Impotence (also called erectile dysfunction or E.D.) is the inability to have an erection of the penis sufficient for sexual intercourse. All patients undergoing radical prostatectomy, regardless of the type of surgery used (open, laparoscopic, robotic) as well as radiation therapy will experience some problems achieving and maintaining an erection. Sexual relations will likely be different than prior to surgery or radiation therapy and it will take some time and patience to learn how to regain and maximize sexual enjoyment. For some couples, misconceptions about impotence can get in the way of a mutually satisfying sexual relationship.

For Men:

• You cannot transmit prostate cancer to your partner through sexual intercourse.
• Libido (sexual desire) is not affected by the surgery or radiation therapy, but can be a side effect of treatments such as hormone therapy.
• You can have an orgasm without an erection, however there will no longer be ejaculation of semen.
• Sensation is not affected by surgery or radiation therapy.
• A woman does not need penile penetration to achieve orgasm.
• Be open to talking about and trying new things. It may feel awkward at first but will get more comfortable over time.
• Be patient with yourself. This is a process.

For Women:

• Be open to talking about and trying new things. It may feel awkward at first but will get more comfortable over time.
• Be supportive but try to avoid phrases like, "sex isn't that important to me, anyhow." It sounds supportive but can produce barriers to long term intimacy.
• Be patient with yourself. This is a process.

What to expect after open prostate cancer surgery

For a month, or up to several months, after traditional open retropubic radical prostate surgery, most men are not able to get an erection. Eventually, about half of men will be able to get an erection sufficient for sexual intercourse, but without ejaculation of semen, since removal of the prostate gland prevents that process.This effect on a man's ability to achieve an erection is related to the stage of the cancer, the patient's ability to have an erection before surgery, and the patient's age. However, most men who have surgery should expect some decrease in their ability to have an erection. For men who are completely impotent after surgery, several solutions are available. 

What to expect after robotic prostate cancer surgery

Patients who undergo a robotic prostatectomy versus traditional open retropubic radical prostate surgery have a better chance of functional potency recovery, according to numerous published articles in peer-reviewed medical literature (see bibliography).Based on your preoperative erectile function, robotic surgery offers men an earlier time for erectile function recovery given the minimally-invasive approach to removal of the prostate. The time for recovery typically takes between 3 and 12 months after surgery. Given the fact that the seminal vesicles and vas deferentia are removed during surgery, there is no ejaculation of semen during sexual relations after prostatectomy.

Learn More >> Frequently Asked Questions about sexual functioning after treatment for prostate cancer. 

Our Patient Navigator, Renee Sevy-Hasterok, coordinates access to all programs and services offered by the Prostate Cancer Center and its members. You may contact her at (678) 843-5665 or  renee.sevy@emoryhealthcare.org. 

Online Resources and Articles

The following resources and articles are on the topic of Erectile Dysfunction and/or Sexual Functioning After Treatment for Prostate Cancer. We hope you will find the information helpful.

The American Cancer Society publishes Sexuality in the Man With Cancer.  In this guide, there is infromation for you and your partner about cancer, sex, and sexuality. The guide is designed to give you enough information to help you and your partner have open, honest talks about your sex life. You will also find some ideas about talking with your doctor and your cancer care team. Click on the topics below to get started.

• Cancer, sex, and sexuality
• How the male body works sexually
• Keeping your sex life going despite cancer treatment
• Erections and pelvic surgery to treat cancer
• Erections and pelvic radiation therapy
• Erections and chemotherapy
• Erections, desire, and hormone therapy
• Erections and the psychological effects of cancer treatment
• Ejaculation and cancer treatment
• Fertility and cancer treatment
• How common cancer treatments can affect sexuality and fertility
• Dealing with sexual problems
• Dealing with short-term problems
• Finding the cause of problems that appear to be permanent
• When is sexual counseling helpful?
• Is there a pill that will cure sexual problems?
• Is there a way to restore erections if the nerves or blood supply of the penis has been damaged?
• Methods to help with erections
• Can testosterone restore sexual functioning?
• What about herbs or natural cures for erection problems?
• Is there a way to make orgasms as intense as they used to be?
• Special aspects of some cancer treatments
• Feeling good about yourself and feeling good about sex
• Chemotherapy changes the way you look
• Changing negative thoughts
• Overcoming depression
• Dealing with grief and loss
• Rebuilding self-esteem
• Good communication: The key to building a successful sexual relationship
• Overcoming anxiety about sex
• Rekindling sexual interest
• Sexual activity with your partner
• The single man and cancer
• Men who have sex with men
• Frequently asked questions
• Professional help
• About the American Cancer Society
• Additional resources
• References

WebMD’s Sexual Conditions Health Center: Prostate Cancer and Erectile Dysfunction, © 2010.

This informative article discusses current treatment options for erectile dysfunction for people who have received treatment for prostate cancer including:

• Pills, including Cialis, Levitra, Staxyn, and Viagra
• Intracavernous injection therapy
• Vacuum constriction device
•  Intraurethral therapy
• Penile prosthesis

WebMD Health News: ED Can Improve Years After Prostate Surgery. Researchers Say Men Show Improvement in Sexual Function 2 Years After Prostatectomy, By Charlene Laino WebMD Health News; © 2010.  Reviewed by Laura J. Martin, MD,  June 1, 2010.

If your sexual function's not what it used to be a year or two after prostate surgery, hang in there.Men who are having trouble achieving erections after prostatectomy for prostate cancer can achieve improvement in function that's sufficient for sexual intercourse more than two years later, researchers say. Read More>>

Women Against Prostate Cancer is a national organization working to unite the voices and provide support for the millions of women affected by prostate cancer, and their families. WAPC advocates prostate cancer education, public awareness, screenings, legislation, and treatment options. Resources available include:

• Prostate Cancer, Intimacy and Sexuality Fact Sheet: Everything You Wanted to Know But Didn't Know to Ask
• Information about Penile Rehabilitation and Intimacy 

Information on this page is provided collaboratively by the team at the Prostate Cancer Center at Saint Joseph's and has been medically reviewed by Rajesh G. Laungani, MD, 2010. Claims regarding treatment are based on years of clinical experience and industry reported data. The PCC follows American Urological Association and  National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for the treatment of prostate cancer.

Disclaimer: All links to other Web sites are provided solely as a convenience to our patients. If you use these links, you will leave the Prostate Cancer Center at Saint Joseph's (PCC) Web site. The PCC is not responsible for any content, materials or other information located on or accessible from any linked site. PCC does not endorse, guarantee, or make any representation or warranties regarding any linked site, or any content, materials or other information location on or accessible from such linked site, or the results you may obtain from using such linked site. If you decide to access any linked site, you do so entirely at your own risk. You should review the policies and terms of use associated with any linked site closely before using or submitting information to the linked site.

Last Updated: May 11, 2011 (RSH)