Yes, it may be possible to get an erection after prostate removal, but recovery varies considerably. Some men regain natural erections, while others need tablets, a vacuum erection device, penile injections or an implant to achieve an erection suitable for sexual activity. Some men do not regain erections firm enough for sex despite treatment.
This article refers to radical prostatectomy, an operation that removes the whole prostate to treat prostate cancer. It does not refer to procedures such as transurethral resection of the prostate, or TURP, which removes only part of the prostate to improve urinary symptoms.
Your chances of erectile recovery depend on your age, erectile function before surgery, general health, the extent of nerve preservation and your surgeon’s experience. Recovery is usually gradual and may continue for months or several years.
Radical prostatectomy permanently stops the ejaculation of semen and means that you will not be able to conceive a child naturally through sexual intercourse. You may still experience an orgasm, but it will be dry and may feel different.
Why Prostate Removal Can Affect Erectile Function
During a radical prostatectomy, the whole prostate and usually the seminal vesicles are removed. The neurovascular bundles, which contain nerves and blood vessels involved in producing erections, run very close to the prostate.
Even when these nerves are preserved, handling, stretching, heat or temporary loss of blood supply during surgery can interrupt their function. This temporary nerve disturbance is sometimes called neuropraxia. It can take many months for nerve signalling to improve.
If one or both nerve bundles must be removed to treat the cancer safely, natural erectile recovery becomes less likely. Blood-vessel health, diabetes, smoking, cardiovascular disease and erectile function before surgery can also affect the ability to achieve erections afterwards.
What Is Nerve-Sparing Prostate Surgery?
Nerve-sparing surgery aims to preserve one or both neurovascular bundles beside the prostate. Depending on the position and extent of the cancer, your surgeon may perform bilateral nerve sparing, unilateral nerve sparing or non-nerve-sparing surgery.
Preserving both nerve bundles generally provides the best chance of erectile recovery. However, nerve sparing is only appropriate when it does not compromise the safe removal of the cancer. Cancer control remains the main priority.
Nerve-sparing surgery improves the possibility of recovery but does not guarantee that natural erections will return. Your age, preoperative erections, other medical conditions and the quality of the nerve-sparing procedure also influence the outcome.
Factors Influencing Erectile Recovery
Erectile recovery after prostate removal can depend on several factors, including your age, overall health, erectile function before surgery and whether the nerves involved in erections were preserved. Recovery varies between individuals, but your specialist can guide you through available support options and what you may expect.
| Factor | How it may affect recovery | What to discuss |
| Erectile function before surgery | Better baseline erectile function is associated with a greater chance of recovery | Your erections before diagnosis and whether you previously needed ED treatment |
| Age | Younger men generally have a higher likelihood of recovery, although age does not determine the outcome alone | A realistic personalised estimate |
| Extent of nerve preservation | Bilateral nerve sparing generally offers better prospects than unilateral or non-nerve-sparing surgery | Whether one or both nerve bundles can be preserved safely |
| Surgeon experience | Surgical experience and the quality of nerve preservation can influence functional outcomes | Your surgeon’s experience and reported outcomes |
| General and vascular health | Diabetes, cardiovascular disease, smoking and poor blood-vessel health can reduce erectile function | Management of relevant health conditions |
| Additional cancer treatment | Radiotherapy or hormone therapy after surgery may further affect erections or sexual desire | How combined treatments may affect sexual recovery |
| ED treatment | Tablets, pumps and injections can help produce treatment-assisted erections | When treatment should begin and which option is appropriate |
How Long Does It Take to Get Erections After Prostate Removal?
Most men experience significant erectile difficulties immediately after radical prostatectomy, including after nerve-sparing surgery. This early loss of function does not necessarily show what your long-term outcome will be.
When natural recovery occurs, improvement commonly takes 12 to 24 months and may continue for several years. Erections may initially be weaker than before surgery, require more stimulation or occur only with treatment.
