You’ll often hear people say that men think about sex every 12 seconds, or some other ridiculous number.
While we may know that isn’t exactly the case, there’s no denying that for most men it’s at the forefront of their mind.
So when undergoing treatment for an enlarged prostate or even prostate cancer, it’s inevitable that questions about your sex life will arise.
This article will look at the most common concerns for men who have undergone, are in the middle of, or are thinking about undergoing treatment.
The importance of Quality of Life
It’s only normal to want to drive into the practicalities. Before you go any further, I want you to understand a key metric, which is particularly challenging to standardize.
It’s called Quality of Life, usually shortened to QoL in the medical literature.
With Prostate Cancer, it’s a particularly important one, due to the high rates of survival for those with localized prostate cancer (both amongst those who opt for treatment, and those who stick to Active Surveillance).
That’s why it’s so important to understand the impact that various surgeries or treatments will have on you.
Quality of Life is how they assess the suitability of any treatment.
Those sort of difficult questions is why QoL is a factor. If you’re a sexually active man in your sixties or seventies (or even later) and they are offering you preventative surgery after a biopsy, you need to ask yourself about the impact it will have, what alternatives are available to treat prostate cancer.
Furthermore, you should always ask what the quality of life after that surgery or treatment will be like.
That’s why we put together this quick guide to erectile function, men’s health and sex after prostate surgery.
It’s not exhaustive by any means, but should certainly give you a jumping off point to better make these decisions that will have a serious impact on a really key aspect of your life.
One last note before we get into it. If the cancer is malignant, surgeons will always push you for a radical prostatectomy, to prevent the cancer from spreading to your lymph nodes.
However, there are instances where your Urologist or specialist will push you towards prostatectomy surgery as a preventative. If you’re in a situation where you have a choice, make sure it’s an informed one.
Each surgical option that you have will impact your quality of life and sexual potency.
How will sex after prostate cancer be different?
One of the treatments of prostate cancer is to remove a portion of the prostate or the totality of the gland before cancer spreads beyond it You may have heard that the tumor is inside the capsule, but moving fast.
The procedure is known as radical prostatectomy and involves incisions, either above the perineum or on the lower abdomen.
Newer surgeries are sometimes robot-assisted, and we also have laparoscopic prostatectomies that do not require a large incision.
The end result is the removal of a portion or the totality of the prostate, and certain surgical approaches may be associated with a lower risk of nerve damage than others. You’ll see this referred to as ‘nerve-sparing’ prostatectomies throughout this guide.
As soon as a man is informed that he will need to go through a Radical Prostatectomy, the likelihood is that one of the very first questions will be about the effect that it will have on their sex life. In a lot of men’s minds, the surgery is thought of like it’s castration.
However, now that there are multiple types of nerve-sparing prostate surgery, many men have found they can maintain sexual activity after surgery.
Likewise, there are plenty of sexual activities open to those who do find they still have the desire, even with some physical changes. We want to help you understand the changes that men can experience after prostate surgery, whether that is physical or mental.
Can a man have a normal sex life after prostate surgery?
The question is loaded – what is a normal sex life anyway? Most men will experience a slowing down or drop off in their sexual activity as they get older.
That said, it is still a source of pleasure and intimacy amongst older couples, and for those for whom it is an important part of their relationship, they are keen to understand what sex after surgery will look and feel like.
The majority of men with a diagnose of localized prostate cancer will undergo a conservative approach known as active surveillance, but some of them will require surgery at some point.
The surgeons will excise the growth, or in some cases remove the entire prostate. There are also less invasive surgeries, such as the TURPs (transurethral resection) and other non-surgical therapies such as radiation therapy.
With careful intervention, most men will be able to resume a healthy sex life after the initial recovery period.
If you have had a radical prostatectomy without a nerve-sparing technique, there’s a high chance you will experience a significant reduction in your sexual sensation and libido
Even then, the likelihood is that pleasure will be diminished, and men will only experience dry orgasms, as they will no longer ejaculate – merely experiencing the mental side of orgasm. This is not common, and when it happens, it is temporary.
How does prostate surgery affect you sexually?
