For men facing prostate cancer, their first worry is about dying. Often, their second worry is whether the treatment will kill their sex life.
But men researching the odds encounter a myriad of confusing information. Depending on what study you read, you might read that anywhere from 30 percent to 97 percent of men return to potency after prostate cancer surgery. But as my Well column in Tuesday’s Science Times explains, the chance of a normal sex life after surgery depends on a number of variables. A man’s sex life before surgery, whether he has a supportive partner, the stage of his cancer, and even how a surgeon defines potency all will influence the odds he is given by his doctor.
Have you or someone you care about had surgery for prostate cancer? Did your sexual recovery match your expectations? Or has it been better or worse than you expected? Read the full column here, and please post your comments below. I look forward to hearing from you.
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From 1 to 25 of 342 Comments
I had surgery for prostate cancer 6 years ago at age 64. This took place at Johns Hopkins and was performed by a surgeon with quite a bit of experience. We chose to go to Hopkins for this reason. Prior to surgery we were told my chances for full recovery were fairly good. However, more nerves were removed than were previously anticipated. Since that time I have found that drugs and vacuum pumps do not work. Injections are uncomfortable and successful about 50 percent of the time. I have a supportive sex partner of 26 years, but we are unsuccessful in achieving an erection. This is obviously a cause of distress. I am healthy with a negative PSA, have urinary control, but my sex life is nonexistant. I think the surgeons overstate their success rate concerning ability to have and maintain an erection following removal of the prostate. I returned to Hopkins for a time, but finally decided it was fruitless. We keep hoping for some new discovery concerning this problem. Thanks for researching the topic. I would appreciate a reply if it is appropriate, or if you uncover anything which would be helpful to me.
— TerryOver 10 yrs. ago my partner of many years was diagnosed with prostate cancer at age 48. We both were afraid it was the end of sex as we had known (and enjoyed) it. His surgery was performed by Dr.Patrick Walsh at John’s Hopkins, who developed the nerve sparing surgery that is routinely performed today. Dr.Walsh also encouraged his pts. after surgery to “use it, or lose it.” It took patience on both our parts, courage on my partners part (he used injections before viagra came on the market), love, commitment, and a good dose of humor, but we prevailed until in the past few years, no aids were necessary. He also was young, in excellent physical condition, and had no erection difficulties prior to his surgery. Still it was a much better outcome than we had ever imagined.
— PatriciaOf paramount importance when one considers sex after treatment for prostate cancer is a through discussion with one’s physician or physician team about the different options for treatment of prostate cancer in the first place. Radiation therapy has been shown to have equivalent chances for disease cure in most men with early stage prostate cancer with a MUCH lower risk of erection dysfunction after treatment than all types of prostate surgery. It is always good to get an opinion from a radiation oncologist as well as a surgeon when contemplating treatment for prostate cancer so as to make an informed decision. It is important to review the procedures involved, the potential for long term control and cure as well as the short term and long term effects of each form of therapy before making a decision on treatment.
The risk of erectile dysfunction after surgery is very much tied to one’s baseline erectile function. Hypertension, diabetes, obesity, vascular disease, and certain other medical conditions will all add to an increased risk of erectile dysfunction after surgery. The better control there is of these conditions prior to prostate cancer treatment, and the better the baseline function, the better chance of functional recovery.
Encouraging patients to exercise vigorously and regularly, and to engage in regular sexual activity prior to (and also, in the case of radiation therapy, during) definitive treatment may reduce the relative post treatment dysfunction
— David Howell, MDI had both my bladder and prostate removed about a year ago and use a urostomy device. In the months following the surgery I would occasionally get erections or semi-erections in my sleep. After about 6 months I was able to get some erection when with my partner with the use of one of the three pills on the market. Levitra seems to work the best. In the last month or so I’ve been able, about 40% of the time, to get and sustain a full erection when with my partner. Vacuum pumps have not been very sucessful. Have not tried injections.