It is important to distinguish between spontaneous erections and erections achieved with tablets, a vacuum device or injections. Being able to achieve a treatment-assisted erection does not necessarily mean that the nerves have fully recovered.
What Research Shows About Erectile Recovery
Age, erectile function before surgery, general health, the extent of nerve preservation and surgeon experience are recognised predictors of erectile outcomes. Early access to ED treatment may help you achieve treatment-assisted erections and resume sexual activity. However, current evidence does not establish one best rehabilitation programme or show reliably that rehabilitation increases spontaneous, treatment-free erectile recovery.
What Should You Expect During Early Recovery?
Weak erections or no erections are expected during the first weeks and months after surgery. Even preserved nerves may remain temporarily inactive while they recover from the operation.
Your age and erectile function before surgery are important predictors, but they cannot guarantee an individual result. Younger men with strong preoperative erections and successful bilateral nerve sparing generally have the best prospects.
Your healthcare team should assess your baseline erectile function before surgery and review your progress afterwards. This allows treatment to be adjusted according to whether you are achieving spontaneous erections, treatment-assisted erections or no usable erection.
What Is Penile Rehabilitation After Prostate Removal?
Penile rehabilitation describes the planned use of ED treatments after radical prostatectomy. It may include PDE5 inhibitors, vacuum erection devices, penile injections or a combination of treatments.
The aim is to help you resume sexual activity and, in some programmes, maintain penile blood flow and tissue health while the nerves recover. However, there is no universally accepted programme, dose or starting schedule.
Treatment is often offered relatively early after surgery, once your surgeon considers it safe. Early treatment may help you achieve assisted erections, but it should not be presented as a proven way to restore spontaneous erections. Your plan should be tailored to your operation, nerve-sparing status, health and preferences.
How Medicines Can Help Improve Erections
PDE5 inhibitors such as sildenafil or tadalafil are commonly offered as first-line treatment, particularly after nerve-sparing surgery. They improve the penile response to sexual stimulation but do not create an automatic erection.
These medicines may help you achieve treatment-assisted erections, but they have not been shown reliably to restore spontaneous erections after surgery. They may also be less effective when the erectile nerves could not be preserved.
PDE5 inhibitors must not be taken with nitrate medicines used for angina, recreational nitrates known as poppers or nicorandil because the combination can cause a dangerous fall in blood pressure. Tell your doctor about heart disease, blood-pressure medicines and all other medication before treatment.
Common side effects include headache, flushing, indigestion, nasal congestion, dizziness and visual changes. Your doctor will explain how and when to take the medicine because incorrect use is a common reason for poor results.
The Role of Vacuum Erection Devices
A vacuum erection device uses negative pressure to draw blood into the penis. It may be used without a constriction ring as part of a rehabilitation programme or with a ring to maintain an erection for sexual activity.
Possible side effects include discomfort, bruising, numbness and small areas of bleeding beneath the skin. If a constriction ring is used, it should be removed within 30 minutes to prevent tissue injury.
A vacuum erection device may not be suitable if you have a bleeding disorder or take anticoagulant medication. Do not use one until your healthcare professional has assessed whether it is safe for you. You should receive instruction on the correct size, pressure and technique rather than purchasing or using a device without guidance.
Can Injections Help After Prostate Surgery?
Penile injections, usually containing alprostadil or another prescribed vasoactive medicine, can produce an erection without relying fully on the erectile nerves. They may therefore help when tablets are ineffective or unsuitable.
You must receive practical training from a qualified healthcare professional before using injections. The dose needs to be adjusted carefully to reduce the risk of pain, bleeding, scarring or an erection that lasts too long.
An erection lasting more than three to four hours may be priapism and requires immediate treatment in A&E. Do not take another injection or combine treatments unless your prescriber has specifically advised you to do so.
Can You Still Have an Orgasm After Prostate Removal?
An erection and an orgasm are separate parts of sexual function. You may still experience an orgasm even when you cannot achieve a firm erection, although the sensation may be weaker, different or occasionally uncomfortable.
