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Erectile dysfunction after prostatectomy: what to expect | CION Cancer Clinics
Almost every man loses erections in the weeks after a radical prostatectomy. That is expected, not a sign of a failed operation. Whether and how far they return depends on whether the nerves were spared, how good erections were before, your age and health, and what you do in the two years the nerves take to heal. This page explains each of those, and what helps when tablets do not. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- Why do erections stop after prostatectomy?
- What decides whether erections come back?
- What does recovery usually look like over time?
- Words you will hear, in plain language
- Four things men tell us, and what is actually true
- Who the options do not suit, and what this page cannot tell you
- Common questions about erections after prostatectomy
The short answer
Why do erections stop after prostatectomy?
Almost every man loses erections in the weeks after a radical prostatectomy, and this is expected rather than a sign that something went wrong. The nerves that carry the signal for an erection run along the outside of the prostate. Even when the surgeon protects them, they are stretched, bruised and slow to recover.
What actually happens to the nerves
The two nerve bundles sit so close to the prostate that they cannot be moved aside without being handled. Handling a nerve does not cut it, but it stops it working for a while. A bruised nerve heals slowly, which is why the return of erections is measured in months and often in years. Tablets may do very little early on, because the nerve signal they rely on is not yet getting through.
Who recovers, and who usually does not
Men who had firm erections before surgery, whose nerves were spared on both sides, and who are younger, tend to recover more. A man whose erections were already weak, whose nerves had to be removed with the cancer, or who has long-standing diabetes or heavy smoking behind him, may not recover natural erections at all. Your surgeon should say which group you are in before the operation, not after.
Nothing on this page can predict your own recovery. That depends on what was found and what could be protected.Four things that matter most
What decides whether erections come back?
These are the questions your surgeon is weighing when you ask "will I be all right". Ask about each one directly.
Whether the nerves were spared
If the cancer sat well inside the prostate, the surgeon can leave the nerve bundles in place. If it was pressing against the edge, one or both bundles may have to go with it. Ask whether the nerves were spared on both sides, one side or neither.
Your erections before surgery
Surgery does not give back what was already lost. A man who needed tablets before the operation is likely to need more help afterwards. Be honest with the surgeon about this.
Your age and general health
Younger men recover more nerve function and recover it faster. Diabetes, high blood pressure, heart disease and smoking all narrow the blood vessels the penis depends on.
Stopping smoking is the one factor here that is fully in your hands.Time, and what you do with it
Recovery continues for up to two years after surgery. Men who use that time with a planned rehabilitation programme, rather than waiting to see what happens, tend to keep the tissue of the penis healthier while the nerves heal.
Not sure whether this applies to you?
Ask an oncologistA typical course
What does recovery usually look like over time?
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The first few weeks
No erections at all. You have a catheter for part of this time and a healing wound. Nobody expects anything to happen yet.
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The first few months
Some men notice a little fullness, often at night or on waking, but rarely enough for intercourse. This is the point at which most surgeons start rehabilitation, if they have not already. Tablets alone may still do very little.
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Six months to a year
This is when men with spared nerves most often report the first useful erections, usually with the help of tablets. If nothing at all has changed by now, say so at your review rather than waiting.
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The second year
Improvement continues, but more slowly. Some men reach a point where tablets alone are enough. Others settle at "partial", and need to decide whether a device or injections suit them better.
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After two years
What you have by now is usually what you will keep. That is not the end of the road, because injections, a vacuum device and a surgical implant all work without the nerves. It is the point to stop waiting and choose.
On your discharge note
Words you will hear, in plain language
- Nerve-sparing
- The surgeon left one or both nerve bundles in place. "Bilateral" means both sides, "unilateral" means one side only.
- PDE5 inhibitor
- The family of erection tablets, which includes sildenafil and tadalafil. They boost a nerve signal that is already arriving; they cannot create one.
- Penile rehabilitation
- A planned programme of tablets, devices or injections used while the nerves heal, to keep the penis tissue healthy and stretchy.
- Vacuum erection device
- A clear tube and pump that draws blood into the penis, with a ring at the base to hold it. Works without any nerve signal.
- Penile implant
- A surgically placed device inside the penis that gives an erection on demand. Usually discussed only after other options and time have been given a fair chance.
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Commonly believed
Four things men tell us, and what is actually true
"It has been three months and nothing. So it is never coming back."
