age, on diabetes, blood pressure and smoking, and on how erections were before the cancer. Only your surgeon can say what was possible in your case.
Who nerve-sparing does not suit
It is usually not attempted when the cancer sits near the neck of the bladder or the prostate, has grown through the bladder wall, or looks close to the nerve bundles on the scan. In those men, leaving the nerves would mean leaving cancer behind, and removing the cancer comes first.
Raising it is not embarrassing
Surgeons and urologists discuss this every week. If it has not been raised, raise it yourself, or ask your son or daughter to ask for you. It can be discussed in Telugu, in private, without your partner in the room if you prefer.
If you notice a painful, prolonged erection after using a tablet or an injection, go to an emergency department the same day. It is uncommon but it needs treatment quickly.Questions we are asked
Common questions about sex after cystectomy in men
When is it safe to have sex again after the operation?
Once the wound has healed, any catheter is out and your surgeon has said it is fine, usually at a follow-up visit in the weeks after surgery. Start gently. With a neobladder, empty it first. With a stoma, empty the bag and use a cover if it helps you feel more at ease.
Can I still have an orgasm without an erection?
Yes. Orgasm comes from different nerves and most men keep it. It will be dry, because there is no semen, and some men say it feels a little different or less intense at first. Many couples find this improves with time and with a partner who knows what to expect.
Will I be able to have children?
Not by natural means, because the glands that make semen are removed. If you may want children in future, ask about storing sperm before the operation. It is a simple process done at a fertility clinic and needs to be arranged before surgery, not after.
Does a neobladder or a stoma make any difference to sex?
The nerve effect is the same, because the prostate is removed either way. A neobladder may leak a little urine at orgasm, which emptying beforehand reduces. A stoma changes how you feel about your body more than what your body can do, and a bag cover or a vest can make a real difference.
Is it safe to take sildenafil after cancer surgery?
For many men, yes, once the surgeon or urologist has prescribed it. It is not safe with some heart medicines, and it needs care with low blood pressure. Get it on prescription, tell the doctor every other tablet you take, and do not buy it loose from a counter.
Will my partner be able to tell?
Only what you choose to share. A dry orgasm is not obvious to a partner. A stoma or a scar is visible, and most couples find that saying so plainly beforehand takes away most of the worry. Our counsellors can see you together if you would like that.
Can the erection nerves be spared in everyone?
No. It depends on where the cancer sits and how far it has grown. When the cancer is close to the nerves, removing it fully matters more than keeping them. Ask your surgeon whether it was possible in your case and what was done, and ask before surgery if you can.
Who do I talk to about this at CION?
Your surgical oncologist or the urology team, at any follow-up visit. You can also call the helpline and ask for a private conversation, in Telugu if you prefer. It is a normal part of follow-up after this operation and nobody will be surprised that you asked.
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Sources
- Cancer Research UK — Sex and bladder cancer
- Macmillan Cancer Support — Bladder cancer
- American Cancer Society — Bladder Cancer Surgery
- National Cancer Institute — Bladder Cancer Treatment (PDQ) - Patient Version
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Nerve-Sparing and Organ-Sparing CystectomyWhen the erection nerves can be kept, and when they cannotSexual Function After Cystectomy in WomenThe changes in women, which are differentWhat Else Is Removed With the BladderWhy the prostate and seminal vesicles come out tooThe Emotional Adjustment to Losing Your BladderConfidence, body image and the people around youCystectomy in Men vs WomenHow the operation differs between the sexes
Talk to us
Want to talk this through before the operation?
Call the helpline or send us your reports. A CION surgical oncologist will tell you what is likely to be possible in your case, in private and in Telugu if you prefer. One helpline serves every centre.