Radical prostatectomy permanently removes your ability to ejaculate semen. Your orgasms will therefore be dry. Semen is not trapped inside your body. The prostate and seminal vesicles, which produce most of the fluid in semen, have been removed.
The operation also makes natural conception through sexual intercourse impossible. If having biological children is important to you, ask about sperm storage before surgery. Fertility preservation needs to be arranged before the prostate and seminal vesicles are removed.
Other possible sexual changes include urine leakage during orgasm, reduced penile length, altered penile shape or curvature and changes in sexual confidence. Discuss these possibilities before surgery so that you and your partner have realistic expectations.
The Impact of Emotional Health on Recovery
Changes in sexual function after prostate removal can affect your confidence, relationships and emotional wellbeing. It is normal to experience concerns, frustration or uncertainty while adjusting during recovery.
- Emotional wellbeing: Managing feelings of stress, worry or frustration can support a healthier recovery experience
- Confidence and relationships: Changes in sexual function may affect self-esteem and communication with your partner
- Stress management: Addressing anxiety and concerns about sexual performance may support coping, sexual confidence and intimacy.
- Open communication: Discussing your concerns with your healthcare team and partner can help you feel more supported
- Holistic care: Considering both emotional and physical recovery can improve your overall wellbeing during this process
Looking after your emotional health alongside your physical recovery can help you feel more supported and prepared for changes after treatment. With the right guidance and support, you can better understand your options and take positive steps towards your recovery.
If distress, loss of confidence or relationship difficulties continue, ask about psychosexual counselling or couples-based support alongside physical ED treatment.
How Lifestyle Changes Support Erectile Function
Healthy habits cannot reverse nerves that were removed or guarantee erectile recovery after prostate surgery. However, erectile function also depends on blood-vessel health, so physical activity, maintaining a healthy weight, controlling diabetes and blood pressure, and avoiding smoking may support your general vascular and sexual health.
Good cardiovascular health is closely linked with erectile function because erections depend on healthy blood flow. Looking after your general health may support recovery alongside any medical treatments recommended by your healthcare team.
Making positive lifestyle changes can also improve your overall wellbeing during recovery. Your specialist can provide advice on habits that may support your health and complement your erectile recovery plan.
The Importance of Communication with Your Partner
Recovery after prostate removal can affect intimacy and relationships, which may bring emotional challenges for you and your partner. Open communication can help reduce pressure and create a more supportive environment during this stage of recovery.
It is important to remember that intimacy is not only about erections or sexual function. Discussing your concerns, feelings and expectations with your partner can help you both adjust while you focus on recovery.
Being patient and supportive with each other can make the recovery process easier. Your healthcare team can also provide guidance and support if you have concerns about changes in sexual health after surgery.
When Should You Discuss Erectile Problems With Your Doctor?
Sexual recovery should ideally be discussed before surgery and reviewed soon afterwards. You do not need to wait several months or until you are certain that erections are not returning.
Ask your surgeon, clinical nurse specialist, GP or an andrology service about treatment once you have recovered sufficiently from the operation. Early discussion allows you to understand how the nerve-sparing result affects your options and how to use treatment safely.
Call 999 or go to A&E immediately if a penile injection causes an erection lasting more than three to four hours.
Does Robotic Surgery Improve Erectile Recovery?
Robot-assisted surgery provides magnified three-dimensional vision and precise instrument control. It is one method of performing a radical prostatectomy.
However, robotic technology itself does not guarantee better erectile outcomes. Current evidence has not consistently shown a clinically meaningful advantage in erectile recovery compared with other surgical approaches.
Your outcome depends more directly on whether the cancer allows safe nerve preservation, the extent of nerve sparing, your erections before surgery and your surgeon’s experience. Ask your surgeon about their own functional outcomes rather than assuming that use of a robot guarantees recovery.
Can All Men Regain Erections After Prostate Removal?
