Regaining Function: Erectile Dysfunction After Prostate Surgery

Why Does ED Happen After Prostate Surgery?

The nerves responsible for erections (the cavernous nerves) run in a delicate bundle right alongside the prostate gland. Even with the most advanced "nerve-sparing" surgical techniques, these nerves can be stretched, bruised, or damaged during the removal of the prostate. This nerve damage, known as neurapraxia, disrupts the signals required to initiate and sustain an erection.

Recovery of these nerves can take anywhere from a few months to two years, and in some cases, the damage may be permanent. Without regular blood flow during this recovery period, the erectile tissues in the penis can suffer from a lack of oxygen, leading to scarring (fibrosis) and making future erections more difficult.

The Goal of Penile Rehabilitation

The primary goal of post-prostatectomy penile rehabilitation is to prevent this scarring and maintain the health of the erectile tissue while the nerves recover. The principle is "use it or lose it." By regularly promoting blood flow to the penis, we can keep the tissues healthy and elastic, giving you the best possible chance of regaining natural erectile function as the nerves heal.

Components of a Rehabilitation Program

A rehabilitation program is typically started 4-6 weeks after surgery and is tailored to the individual. It may include:

• PDE5 Inhibitors: Medications like Sildenafil (Viagra) or Tadalafil (Cialis), often taken at a low dose daily, help to increase blood flow and promote oxygenation of the penile tissues.
• Vacuum Erection Devices (VED): A VED is a cylinder placed over the penis that uses negative pressure to draw blood into the erectile chambers, passively creating an erection. Using this device for a few minutes daily can be very effective at preventing tissue fibrosis.
• Intracavernosal Injections (ICI): For men who do not respond to oral medications, injecting a medication directly into the side of the penis can produce a reliable erection. This is a powerful tool for maintaining tissue health and allowing for penetrative intercourse during the recovery period.

Managing Expectations

Recovery is a marathon, not a sprint. The success of rehabilitation depends on the extent of nerve damage, your age, and your health before surgery. Our specialists will work with you to create a realistic plan, provide the tools you need, and offer support throughout your recovery journey.