Prostate cancer is the most common cancer found in men. Prostatectomy, which involves removing some or all of the prostate, is often the recommended treatment once prostate cancer has been diagnosed. While there have been enormous improvements in the techniques and outcomes for prostate surgery, a common side effect of the procedure is erectile dysfunction.
How Does Prostatectomy Cause Erectile DysfunctionTo understand how a prostatectomy can result in erectile dysfunction you understand the basics of how erections work.
The nerves and blood vessels that are involved in erection run alongside the prostate. Depending on the location of the cancer, it can be impossible to perform a prostatectomy without damaging these nerves and blood vessels. This can result in loss of sensation, which can impact one's ability to get an erection. If the damage is more severe, it can also effect the tissue in the penis. As well, the veins that are usually compressed and hold blood in the penis during an erection may leak following a prostatectomy, making it difficult to maintain an erection or get erections that are as firm as before.
How Likely Is Erectile Dysfunction Following ProstatectomyResearch on erectile dysfunction following prostatectomy doesn't offer much in the way of precise answers to most men's questions. Studies have documented erectile dysfunction in as few as 10% of men and as many as 100% of men following radical prostatectomy.
Most studies show that immediately following the surgery, almost all men experience erectile dysfunction, and that for many men their erectile functioning improves to a degree. One of the largest studies, which followed men five years after prostatectomy, found that at the five-year point 55% of men were unable to get erections at all. Twenty-eight percent of men had erections they considered firm enough for intercourse.
While there are no formulas to determine your precise risk before choosing to have the surgery, there are several known factors that influence erectile functioning following prostatectomy. These include:
- What your erections were like prior to the surgery.
- The type of surgery that is being done, both the technique and whether or not the procedure is robotic-assisted prostatectomy.
- The experience and skill of the surgeon.
- Where the cancer is, and how much it has spread.
- Your general health and fitness.
If you combine the research and the kind of anecdotal evidence one hears from erectile dysfunction forums, it seems reasonable to say that if you are going to have a prostatectomy, you should assume that you'll be dealing with some degree of erectile dysfunction. This doesn't mean an end to your sex life, but it may mean expanding your ideas of what your sex life includes, and it certainly means talking with partners and your doctors about sex.
What You Can DoIf you're facing the decision of having surgery there is little you can do in the moment that will affect how long and how severe the erectile dysfunction following surgery will be. But here are some things you can do before, and after, that may reduce long-term negative effects.
- Know your surgeon. Find out how much experience they have, how many surgeries they regularly perform. We don't always have a choice of surgeon, but for many people knowing is better than not knowing.
- Talk with your doctor about the procedure, and given your particular situation, ask them what they consider to be the risk of erectile dysfunction following surgery. You may decide that you'd rather not know, but making the most informed choice can leave you feeling less bitter or angry after the fact.
- Ask about the plan for penile rehabilitation. There are many different erectile dysfunction treatments, but there is also research that is looking at how certain interventions immediately following surgery, which are considered part of a rehabilitation plan, can reduce the long term risk of erectile dysfunction. Make sure you and your doctor have a plan.
- Rely on your supports. If you have a partner, bring them into the conversation as soon as you feel comfortable. You get to set the pace, but even though it may feel like an impossible thing to talk about, the success of your sex life does depend on your ability to communicate. If you don't have a partner, consider talking with a friend or trusted family member. We're told to keep topics like erectile dysfunction hidden, but silence makes it easier for us to feel ashamed and isolated.
Magheli, A. and Burnett, A.L. "Erectile Dysfunction Following Prostatectomy: Prevention and Treatment" Nature Reviews Urology Vol. 6 (2009): 415-427.
Penson, D.F., McLerran D., Feng Z, et. al. "5-Year Urinary and Sexual Outcomes After Radical Prostatectomy: Results From the Prostate Cancer Outcomes Study". Journal of Urology Vol. 173 (2005): 1701–5.
Tal, R., Valenzuela, B.S., Nadid Aviv, B.S., et. al. "Persistent Erectile Dysfunction Following Radical Prostatectomy: The Association between Nerve-Sparing Status and the Prevalence and Chronology of Venous Leak" Journal of Sexual Medicine Vol. 6 (2009): 2813-2819.