Not every man will regain erections after prostate removal, so it is important to have realistic expectations before surgery. Some men experience a full recovery, while others may need ongoing treatments or support to achieve erections suitable for sexual activity.
Your chances of recovery depend on several individual factors, including your age, overall health, erectile function before surgery and the details of your procedure. Your specialist can assess these factors and provide a clearer understanding of what you may expect.
Even if natural erections do not fully return, there are treatment options available that may help improve sexual function. Discussing your concerns with your healthcare team can help you explore the most suitable approach for your recovery.
What If Tablets, Pumps and Injections Do Not Work?
If less-invasive treatments are ineffective, unsuitable or unacceptable to you, a penile implant may be considered. Implants can provide a reliable erection independently of the erectile nerves.
Inflatable and semi-rigid implants are available. Choosing an implant requires specialist assessment and detailed counselling about how the device works, the expected appearance and possible complications.
Implant surgery carries risks such as infection, mechanical failure, pain and the need for revision surgery. It is generally considered when other treatments have failed or when you prefer a definitive surgical option.
The Importance of Follow-Up Care After Prostate Removal
Follow-up appointments allow your healthcare team to monitor cancer control, review urinary and sexual recovery, and adjust erectile dysfunction treatment when needed. Attend your scheduled appointments and report any new symptoms, treatment problems or concerns about your recovery.
Myth vs Fact
| Myth | Fact |
| You will never get an erection after prostate removal. | Some men regain natural erections, while others achieve erections with tablets, a pump or injections. Some men do not regain erections sufficient for sexual activity. |
| If erections do not return quickly, recovery is impossible. | Erectile recovery can continue gradually for months or even years after surgery. |
| Nerve-sparing surgery guarantees normal erections. | Nerve-sparing techniques may improve recovery chances but do not guarantee results. |
| Older men cannot recover erectile function after surgery. | Age can influence recovery, but many older men may still improve depending on their overall health. |
| Erectile problems after surgery cannot be treated. | Medicines, devices, injections and other treatments may help improve sexual function. |
| Penile rehabilitation guarantees that natural erections will return. | Treatments can help you achieve erections and resume sexual activity, but no rehabilitation programme guarantees spontaneous recovery. |
| Robotic surgery guarantees better erections than open surgery. | Robotic technology does not guarantee better erectile recovery. Nerve preservation, baseline function and surgeon experience are more important. |
| You cannot have an orgasm after prostate removal. | Many men can still have an orgasm, but it will be dry because ejaculation permanently stops after radical prostatectomy. |
Key Takeaways
- It may be possible to achieve erections after radical prostatectomy, either naturally or with treatment.
- Erectile difficulties are expected immediately after surgery, including after nerve-sparing surgery.
- Recovery may continue for months or several years, but not every man regains natural erections.
- Age, erectile function before surgery, general health, nerve preservation and surgeon experience affect the outcome.
- No specific penile-rehabilitation programme has been shown reliably to increase the chance of spontaneous, treatment-free erectile recovery after nerve-sparing radical prostatectomy.
- Tablets, vacuum devices, injections and penile implants can help selected men achieve treatment-assisted erections.
- PDE5 inhibitors must not be combined with nitrates, poppers or nicorandil.
- Radical prostatectomy permanently stops ejaculation and the ability to conceive naturally through sexual intercourse, although orgasm may still be possible.
- Sexual recovery should be discussed before surgery and reviewed during follow-up.
Frequently Asked Questions
1. Can you get an erection after prostate removal surgery?
Yes. Some men regain natural erections after prostate removal, while others need tablets, a vacuum device, injections or an implant. Your outcome depends on factors including your age, erections before surgery, health and whether one or both nerve bundles could be preserved.
2. Why does prostate removal affect erectile function?
The nerves responsible for erections are located close to the prostate and can be affected during surgery. Even when they are preserved, they may need time to recover and regain normal function.
3. What is nerve-sparing prostate surgery?
Nerve-sparing surgery aims to protect the nerves involved in erections during prostate removal. When suitable, preserving these nerves may improve your chances of recovering erectile function after surgery.
