Sexual life after prostate removal

This post is for all the men who have prostate cancer or are worried about prostate cancer. One of the most feared side effects of therapy for prostate cancer is the impact on sexual health.

prostate diagram

click to expand the image

Hopefully this will give men a better idea of what to expect and take some of the fear of the unknown away.

The prostate makes the liquid in the ejaculate. This is necessary for the sperm to work and therefore to have children. Other than having children, the prostate is of little use later in life and only causes problems with urination (BPH) and is a leading cause of cancer.

nerves surrounding the prostate

click to expand the image

The “nerves” that go to the penis course very close to the prostate. They are only a few millimeters from the prostate and can be affected by surgery or radiation. These nerves are solely responsible for erections, or the ability of the penis to get hard.

The net effect of someone having his prostate removed is:

  1. He will lose the ability to have an ejaculate, and will be sterile. You can still have children with your own sperm by artificial means.
  2. He will maintain full sensation of the penis. With masturbation or other stimulation, he will still have the ability to have an orgasm.
  3. He will probably lose the ability to get a firm erection after surgery. I have had many patients who kept their erections with robotic surgery, but this is not the rule. With time he will hopefully get his erections back normally.

Factors that are responsible for the ability to get erections are:

  1. Preoperative function- Surgery can not help erections. If they are not that good to start, then they are less likely to come back.
  2. Age- The older the patient, the more they need the nerves working perfectly to have erections.
  3. Other medical problems- Illnesses that affect erections such as diabetes and high blood pressure will not help.
  4. Frequency of intercourse- The more sexually active the person is, the better the recovery rate.
  5. The ability of the surgeon to spare the nerves. If the cancer is such that the nerve shouldn’t be spared, erections are less likely to come back. If the cancer is such that the nerves are able to be spared, then technical factors such as how much tissue is saved, using less cautery in the areas of the nerve bundles, and stretching the nerves less all play a role in recovery.

The following video was from a surgery done at Newark Beth Israel and demonstrates the nerves being separated from the prostate. The da Vinci robot that was used for this procedure gives 10 times magnification of the anatomy and a near high definition, 3D picture.

October 2007 Update: I have a new post that may help men that are looking for insurance companies to help cover the cost of penile rehabilitation PDE5 medicines.

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108 Responses to Sexual life after prostate removal

  1. m.c. rastogi says:

    prior to benign (non-cancerous) prostat removal in April 2009 a 3 mm stone was detected in left kidney which the physician left untouched. Post-prostate removal the physician detected urine crystals in the urine and had suggested cat scan which I did not undergo as I also did not feel any discomfort except the fact that in August 2009 I had noticed blood discharge during my sleep twice which was also without any sensation or pain or awareness. This blood discharge has been happening at regular interval of 18 months since 1995 whereas I had underwent vasectomy in January 1994.
    I would like to know any repurcussions or treatment required as the prostate presumed to be cause of blood discharge during nights is no more and the prostate was benign (non-cancerous).

  2. Domenico Savatta, M.D. says:

    Blood in the urine should be evaluated by assessing the bladder, ureters, and kidneys. A small stone can be followed, but may grow and would likely cause pain if it was trying to pass. If there is blood in the urine a person should make sure they get a full assessment from a urologist with a cystoscopy and IVP or CT scan or maybe ultrasound to assess the kidneys. Urine tests are also done to assess for abnormal cells.

  3. Donna says:

    This question may seem odd – My husband had prostate surgery 2 years ago and we weren’t sexually active for over a year but we are now. His urologist told him recently that at his age (56) and because of the prostate cancer he shouldn’t be having sex more than twice a week. I have not seen any advice like that in any reputable web site. I’m skeptical because this doctor never told him about using viagra during the months after surgery, which seems to be a standard of good treatment and probably would have made his recovery easier. Is there any reason to limit sexual activity 2 years after surgery? (My husband had high blood pressure but it is under control with medication). Does my husband need a new urologist?

  4. Domenico Savatta, M.D. says:

    I am not familiar with any limitation on sexual intercourse frequency. In general, the more frequent a man has sexual function, the better it is to promote penile well being. I would recommend asking your urologist for a reference.
    Good luck,
    Dr Savatta

  5. Brett B says:

    I had the robotic surgery in November of 2009, very successful, both
    nerves spared. Unfortunately, the preoperative physical discovered a
    lymphoma, and I followed up the surgery with 4 months of chemotherapy.
    My urologist says I should regard my recovery as starting at the end of
    the chemo. As well, I have extremely low testosterone, 40ng/dl. I’m
    told I can get suplements starting a year from the surgery.

    From that perspective, I guess I’m on schedule, I get floppy erections
    just before climax. The big problem is that climax is painful, like
    somebody is driving a spike into the base of my scrotum. Is there
    anything I can do to prevent this pain?

  6. I have had a significant amount of patients (maybe 3-5%) that complain of pain during an orgasm.

    I have not read anything that explains why this would happen or how to treat it. Usually the pain lasts for a short period of time- seconds or minutes.

    Most patients have less pain over time, but it doesn’t always go away.

    Please post back on your experience if possible for other patients.

  7. Fred says:

    Dr. Savatta,
    I too have discomfort during orgasm. Five years after surgery, instead of pain, I experience a somewhat of a burning sensation which does go away quickly.

  8. Pingback: Sexual function after prostate removal | The Robotic Surgeon – Home of Domenico Savatta, M.D.