Editorial
Written byMen's Health Istanbul Editorial Team
Medical reviewer (awaiting sign-off)Asst. Prof. Dr. Yusuf İlker Çömez
Published
Updated
Medically reviewedNot yet
The short answer
Yes, many men have a sex life after prostate surgery, but it often changes. After removal of the whole prostate for cancer, erections are commonly weaker at first and may take many months or longer to recover, if they recover fully; nerve-sparing surgery and good erectile function beforehand tend to help. Orgasm is still possible, but there is usually no ejaculation. After surgery for an enlarged prostate, erections are often unaffected, but semen may flow backwards into the bladder. Tablets, injections, vacuum devices and penile implants can all help, and a urologist can plan this with you.
Key takeaways
- Removal of the whole prostate often weakens erections at first; recovery is gradual and varies a great deal between men.
- Orgasm remains possible after prostatectomy, but it is usually dry because the glands that make semen are removed.
- Surgery for an enlarged prostate more often affects ejaculation than erections.
- Tablets, injections, vacuum devices and penile implants give men several routes back to sex, and they can be tried in stages.
Which prostate operation are we talking about?
"Prostate surgery" covers two very different kinds of operation, and they affect sex in different ways.
- Radical prostatectomy removes the whole prostate and the seminal vesicles, usually to treat prostate cancer. It may be done as open, keyhole or robot-assisted surgery.
- Surgery for an enlarged prostate, such as transurethral resection of the prostate (TURP) and similar procedures, removes or reshapes only the inner part of the gland that is squeezing the urethra.
Most of what follows is about radical prostatectomy, because that is where the biggest changes happen.
Will I get erections after a prostatectomy?
The nerves that trigger erections run in fine bundles right alongside the prostate. Even when a surgeon spares them, they are stretched and bruised during the operation and can take a long time to recover. That is why erections are often weak or absent in the first months after surgery.
How well they return depends on several things: how good erections were before surgery, age, general health (for example diabetes or heart disease), and whether one, both or neither nerve bundle could be preserved. Cancer control always comes first, so sometimes nerves cannot be spared.
The ProtecT trial, which compared monitoring, surgery and radiotherapy for localised prostate cancer, found that surgery had the greatest negative effect on sexual function and on urinary control, with some recovery over time. That matches what urology guidelines tell men to expect: improvement is gradual, it varies widely, and not every man returns to where he was.
What happens to orgasm and ejaculation?
After radical prostatectomy the glands that make most of the fluid in semen are gone, so orgasm is usually dry. The sensation of orgasm itself is separate from ejaculation and from erection, so most men can still climax, even without a firm erection.
Some men notice orgasm feels different or less intense. Some leak a little urine at the moment of orgasm (called climacturia). Some also feel that the penis looks shorter. These changes are worth mentioning to your urologist, because there are practical ways to manage them.
After surgery for an enlarged prostate, erections are often unaffected, but semen commonly travels backwards into the bladder instead of out of the penis (retrograde ejaculation). It is harmless, and the semen leaves with urine, but it does affect fertility.
What treatments help erections after prostate surgery?
Guidelines describe a step-by-step range of options, and many men use more than one:
- Tablets (PDE5 inhibitors such as sildenafil or tadalafil) tend to work better when at least some nerve function remains. They need sexual stimulation and must never be combined with nitrate heart medicines.
- Vacuum erection devices draw blood into the penis without relying on nerves. Our explainer on vacuum erection devices covers how they work.
- Injections into the penis or medicine placed in the urethra act directly on the blood vessels.
- A penile implant is an option when other treatments have not worked well enough.
Some surgeons encourage starting treatment early, sometimes called penile rehabilitation, to keep blood flowing to the erectile tissue. Evidence on exactly which approach works is mixed, so your doctor will decide what suits you.
How do couples cope in the meantime?
Recovery takes patience, and it is easier when both partners know what to expect. Intimacy does not have to depend on penetration. Touch, closeness and orgasm without a full erection are all still possible. Talking openly, and bringing a partner to appointments if you wish, often helps more than waiting in silence.
Leaking urine during sex, which is common in the early months, usually improves as continence recovers. Emptying the bladder beforehand helps.
When to see a doctor
Raise sexual function before surgery, not only afterwards, so your baseline is recorded and a plan is in place. Afterwards, speak to your urologist if erections are not improving, if orgasm is painful, or if you are finding the changes hard to live with. Our erectile dysfunction guide explains the treatment options in more detail.
Questions men also ask
How long after prostate surgery can I have sex?
Your surgeon will tell you when it is reasonable to resume sexual activity, usually once the catheter is out and the wound has healed. Sexual touch and intimacy do not need to wait for a full erection.
Will I still be able to have an orgasm?
Most men can still reach orgasm after prostate surgery. It often feels different and, after removal of the whole prostate, there is usually no semen.
Can I still father a child after prostatectomy?
Natural conception is not possible after radical prostatectomy because no semen is produced. Men who may want children should ask about sperm banking before surgery.
Sources & further reading
- New England Journal of Medicine Patient-Reported Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer (opens in a new tab) (2016) Donovan JL, et al.
- EAU EAU Guidelines on Prostate Cancer (opens in a new tab) (2024) European Association of Urology
- European Urology European Association of Urology Guidelines on Sexual and Reproductive Health—2021 Update: Male Sexual Dysfunction (opens in a new tab) (2021) Salonia A, et al.
- Journal of Urology Erectile Dysfunction: AUA Guideline (opens in a new tab) (2018) Burnett AL, et al.
Concerned about something you've read?
Ask one of our specialists privately. There is no obligation, and no question is too awkward.
This article is general health information. It does not replace an individual medical consultation, examination or diagnosis. Read our editorial policy and medical review policy.
