Sex After Prostatectomy

If you are intent and motivated, you are virtually guaranteed to be sexually active again after surgery.  The best chances for natural sexual relations postop requires nerve preservation at the time of surgery.  The more nerves spared, the better the likelihood of returning to natural intercourse.  Robotic surgery, because of better magnification, better instrument dexterity, and the bloodless field of operation, allows for the best chances of preservation of potency and sexual function.  Because these nerves may be handled more gently with robotics, the times to return of erectile and sexual functions are months faster than with open surgery.

Whether or not to spare nerves is not necessarily an all or none proposition.  If both nerves are fully spared in a young patient with excellent preoperative erections and function, the chances of preserving function is up to 85%.  Those with bilateral partial nerve sparing, or unilateral nerve sparing, have lesser chances.  Those with total bilateral nerve sacrifice, as is done for patients with high-risk cancer, have virtually no chance of natural erections.  The term “natural” includes the use of oral pharmaceutical agents (Viagra, Cialis or Levitra) for many.

Certain risk factors are known to impact on long-term erections and sexual function: preoperative erectile function and sexual activity level, age, and cardiovascular issues (diabetes, hypertension, high cholesterol level, smoking).  Younger patients without cardiovascular issues, with excellent preoperative erections, and who are sexually active do better on the whole than those who have risk factors.

What can you do to improve your chances of preserving erectile function?  For those who undergo nerve sparing surgery, the answer is penile rehabilitation.  From the time the catheter is removed (typically at a week postop), you are encouraged to use a penile vacuum pump daily, and oral phosphodiesterase inhibitors (ie, Viagra, Cialis or Levitra).  Patients who perform penile rehab have earlier return to erections and sexual function, and fewer long-term pharmaceutical requirements, compared to patients who do not use these agents.

Treatment Options for Patients with Erectile Dysfunction:

  • Oral agents (Viagra, Cialis, Levitra, Staxyn, Stendra)
  • Trans-urethral agents (Muse)
  • Penile injections (Caverject, Trimix)
  • Vacuum pump
  • Penile prosthesis

The placement of a penile prosthesis is typically the option of last resort and very few come to this, however it is not to be overlooked.  It requires a surgical procedure, of course, with its own set of risks, but most patients who choose this option are elated.  The point is that your motivation is all that is necessary to achieve an erection.

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