Post-Prostatectomy Erectile Dysfunction and Penile Rehabilitation

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Overview
Diagnosis
Treatment

What is Post-Prostatectomy Erectile Dysfunction?

Erectile dysfunction, also known as ED, is the inability to get and maintain an erection hard enough to have intercourse. 90 percent of men experience ED after having a prostatectomy, surgery to remove part or all of the prostate gland.

Causes of Post-Prostatectomy Erectile Dysfunction

ED is a normal side effect of prostate removal. Post-prostatectomy ED doesn't seem to happen more often with one type of prostatectomy over another.

Prostatectomy tends to cause ED because the surgery weakens the pelvic floor, a part of the body that's vital to getting an erection. Located just under the bladder and behind the base of the penis, the pelvic floor contains many muscles, nerves, and blood vessels. In order to get an erection, the brain needs to send signals through these nerves, the blood vessels must allow enough blood to flow into the penis, and pelvic floor muscles have to squeeze blood into the penis. If any of these parts are damaged during surgery, you may not be able to get and keep an erection.

Post-Prostatectomy Erectile Dysfunction Symptoms

Symptoms of post-prostatectomy ED are the same as symptoms for regular ED. These include:

The inability to get an erection
Having erections that aren't hard enough for intercourse
Having erections that don't last until orgasm

Even though it's very common, ED can also cause some men to feel embarrassed. In addition, it might cause stress for you and your sexual partner.

Post-Prostatectomy Erectile Dysfunction Diagnosis

While ED is a known complication after prostate removal, your doctor will examine your genital area to confirm the cause of your ED. They may ask you to get blood tests in order to check your hormones and general health, and a urine test.

Your doctor may request extra tests, including:

A Doppler ultrasound: Seeing ultrasound images of the penis, while both soft and erect, will allow your doctor to see how blood is flowing through it.
An intracavernosal injection test: Your doctor injects medicine into your penis that causes an erection, which they then measure.
A nocturnal penile tumescence test: The purpose of this test is to check whether you have erections at night. If you do, the cause of the ED likely isn't physical.

Post-Prostatectomy Erectile Dysfunction Treatment

One of the most important components of treating ED is penile rehabilitation — using or exercising your penis in order to maintain its ability to become erect.

Rehabilitative treatments your doctor may recommend include:

Oral medicine: Oral medicines for ED work as muscle relaxants. When the smooth muscle of the penis is relaxed, more blood can flow into it, which helps create an erection.
A vacuum device: A tube is placed over the penis, forming a vacuum that pulls blood into it and makes it erect. Once the penis is erect, a band is placed around its base to hold the blood in the penis. This allows the blood vessels and muscles to stretch.
Injection: The doctor injects a muscle relaxant into the penis with a very small needle, allowing blood to flow into it.
A penile prosthetic device: There are two types of prostheses that make the penis erect: non-inflatable, or rigid, devices, and inflatable devices, which fill with liquid. Both types of devices are permanent and implanted through surgery.

Because ED can affect your relationship with your partner, sex therapy can also be helpful. In partner therapy sessions, you can work on methods for better communication, resolve anxiety, and find ways to make your physical relationship more satisfying.