If you are diagnosed with prostate cancer and opt for a prostatectomy, particularly a radical prostatectomy, the surgeons will have removed your prostate.
While the prostate isn’t directly responsible for your libido or sexual sensation, in some men who have had a prostatectomy, there can be damage to nerves or blood vessels.
The prostate is next to a dense group of nerves and the seminal vesicles (which produce the majority of the liquid in semen).
There is a heightened chance of an infection such as spermatocystitis which can cause you pain or in some cases impotence.
For men who have had an open prostatectomy, they will find that they can no longer ejaculate. This is known as a ‘dry orgasm’ and can still be pleasurable.
Even with less invasive surgeries, the most common complaint or side effect tends to be sexual in nature.
However, according to systematic reviews and meta-analysis of the scientific data, these cases of sexual dysfunction are often associated with psychological factors that might be present before surgery or as a result of stress related to the surgical procedure.
Radiation therapy can impact the pelvic floor muscles and nerves that control erections and provide pleasure.
According to a 2016 study, around half of Prostate Cancer patients who have any form of radiation therapy go on to develop erectile dysfunction.
For a large section of men who opt for radiation-based therapies, the first stage is usually hormone therapy.
That means a drug like Lupron which inhibits or completely stops the production of Testosterone, the hormone most responsible for men’s sex drive.
That’s why some men experience a drop off in sexual desire even if they can maintain an erection. Another side effect of reduced Testosterone is a reduction in the volume of semen released.
How soon after prostate cancer treatment can you be sexually active again?
Different Prostate Cancer treatments have various periods before one can resume sexual activity. It’s also down to an individual’s recovery time, which has to factor in age.
A man who has had a prostatectomy in his eighties will find that it will take him a lot longer to resume any sexual activity than a man in his fifties who has had external beam therapy.
The individual’s general health and genetics all play a part in the healing process. With a prostatectomy, studies tend to show that it is at least several months before erectile function returns, but it can be up to a year.
For more limited surgery, such as TURPs, one can expect to be sexually active again within 4 – 6 weeks – if that is the only surgery and treatment. Often it happens in conjunction with other treatments, such as hormone or radiotherapy, which have much longer recovery times.
There are still options that are open to men before that. If a man still feels sexual desire, then sexual activity is still possible.
There are three parts to orgasm, and while the sensation of fullness or ejaculate may no longer be present, the mental part of orgasm which takes place in the brain is just as possible as before surgery. Plus there’s absolutely nothing stopping a man from being more focused on his partner’s sexual pleasure.
Prostate surgery and erectile dysfunction
The short answer is – yes – prostate surgery is very likely to cause erectile dysfunction.
A prostatectomy, even though modern surgeries are ‘nerve-sparing’ is likely to cause months of issues to a man’s sex life.
Less invasive procedures that avoid the bundle of nerves and seminal vesicles next to the prostate will still likely cause ED, even if it’s a shorter-term issue.
Other surgeries are less likely to cause lasting damage, but the fact is that sexual dysfunction is a complicated issue. Men have to grapple with the mental side of it as well.
A cancer diagnosis can weigh heavily on a man’s mind, which can impact both his sex drive as well as his ability to maintain an erection.
There’s also the fact that as we age, men experience a natural reduction in sex drive and are likely to be less able to get and maintain an erection.
The likelihood is that any surgery would just exacerbate the underlying issue.
Around 1 out of every 4 men over the age of sixty will experience some form of erectile dysfunction. That’s also the most likely group to undergo surgery, which is why the two are often linked, but not necessarily the sole cause.
If you have some pre-existing medical condition that impacts your floor muscles, sexual function or urine/ urinary function than you might find that the side effects of the surgery are more severe.
You should talk with your Urologist about any pre-existing medical conditions and how they might affect the treatment.
How do you treat erectile dysfunction after having prostate surgery?
The good news is that there are numerous treatments that can help men regain their sexual function after prostate surgery. They can be divided into physical, pharmaceutical or natural treatments.
Pharmaceutical treatments are numerous, and there are many drugs on the market which will help you get an erection. They include Sildenafil (Revatio, Viagra), Tadalafil (Adcirca, Cialis), and Vardenafil (Levitra, Staxyn). These are all types of PDE5 inhibitors.