— RogerOf the 219,000 men diagnosed each year with prostate cancer (according to this article), well over 10,000 must be gay men. Almost all the literature about prostate cancer refers to heterosexual men, but the issues involved are somewhat different for gay men, physically and psychologically. Doctors (and journalists) need to be more aware of this. The “adequate for intercourse” criterion specifically implies “adequate for heterosexual intercourse.” Even this generally neutral NYT article, which managed to be inclusive with its mention of “partners,” ended up positioning the whole question in a heterosexual context in the final phrases.
One useful recent resource is the Haworth Press’s “A Gay Man’s Guide to Prostate Cancer” (2007). More publications are needed addressing this precise point for two reasons: (a) they will give gay patients access to information that will be helpful specifically to them; (b) they will also educate doctors (and journalists), many of whom still have a tendency to flounder around when attempting to tackle this subject from a gay perspective.
It can be a very negative experience for a gay man to realize that the highly competent surgeon who will perform his prostatectomy is imperturbably heterocentric, sometimes homophobic, and anyway cannot talk comfortably about gay sex, either before or after the operation. It’s a situation that, at best, inhibits optimal medical treatment.
My doctors (for both surgery and radiation) were very sympathetic but their explanations were not sufficient. Five years after a relatively successful radical prostatectomy (at age 52) in which most of the nerves were spared, and after some follow-up radiation as well, at the practical level “the equipment” does seem to work somewhat differently. Erections can certainly be solid and hard without any external aids, chemical or otherwise, but they seem, inconveniently, to be unlinked to desire.
Yes, the equipment is now somewhat smaller, shorter. Learning to control it has at times felt a little like being an adolescent again — except that it was all too easy at the age of 13, and it’s difficult now. The build up requires more work and energy, and the window of opportunity closes more quickly. Orgasms are certainly different. Curiously, after the necessarily faster build up, they are slower, longer, and calmer, but still satisfying in a different way that I have learned to appreciate. On the other hand, the dry ejaculations remain psychologically disappointing.
The main concern of my doctors now (apart from checking that my PSA remains at zero) seems to be simply whether I “get erections” and “achieve orgasms.” The correct answer to both is “yes” but these questions are far too basic. The fact that the erections are relatively fragile, require rapid follow-through, and can disappear like mist, seems irrelevant to them, whereas it is not irrelevant to me or my partner.
From TPP — Interesting perspective. I actually had an anecdote from a doctor about a gay man that I decided not to use, because it seem irrelevant whether he was gay or straight — and kind of insensitive to mention his sexuality. But i see your point. i almost wonder if there isn’t an entirely separate article on how prostate cancer affects the gay community. This particular man really struggled and felt his sexual identity had changed after prostate cancer. And I see your point about the unique physical challenges he must have faced. I also think that your comments explain incredibly well why the definition of “adequate for intercourse” is quite misleading. It shows how narrowly the medical community defines sex and a lack of understanding about the lives of their patients. That said, in my experience, the urologists I’ve known are quite sensitive to the unique needs of gay patients, so i think if your doctor is not, you should look around for someone who is comfortable talking about sex with you. A woman should expect no less from her gynecologist. Thanks for taking the time to comment.
— DavidI had a prostatectomy in January 06. . . .the operation itself took 6 1/2 hours due to the difficulty the surgeon had which was caused by the depth of my pelvis. . . .the surgeon, Dr. I Cagiannos, well, I was fortunate to have the benefit of his expertise. . .the suggestion was that I would begin to experience normal erections in up to 18 months. . . .my sex drive was reduced somewhat by the injection of Lupron several months before surgery in order to reduce the size of the prostate. . I continued to experience hot flushes and the other side-effects of this drug for a considerable period after the surgery. . however, I began to experience nearly normal erections within about 45 days following the surgery, not 18 months. In a follow-up visit with my surgeon about 4 months after the operation Dr. Cagiannos suggested that I take Levitra. . not because I was having difficulty obtaining an erection, but because, apparently, the use of Viagra or Levitra or Cialis helped the nerve endings connect or heal more quickly. As for orgasms. . .I’m not certain whether the absence of ejaculate has forced me to be more aware of my orgasms but they seem to be longer and more intense. . .and I cut the Levitra pills in half since I don’t really need a whole pill. . as for penis size. . I don’t think my erections are as big as they once were. . and also, after orgasm, that appears to be the time when my penis is at its most erect stage.