4. How long does it take to get erections after prostate removal?
Most men have erectile difficulties immediately after surgery. When recovery occurs, improvement commonly takes 12 to 24 months and may continue for several years. Erections may initially require tablets, a vacuum device or injections.
5. Does your age affect erectile recovery after prostate surgery?
Age can influence recovery, and younger men generally have better erectile outcomes after surgery. However, age is only one factor, alongside erectile function before surgery, vascular health, nerve preservation and surgical experience. Older men may also recover, depending on their individual health and circumstances.
6. What is penile rehabilitation after prostate removal?
Penile rehabilitation is the planned use of ED treatments after surgery, such as PDE5 inhibitors, a vacuum erection device or injections. It can help you achieve erections and resume sexual activity, but there is no agreed best programme and it has not been proven to guarantee spontaneous erectile recovery.
7. Can medicines help you get erections after prostate surgery?
Medicines such as PDE5 inhibitors may help some men achieve an erection in response to sexual stimulation. However, they have not been shown reliably to restore spontaneous, treatment-free erections after prostate surgery.
8. Can you still have an orgasm after prostate removal?
Many men can still experience an orgasm, although it may feel different. You will not ejaculate semen after radical prostatectomy, and you will not be able to conceive naturally through sexual intercourse. Ask about sperm storage before surgery if you may want biological children in the future.
9. What happens if erections do not return naturally after prostate surgery?
If natural erections do not return, tablets, a vacuum erection device or penile injections may still help you achieve an erection. A penile implant may be considered if other options are ineffective or unsuitable.
10. When should you speak to your doctor about erectile problems after prostate removal?
Discuss sexual recovery before surgery and ask about treatment during your early postoperative follow-up. You do not need to wait until it is clear that natural erections are not returning. Call 999 or go to A&E immediately if a penile injection causes an erection lasting more than three to four hours.
Final Thoughts: Supporting Your Recovery After Prostate Removal
It may be possible to regain erections after radical prostatectomy, but recovery is different for every man. Some men recover natural erections, some rely on treatment-assisted erections and some continue to experience significant erectile dysfunction.
Your age, erectile function before surgery, general health, extent of nerve preservation and surgeon experience all influence your outcome. Although treatment cannot guarantee that the nerves will recover, tablets, vacuum devices, injections and penile implants can provide useful options for sexual activity.
Radical prostatectomy also permanently stops ejaculation and the ability to conceive naturally through sexual intercourse, while orgasm may continue but feel different. Discuss erections, orgasm, fertility and your relationship concerns before surgery and throughout follow-up. If you are concerned about sexual recovery after prostate removal, you can contact Prostate Clinic London for an individual assessment and advice about appropriate treatment options.
References
- European Association of Urology (2026) EAU Guidelines on Prostate Cancer: Quality of Life Outcomes in Prostate Cancer. Available at: https://uroweb.org/guidelines/prostate-cancer/chapter/quality-of-life-outcomes-in-prostate-cancer
- European Association of Urology (EAU) (2026) ‘EAU Guidelines on Sexual and Reproductive Health: Management of Erectile Dysfunction’. Available at: https://uroweb.org/guidelines/sexual-and-reproductive-health/chapter/management-of-erectile-dysfunction
- NHS (2025) Treatment for prostate cancer. Available at: https://www.nhs.uk/conditions/prostate-cancer/treatment/
- European Association of Urology (EAU) (2025) ‘Erectile dysfunction’. Available at: https://patients.uroweb.org/condition/erectile-dysfunction
- Prostate Cancer UK (no date) Surgery: radical prostatectomy. Available at: https://prostatecanceruk.org/prostate-information-and-support/treatments/surgery/
- Salonia, A. et al. (2015) ‘Prevention and management of post prostatectomy erectile dysfunction’, Translational Andrology and Urology, 4(4), pp. 421–437. Available at: https://pubmed.ncbi.nlm.nih.gov/26816841/