When you inhibit the enzymes, your body relaxes muscles allowing and encouraging blood flow into the penis, causing an erection. However, these drugs will not help if there has been nerve damage as a result of the surgery.
For more severe cases of ED, there are stronger medications available. Men have the option of Alprostadil (often sold as Caverject for injection or Muse for suppository), which can be taken either as an injection at the base of the penis or as a suppository, where the man places a small pellet into the tip of the penis.
Many men have concerns about penile injections, however, these are not as painful as you might imagine and only the first dose is administered by a doctor. You administer the other penile injections at home and should experience an erection within 5-20 minutes.
Both approaches have the same effect, of encouraging blood flow throughout the body, to treat erection problems.
The injection is effective for about 80% of men and the suppository for about 40%. However, it has to be used with guidance, as improper use can cause permanent, irreversible damage to the penis.
It also cannot be used more than three times a week, and there must be at least 24 hours between uses. These treatments do not normally impact your ability to pass urine.
Due to various side effects from pharmaceuticals, or just a desire to approach the issue in a more holistic way, many men opt for natural treatments.
Supplementation to increase libido includes DHEA, Maca, Gingko, Ginseng, and Yohimbine, which generally start to increase sex drive over two weeks.
Other men find that instead of focusing on sex drive, they pursue natural ways to increase Testosterone.
Testosterone is responsible not just for libido but can help improve bone mass, fat distribution and increase strength.
Nutrients such as Tongkat Ali have both been shown to increase testosterone production in men. Of course, it will only work if the individual is no longer taking drugs that prevent Testosterone, such as Lupron.
Recent studies have shown that the hormone Oxytocin can help men. A man who took it intranasally was found to improve across the ‘Arizona Sexual Experience Scale,’ experiencing improvements libido, sexual arousal, erectile function and satisfaction with orgasm.
There isn’t really enough evidence yet to say Oxytocin definitively that it can alleviate ED, but as there are no known side effects, it is a low-risk experiment.
There are also other natural ways to improve the symptoms of ED, focused on lifestyle. Getting your diet right is a key part of this, and increasing your general fitness. That’s because so much of a man’s sexual function is psychological.
There are physical exercises, such as pelvic floor exercises (Kegels) and penis rehabilitation which we will cover later.
There are two other external physical approaches. Firstly, using a vacuum pump, which goes over the penis and physically pulls blood into the penis.
However, if nothing else works, the primary physical intervention, however, is known as either penile prosthesis or implants. It’s usually used as a last measure when no medication or other change has worked. That’s because it requires additional surgery.
Pelvic floor exercises will help with urinary issues whereas there is some concern that penile prosthesis, may impact your ability to pass urine.
Penile implants are one of two types – either semi-rigid or inflatable. The semi-rigid option has been around for longer and was initially provided for men with spinal cord injuries.
It involves the implantation of two rods into the penis. The penis then just needs to be adjusted into a position to allow for sexual intercourse to take place.
However, the newer approach is an inflatable implant, which involves surgery, and two or three parts. The inflatable cylinder inside the shaft of the penis, a pump that is placed inside the scrotum and then a fluid reservoir that is inserted under the abdominal wall.
However, sometimes the reservoir and pump are combined into one unit inside the scrotum.
This can allow for more natural-seeming erections, although it won’t have any impact upon the desire a man feels, or the sensation experienced.
Due to the surgery and insertion, there are also numerous risks, including infections and problems with the implant itself. They can also slowly erode and rub against the inside of the penis.
What are pelvic floor exercises, and can improve erection quality?
As we age, we lose muscle tone throughout your body. That includes the muscles that men need to maintain erections. However, there are physical exercises men can do to reduce erectile dysfunction. The best ones are known as pelvic floor exercises or kegels.
Those muscles are the core of how your body maintains blood flow to the penis and therefore keeps erections strong.
They put pressure on the veins in your penis, preventing blood from flowing back into the rest of your body. If they aren’t strong enough then even if you can get an erection, you won’t be able to keep it.