— GordonMy surgery, by the way, was in Ottawa, Canada, at the Civic Hospital Campus. . . .and my surgeon is also a Professor at Ottawa University.
I am the surgeon who wrote the December 2005 paper quoted in the article. We found that at 12 months of follow-up, 97% of a selected group of men with no erectile dysfunction before surgery who underwent the specific type of nerve sparing ( the “veil” ) that we described, were able to have sexual intercourse. 51% of these patients had normal erections without medications, and 86% with medications. If they did not have the veil type of nerve sparing, the potency results were lower.
We concluded: “Potency rates after radical prostatectomy vary with the measure used to define potency”, and also with the surgical technique. I tell patients with normal sexual function who undergo the veil type of nerve sparing that there is a > 90% chance that they will be able to have intercourse at 1 year, but only a 50% chance that they will have normal erections without medications. These results do not apply to all patients who undergo prostate cancer surgery, as Dr. Tewari points out.
Mani Menon, MD, Vattikuti Urology Institute, Henry Ford Hospital, Detroit
— Mani Menon, MDFrom TPP — Dr. Menon — it’s an honor to have your comments here on the Well blog. Thanks for sharing your insights.
What are the effects on gay men?
From TPP — The physical changes for a gay man would be no different than a heterosexual man. However, as reader #5 has expressed, there are some practical issues associated with men having sex with men that might make it more difficult for a gay man to return to a normal sex life after prostatectomy.
— Robert LucasThank you for posting these. They’re articulate and informative. My own “thing” with this will be a minority opinion and one that never gets talked about which is fine. For me, there are no acceptable options here. The loss and the struggle would be too much, and the invasiveness too extraordinary. I would not choose to be alive. I know that other men would not agree. But it’s a personal choice. And facing this sort of a facsimile of a life is not an option I could tolerate. I would exit. And call it good.
— TomI will be undergoing surgery for a penile implant this week after nearly ten years since my radical prostetectomy (which was successful). My surgeon did remove the nerve bundle on one side due to the proximity of the cancer. I have attempted to use the injections (painful), vacuum device (lack of spontaneity and partially successful, medications including viagara,levitra and cialis which helped achieve erection but not allowing enough time to have orgasm. It has been a frustrating experience for my wife of nearly 25 years, as well as myself.I have medications for hypertension,depression and have exercised before and after surgery on a fairly regular basis. I feel I made the right choice to become cured of my cancer, as my surgeon now tells me, however it has not been without its challenges. My wife is extremely supportive and my primary support.
From TPP — I once interviewed a man who had a penile implant and he was thrilled with it, so was his wife. I think this is an under-rated option for men…It really can normalize sex for both parties and the physical experience for the man is good. Good luck with your surgery and write back and tell us all about it!!!
— BURT MORGANPlease don’t flame me… this is a legitimate question / comment.
Facing cancer, which could be life-threatning, who thinks about their sex life? Or really, any of the *extras*? I have a female friend who faced cancer at a young age and she was encouraged by her doctor to delay treatment in order to bank her eggs. She thought he was crazy! All she could think about was getting healthy, not the possibility of bearing children in the future, if she even survived!
Another question - by the time most men face prostate cancer, they are in their late 40’s or older…. why is sex important then? They’ve had 30+ years to enjoy it already?!
