About this page. This is a plain English summary of how erections can be helped to recover after prostate cancer surgery. It does not replace medical advice from your own doctor or specialist.
For full information and references, please read the detailed page.
Why does recovery take time?
Two small bundles of nerves run very close to the prostate and are responsible for erections. Even when the surgeon takes great care to spare these nerves, they are bruised by the surgery. They can take 1 to 3 years to recover, and not every man returns to his pre-surgery level.
The aim of "sexual rehabilitation" is to keep the penis healthy during this recovery time, and to give the nerves the best chance of bouncing back.
The three main tools
Most men use a combination of these. They work in different ways and complement each other.
1. Tablets
Tablets like Viagra and Cialis are called PDE5 inhibitors. When the catheter comes out (around day six), Dr Kooner usually starts patients on one of these tablets.
- Studies have shown that taking these tablets early is linked with better return of nerve function over the following 12 to 18 months.
- The main downside is cost.
- Important: these tablets must not be taken with nitrate heart medicines. Any chest pain or tightness needs urgent medical review.
- For most men they are well tolerated when used as prescribed.
2. Vacuum pump
A vacuum pump is a clear plastic sheath that fits over the penis. The pump creates a gentle suction that draws blood in. A soft band is then slipped to the base of the penis to hold the erection long enough for sex.
It is usually started about six weeks after surgery to allow healing.
- Easy to learn and reproducible.
- Relatively low cost.
- Not spontaneous: it has to be planned.
- The base of the penis can feel a bit "hinged" because the band sits there.
3. Injection therapy
This sounds daunting but most men find it straightforward once they have learnt the technique. A small amount of medicine (often prostaglandin, sometimes a "tri-mix" of three drugs) is drawn into a fine syringe and injected into the side of the penis. It works in 5 to 10 minutes and lasts about 20 to 30 minutes.
Like the vacuum pump, it usually starts about six weeks after surgery.
- Erections are firmer and more natural-feeling than with the pump.
- Usually used up to 2 to 3 times a week.
- The injection site needs to be varied each time, to reduce the risk of small areas of scarring.
- A rare but serious side effect is priapism: an erection that does not go down. If an erection lasts more than around 4 hours, this is a medical emergency and needs urgent assessment in the emergency department.
Putting it all together
Most men use the tablets every day or every other day, plus either the pump or the injections (or both). The key idea: the pump and injections are not just for sex. Regular use keeps the penile tissue healthy while the nerves are recovering.
Important things to know
- No treatment can guarantee that erections will return to exactly how they were before surgery. Rehabilitation gives the best chance, not a promise.
- Tablets, the pump, and injections all need a prescription and proper instructions. They are not "the same drug" and should not be swapped between people.
- Recovery takes time. Most progress happens in the first 12 to 18 months, with some men still improving up to 3 years out.
- Open conversation with your partner often makes a big difference. Many couples find this part of recovery is as much emotional as physical.
- If progress feels stalled, it is worth coming back to discuss other options rather than giving up.
What you can do next
- Read the full detailed page with references.
- Short version: robotic prostatectomy.
- Short version: surgery options.
- Request a second opinion if you are unsure about a recovery plan.
- Call 02 8382 6980 to make an appointment.