The process starts with identifying the muscles you need to activate. That’s best achieved by lying down with knees bent and feet flat on the floor. That’s when you breathe out and squeeze your pelvic floor muscles for 3 seconds.
It’s important that you identify the right group, at the base of your buttocks, on either side of your perineum. It can be easy to mistake other muscles, such as the legs or stomach for the pelvic floor.
Once you are confident you have the right muscle group, then doing the exercises in a seated or standing position three times a day can firm and strengthen the muscles, with a likely improvement within four to six weeks.
Some men find that after the initial strengthening that options like Pilates become appealing – as not only are there many exercises which improve the pelvic floor, but they can improve overall posture and strength.
We would also recommend them as part of a daily routine, for men who are experiencing general sexual problems or incontinence. Your general health is an essential indicator of how likely you are to experience ED.
What treatment options for sexual dysfunction are safe after prostate surgery?
All of the treatment options come with risks, even the all-natural ones. You need to be careful about sourcing supplements, being confident in the supply.
Many US-based manufacturers were caught by the FDA selling ‘natural’ Tongkat Ali which actually contained prescription ED drugs! Likewise, overtraining can lead to injury or soreness. However, there’s no doubt that the natural approach is safer than the alternative.
Only purchase Tongkat Ali supplements from a reputable company that provides 3rd party lab tests to prove that it is an unadulterated and safe supplement.
If you are looking for a safe and natural testosterone boosting supplement that contains Tongkat Ali, we recommend our Testo-Booster supplement.
The side effects from the most commonly used ED pharmaceuticals include minor ones, such as headache, flushing, runny nose and pains in the stomach or back.
In some cases, dizziness and a sudden drop in your blood pressure can take place. That’s why men with heart conditions have to be evaluated by a physician before they take it, and may have to rely on a lower dose.
Around 1 out of every fifty men who take those drugs will also experience painful or persistent erections.
The highest risk group, however, is those who undergo surgery to get an implant. That’s why it’s always the last choice. As the surgeon needs to make an incision into the scrotum, penis and often the abdominal wall, there is a risk of infection.
In addition, the implant itself may degrade, and is a constant risk of infection, even after the surgery has healed. Around a third of implants need to be replaced within 10 years.
Can prostate surgery affect penis size or sensitivity?
Prostate surgery is very unlikely to affect penis size. The only likely case this would occur if an individual underwent surgery for ED after prostate surgery. Implants will often cause a slight shortening of the penis.
Sensitivity, however, is an issue. In order to allow men to urinate, they have to operate on the prostate.
It’s right next to the bundle of nerves that relay the sensation to the brain, causing a lot of the physical pleasure that men experience during sex.
It used to be the case that a prostatectomy would almost always damage those nerves, causing a permanent decrease or even loss of sensation. It would often be 8 months to a year before men reported any sense of sexual desire after the surgery.
However, nerve-sparing surgeries, particularly robotic prostatectomies, can avoid that nerve group far more effectively.
It’s never a guarantee, but a majority of men who have undergone a nerve-sparing procedure can expect to regain the majority of the sexual desire and sensation they had before the operation.
For less-involved surgeries, men can expect to regain their sexual function a lot sooner. TURPs, ReZum, Aquablation or various other novel surgeries are all less likely to damage nerves and have faster recovery periods.
However, for men with localized prostate cancer, these may not be options available to them. If they are being used purely to alleviate urinary symptoms, the vast majority of men will regain full sexual function within 1 to 2 months of the surgery.
The function of the prostate includes combining the seminal fluid with the sperm. Once the prostate is removed, that function is no longer available. In addition, the semen tends to go into the bladder rather than be ejaculated.
However, orgasm is not the simple process of ejaculation. It has two other parts. Prior to surgery, men would be used to the feeling of their urethra filling with secretions from their seminal vesicles and testicles.
That feeling of fullness, sometimes described as a sensation of inevitability will no longer be present.
The most significant part of the orgasm takes place in the mind, however, with heightened activity in the limbic system (which governs memory and emotions), the hypothalamus (which controls body temperature, hunger, thirst and sleep amongst other things) and the prefrontal cortex (normally used for problem-solving). That’s why no matter what surgery one has, satisfying orgasms are still achievable.