— SharonI had radical prostatectomy about six years ago at the age of 52. Before surgery I was fully potent and never had a problem attaining or maintaining an erection. My surgeon at NYU Medical Center, Dr. Lepor prescribed that I take a quarter of a tablet of Viagra every day after surgery and advised me of the “use it or lose it” rule. My wife of 30 years who is very beautiful and sexy and a wonderful understanding partner played a large role in my being able to deal with the impotency that followed surgery. We continued to have fun satisfying sex, albeit without my being able to achieve penetration. It took two years before the “eureka” moment happened when we were able to have intercourse. My ability to get an erection now is dependant on a Levitra tablet before hand and the erection is about 75% on average of what it was before surgery; sometimes stronger, sometimes weaker. It also varies in intensity during sex. In other words, there are times when I start off strong but soften later on. Also, even though I am able to achieve penetration, because of the incomplete and well nigh erection, the intercourse has never had the same quality to it. Orgasm is still great. That has never changed.
— LouThis reminds me forcibly of the statistics vs. anecdotal reports of the effect on sexuality and ability to achieve orgasm while taking antidepressive drugs. Warning labels quoted a 5% chance of decreased sexual appetite, while the reported incidence was hugely higher, over 50%.
— ShellAt age 59(3 years ago) I was diagnosed with Gleason 8 prostate cancer and underwent a nervesparing radical prostatectomy. I regained continence quickly and my PSA remains undetecable. I have 3 wonderful children Ages 25 (conceived with my first wife of 23 years) and ages 6&9 conceived with with my second wife of 13 years who is 26 years younger than myself. I tried every tratement for the first 2 years post-surgery -meds, injections, pumps with very little success. During a counseling session wy wife said that making love was like doing an “Experiment!” and that she was not interswted in trying anything more and was not intersted in having sex with anybody again. I subsequently came upon incontravertable proof that she was and is having an ongoing affair with the little one’s TaeKwonDo instructor for the past year. Last april I had an inflatable prothesis placed but it has never been used other than by me. I am still with her for the sake of the kids and because I still love her as irrational as that might sound. The last 3 years have been the most anguishing of my life. My advice is to start counseling as soon as possible after the diagnosis is made. I am convinced that we would still be “together emotionally/physically” if we had done so.
— HerbAs a gay man, the dread that swept over me the night before my radical prostatectomy thirteen years ago was so presciently overwhelming that I almost discharged myself. I ought to be, and I am, profoundly grateful my life was spared. Consequent to surgery, however, relational possibilities were vastly reduced; penile appearance diminished; ejaculate, non-existent; and orgasmic quality, altered. These effects have been sources of enduring shame and embarrassment and an assault on my identities as a male.
I had chosen the chief of urological surgery at a prominent medical university hospital. Though I was advised by an oncologist that he could refer me to a radiologist who would give me “equal odds” to survive, the surgeon advised that, given I was then 58, surgery was the best option for long term survival.
Recovery from “nerve sparing” surgery was hard. My first erection felt dead and numb. No concern to “rehabilitate” penile function was offered. My observation of reduction in length was professionally derided. Erectile function ceased for many months, though a hobbled recovery of sorts slowly returned. Good sensation has remained, though eventually I have had to be treated for increased dysfunction.
— CharlesI would be interested in reading about sexual function experiences for those men who have had hormone injections followed by radiation treatment for their prostate cancer, as my husband has. It has had a much greater effect on our sex life than we had been led to believe.
— ToryI am a 40 y.o. woman. At 25, I had surgery for endometriosis, a laster laparoscopy with d/c. I’m still haunted by the words of the receptionist who told me, “Don’t worry, Dr. X is very thorough.”
— AnnAll I can say is, there needs to be nerve- sparing surgery for women as well. From the research I’ve been able to dig up on my own, the nerves linked to sexual response in the female remain unmapped. Nobody knows where they are. Mine were cauterized or cut while having endometrial tissue removed and that was that. Nobody told me this was even a risk or side effect. I went in blindly and came out with a life sentence of no sexual response. Anyway, it’s been hard, I have to choose between deceiving a man in bed, or telling the truth. Equally unappealing and with the same outcomes. A therapist told me to grieve and get on with it. So I lead a celibate life and people wonder why the pretty, shy woman has never met anyone. But life is still worth living, for the commenter, Tom, above who said he’d rather die than have this problem. Sex truly is not “everything” and for those of us who’ve gotten some tough breaks, it doesn’t help to hear assertions like that.
