Cancer Survivorship & Post-Op ED
Why erections change after prostatectomy or radiation, penile rehabilitation, and the options when pills and injections aren't enough.
Written and reviewed by Shervin Badkhshan, MD · Last reviewed
November 2026
Part of:
After prostate cancer treatment
Office & surgery
Implant recovery: 4–6 weeks
Fellowship-Trained Reconstructive Urology
AT A GLANCE
From symptoms to treatment
1. SYMPTOMS
• Weaker or no erections • Shortening • Dry orgasm
2. TESTING
• Review of treatment history • Morning testosterone • Response to pills or injections
Test result guides →
Erection changes are among the most common effects of prostate cancer treatment, and one of the most treatable. Many men recover partially or fully. For those who don't, there are reliable options.
Why it happens
- After surgery: the nerves that control erections run right alongside the prostate. Even when they're spared, they're stretched and stunned, and can take 1 to 2 years to recover.
- After radiation: changes to the small blood vessels in the penis tend to reduce firmness gradually over the first 1 to 2 years.
- Hormone therapy lowers testosterone, which reduces desire and can make erections harder to get.
Penile rehabilitation
While the nerves recover, the penis may go long stretches without erections. That lack of blood flow can lead to scarring and loss of length. Rehabilitation aims to keep the tissue healthy until function returns, starting soon after the catheter comes out. It may include:
- Low-dose daily or scheduled ED pills
- A vacuum erection device
- Penile injections, which work even when the nerves haven't recovered
When pills and injections aren't enough
An inflatable penile implant is a reliable option once it's clear natural function isn't coming back. It's safe after cancer treatment and doesn't interfere with PSA monitoring. Sensation and orgasm are not changed by the implant.
Other changes worth mentioning
- Leaking urine with orgasm (climacturia) is common after prostatectomy. It can be addressed, sometimes at the same time as other surgery.
- Leakage during the day can be treated too. A penile implant and an artificial urinary sphincter can be placed together.
- Intimacy: recovery isn't only physical. Partners are welcome at visits, and counseling can help.
Related
Penile injections: home guide · Penile implants · Testosterone results explained · Life after prostate cancer treatment
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