Sexual Function After Prostatectomy

Andrew Siegel, MD 2/6/2021

Your cancerous prostate was surgically removed using the state-of-the-art laparoscopic robotic nerve-sparing technique by a highly skilled and experienced urologist. With the cancer concerns gone and the PSA undetectable you breathe a major sigh of relief. Now a new concern has emerged: erectile dysfunction. Things down below were working well or reasonably well before the operation and you and your partner would like to resume normal sexual relations as soon as conceivable. Right now, however, erectile function seems to be in a state of shock.

It is vital to understand that “nerve-sparing” prostatectomy does not mean “immediate nerve-functioning” as it can take a considerable amount of time for nerve and erection recovery, even when the surgery is performed by the most skilled robotic urological surgeon. Erectile function will typically gradually improve over time, sometimes taking 2 years or even longer until optimal function returns.


  • Age (younger = better recovery)
  • Pre-treatment function (better functional beforehand = better recovery)
  • Extent of preservation of the nerve bundles (both nerves spared better than one nerve spared better than no nerves spared)
  • Body mass index (healthier BMI = better recovery)
  • Medical co-morbidities (fewer medical issues = better recovery)
  • Surgeon skill and experience (more skilled and experienced = better recovery).


After prostatectomy, there is a period of time in which the nerves to the erectile chambers remain in a state of dormancy. Failure of nerve conduction results in the inability to obtain or maintain an erection and therefore the loss of the capacity for penetrative sexual intercourse. In this dormant state, there is diminished release of nitric oxide–the key chemical responsible for relaxation of erectile smooth muscle and the capacity for erections.


It is vital to obtain erections in order to maintain erections. Erections not only provide the capacity for penetrative sexual intercourse, but also keep erectile smooth muscle and erectile tissues richly oxygenated, elastic and functioning, preventing disuse atrophy.

A consequence of prolonged penile flaccidity that can occur after prostatectomy is scarring and damage of the erectile tissues. This can lead to permanent erectile dysfunction on the basis of venous leakage (veno-occlusive disease) in which the penile blood trapping mechanism fails to work properly, further impeding rigidity and durability of erections. Herein lies the importance of efforts directed at the expeditious resumption of erectile function to prevent the occurrence of this vicious cycle and optimize long-term erectile function.

Next week’s entry–penile rehabilitation, a.k.a. “penile rehab”–will explore all of the techniques that can hasten sexual (and urinary) recovery following prostatectomy.

Wishing you the best of health,

2014-04-23 20:16:29

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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States.  His latest book is Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families. 

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Video trailer for Prostate Cancer 20/20

Preview of Prostate Cancer 20/20

Andrew Siegel MD Amazon author page

PROSTATE CANCER 20/20 is now available at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours). 

Dr. Siegel’s other books:

FINDING YOUR OWN FOUNTAIN OF YOUTH: The Essential Guide to Maximizing Health, Wellness, Fitness and Longevity

PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food

MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health


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