Sexual life after prostate removal

This post is for all the men who have prostate cancer or are worried about prostate cancer. One of the most feared side effects of therapy for prostate cancer is the impact on sexual health.

prostate diagram

click to expand the image

Hopefully this will give men a better idea of what to expect and take some of the fear of the unknown away.

The prostate makes the liquid in the ejaculate. This is necessary for the sperm to work and therefore to have children. Other than having children, the prostate is of little use later in life and only causes problems with urination (BPH) and is a leading cause of cancer.

nerves surrounding the prostate

click to expand the image

The “nerves” that go to the penis course very close to the prostate. They are only a few millimeters from the prostate and can be affected by surgery or radiation. These nerves are solely responsible for erections, or the ability of the penis to get hard.

The net effect of someone having his prostate removed is:

  1. He will lose the ability to have an ejaculate, and will be sterile. You can still have children with your own sperm by artificial means.
  2. He will maintain full sensation of the penis. With masturbation or other stimulation, he will still have the ability to have an orgasm.
  3. He will probably lose the ability to get a firm erection after surgery. I have had many patients who kept their erections with robotic surgery, but this is not the rule. With time he will hopefully get his erections back normally.

Factors that are responsible for the ability to get erections are:

  1. Preoperative function- Surgery can not help erections. If they are not that good to start, then they are less likely to come back.
  2. Age- The older the patient, the more they need the nerves working perfectly to have erections.
  3. Other medical problems- Illnesses that affect erections such as diabetes and high blood pressure will not help.
  4. Frequency of intercourse- The more sexually active the person is, the better the recovery rate.
  5. The ability of the surgeon to spare the nerves. If the cancer is such that the nerve shouldn’t be spared, erections are less likely to come back. If the cancer is such that the nerves are able to be spared, then technical factors such as how much tissue is saved, using less cautery in the areas of the nerve bundles, and stretching the nerves less all play a role in recovery.

The following video was from a surgery done at Newark Beth Israel and demonstrates the nerves being separated from the prostate. The da Vinci robot that was used for this procedure gives 10 times magnification of the anatomy and a near high definition, 3D picture.

October 2007 Update: I have a new post that may help men that are looking for insurance companies to help cover the cost of penile rehabilitation PDE5 medicines.