Three months is early. Nerve recovery after prostatectomy is slow and continues for up to two years. Most men who recover have very little to show at three months. What matters now is that a rehabilitation plan is in place.
"The tablets did not work, so nothing will."
Erection tablets need a nerve signal to work with. Early after surgery that signal is weak, so the tablets appear to fail. Injections, urethral pellets and vacuum devices do not need the nerve at all, which is why they work when tablets do not.
"Nerve-sparing means my erections will be untouched."
Nerve-sparing means the nerves were left in place, not that they were left undisturbed. Even with both bundles spared, expect a period of no erections and a slow recovery. Without nerve-sparing, natural erections are unlikely, and other options become the plan.
"My wife will not want to know about this."
Most partners want to be told, and most are more worried about the cancer than about erections. Couples who talk about it early cope better than couples where one person quietly withdraws.
Being straight with you
Who the options do not suit, and what this page cannot tell you
Every treatment for erection problems has a group it does not suit. Tell whoever treats you about every medicine you take, including tablets from a cardiologist and anything bought over the counter.
Erection tablets
They are not safe with the nitrate tablets and sprays used for chest pain, because the two together can drop blood pressure dangerously. Men with certain eye conditions, severe liver disease or a recent heart event are also usually told to avoid them.
Devices, injections and implants
A vacuum device is awkward for men with a bleeding disorder or on strong blood thinners. Injections need steady hands and carry a small risk of an erection that will not go down. An implant is a second operation and is permanent, so it is usually the last option tried.
What this page cannot tell you
It cannot tell you whether your own erections will return, how far, or when. It cannot replace the conversation with your surgeon about what was found and what was spared. If that has not happened, ask for it at your next review.
If low mood has come with this, say so. It is common, it is treatable, and it is not a weakness.Questions we are asked
Common questions about erections after prostatectomy
Will I ever get erections back after prostate removal?
Many men do, at least partly, if the nerves were spared and erections were good before surgery. Recovery is slow and continues for up to two years. If the nerves could not be spared, natural erections are unlikely, but injections, a vacuum device and an implant all work without them.
How soon after surgery can I try to have sex?
Once the catheter is out, the wound has healed and you feel ready, usually a few weeks after the operation. Ask your surgeon at the first review. Early attempts are more about closeness and finding out what works than about intercourse, and there is no harm in trying with a soft penis.
Do the erection tablets work after prostatectomy?
They work only when some nerve signal is getting through, so early on they often seem to do nothing. Many surgeons still prescribe them on a schedule as part of rehabilitation, and their effect improves as the nerves heal. Your doctor sets the dose and timing, never a friend or a chemist.
Can I still have an orgasm without an erection?
Yes. The nerves for climax are separate from the ones for blood flow, so most men can reach orgasm with a soft or partial penis. It will be dry, because the prostate and the glands that make semen have been removed. Some men notice a small leak of urine at climax, which usually settles with time and pelvic floor exercises.
Is it safe to take sildenafil with my heart tablets?
Not with nitrates, the tablets or sprays used for chest pain. Together they can drop your blood pressure to a dangerous level. With other heart medicines it is often fine, but only your own doctor can say. Take the full list of what you use to the appointment and ask directly.
Does hormone therapy after surgery make this worse?
Usually yes. Hormone therapy lowers testosterone, which lowers desire and makes erections harder to get, on top of the nerve injury. If hormone therapy is planned, ask how long it is for and what can be done during it. Desire and function often improve after it stops, though not always fully.
Will a penile implant stop me feeling anything?
No. An implant replaces the erection, not the sensation. Skin feeling and the ability to reach climax stay as they were. The erection is produced on demand and does not depend on nerves or tablets. It is a second operation, it is permanent, and it is usually considered only after other options.
Who do I talk to about this at CION?
Start with your surgical oncologist at the follow-up visit. Raise it directly; it is a routine part of the conversation and nobody will be surprised. If you would rather not raise it in front of family, ask for a few minutes alone, or call the helpline and ask for the question to be passed on.
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Sources
- NHS — Prostate cancer: treatment
- Cancer Research UK — Surgery for prostate cancer
- National Cancer Institute — Sexual health issues in men with cancer
- American Cancer Society — Surgery for prostate cancer
- NHS — Erection problems (erectile dysfunction)
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.
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