Erectile Function After Radical Prostatectomy: Top 10 Frequently Asked Questions

Erectile dysfunction is common after radical prostatectomy for prostate cancer. Most men have little or no erection in the months after surgery. Recovery takes time—often up to 1–2 years. Only about 20–25% of men return fully to baseline, but many improve with treatment. Early penile rehabilitation, including medications or devices, improves long-term outcomes. If pills do not work, other effective options are available. Sexual health is an important part of cancer recovery.

FAQ 1: Is erectile dysfunction common after radical prostatectomy?

Yes. Erectile dysfunction is common and expected after radical prostatectomy.

Most men will have difficulty getting an erection on their own for the first 12 months after their surgery.  The nerves and blood vessels that control erections run very close to the prostate and can be affected during surgery.

 

 

FAQ 2: Why does erectile dysfunction happen after prostate cancer surgery?

ED can occur due to:

• Stretching or injury to erection nerves
• Reduced blood flow to the penis
• Temporary nerve “shock”
• Injury to small blood vessels (which some men rely on more than others)

These effects can happen even with nerve-sparing surgery.

 

FAQ 3: How long does it take for erections to recover after surgery?

Recovery takes time:

• Most improvement happens in the first 12 months
• Smaller improvements may continue up to 24 months
• Changes after 2 years are usually limited

 

FAQ 4: Will I ever return to my baseline erectile function?

After robotic radical prostatectomy:

• About 20–25% of men return to baseline erectile function
• Most men have some improvement, even if they do not fully return to baseline

For comparison:

• About 40–45% of men return to baseline after radiation therapy

 

FAQ 5: Does nerve-sparing surgery improve erectile recovery?

Yes. Nerve-sparing surgery improves the chances of recovery, but results vary.

Recovery depends on:

• Whether both nerves are spared
• Erections before surgery
• Age and overall health
• Surgeon experience

 

FAQ 6: Can doctors predict erectile recovery?

Yes—doctors use factors such as:

• Age
• Weight (BMI)
• Baseline erectile function
• Nerve-sparing status
• Surgeon experience

Examples:

• Younger men with no ED and bilateral nerve-sparing surgery may have a high chance of recovery
• Older men with some ED before surgery may have a lower chance

 

FAQ 7: When should erectile dysfunction treatment start?

Early treatment is strongly recommended.

Penile rehabilitation often starts:

• Soon after the catheter is removed

Early treatment helps:

• Preserve penile tissue
• Improve long-term recovery
• Prevent permanent changes

 

FAQ 8: What treatments are available after prostatectomy?

Treatment usually happens step-by-step:

• ED medications (sildenafil, tadalafil)
• Vacuum erection devices
• Penile injections
• Penile implants

Many men need more than pills alone.

 

FAQ 9: Does surgery affect orgasm or penis length?

Yes, changes can happen:

• Many men notice penile shortening, especially early after surgery
• Partial or full recovery of length is possible over time
• Orgasms still occur, but there is no ejaculation
• Sensation may feel different at first

 

FAQ 10: When should I seek sexual medicine or sex therapy support?

At any point. It’s never too early or too late.

Referral can help:

• Before treatment (to set expectations)
• Early after surgery (to start rehab)
• Later for persistent ED or relationship stress

 

Bottom Line

Erectile dysfunction after radical prostatectomy is common, predictable, and treatable.
Early education, early treatment, and open conversations lead to better quality of life.