I don’t understand these comments. If your sex life is more important than prostate cancer then don’t have surgery or treatment. If life in general is more important than get it. It is your choice. Worry about the details after you live.
— RichI did radiation therapy in late 2005, the reaction and side effects were extreme and amazed even the battle hardened medical folks. Things didn’t start to get significantly better until mid last year (2007) then improved rapidly. until now, I am almost back to normal, except for sexual function.
Fatigue still raises its head frequently and slowly that is falling away.
Sexual function has been non-existent, and viagra and other sexual aids have been a complete zero. But, I now detect the stirrings of old and believe in time that function will return, and sooner than later I am convinced.
It has been quite a ride, wouldn’t care to go through it again. But I understand men with other treatments have had difficulties as well.
The people that have been the greatest comfort are those with insight borne of experience, the people of US Too.
The Doctors and their staff have been nothing less than wonderful and have done the best for me the were capable of. I’m grateful for it all and a better man for having come through this obstacle course.
Thanks for the opportunity to write about this.
— steveThis line says it all….
“Having a beautiful wife — that also helps,” said Mr. Anthony, who has been married for 19 years. “My wife is better than any Viagra.”
Maybe if this article was on preventing female obesity, the numbers would be better…..
— Mr.My goodness. All very informative.
NYT did a long story on this subject a year or more ago in one of its special “men’s health” sections, and ALL the men interviewed who had had ANY type of prostate cancer treatment, including radiation without surgery, said they experienced sexual problems. It was clear that radiation itself is extremely destructive to the nerves, just as surgery can be.
This entire subject is shrouded in such secrecy and denial and that is not serving anyone. I remember when Bob Dole had the surgery and he was asked afterward if he had potency problems and he said No—like he’s going to tell the truth to a national audience? Then later we saw him flogging Viagra for ‘ED’. Right.
So what I have seen in this discussion is info I have never read anywhere, anywhere, in any article on this subject: the use it or lose it advice, which sounds fatuous and meaningless except for one poster’s statement that his doc told him that ED drugs like Cialis et al. actually help the nerve to ‘heal’. Ie, to regrow? This is HUGE. Huge. And supports a theory that people can and must try the activities they want to engage in, in order to regrow not just CNS pathways but also somatic nerve pathways.
Even the advice that persistence in the desired activity is likely to result in improvement—I have never heard this and I’m betting most men haven’t either. Including most prostate cancer pts.
So…what exactly are we talking about here? Are we saying that these drugs have an effect on the nerves directly? Or that, by making a sexual act possible, that act itself helps rebuild nerves?
I’m reminded of Christopher Reeve’s success in the last couple years of his life in rebuilding peripheral nerves by relentless physical therapy. He did regain a small amount of motor and sensory function, and this was really a groundbreaking achievement, and said something about the capacity of the peripheral nervous system to recover.
— appleI had a radical with nerve sparing in 2001. The three important things to consider, in order of importance are living, urinary control, and finally, sexual function.
— jonathanI completely recovered and have full erectile ability without any drugs, although drugs do make it easier.
Perhaps what is overlooked is how important a caring a supportive partner is to help with returning to sexual function and activity. I well know as my partner at that time was not suppoortive, unsympathetic, and completely uninvolved. Another important area is follow up with the physician after surgery, even a support group.
Prostate surgery can be a devastating experience for a man, and even though you do you research, ask the right questions, it still is not an easy thing to cope with. I am lucky. I had a great surgeon, a successful surgery with no complications and have had a clean bill of health now for years.
Sharon — when you get to be 40 or so yourself, you may find out why sex is important. Although, from your comment, it is doubtful, as you seem to not fully appreciate it even now.
— RalphThere is a subclass of men like myself who underwent successful radical nerve sparing prostitectomy and then the cancer came back and needed salvage radiation.
— MaxI was 52 in 1999 and smart enough to get a great doctor, Dr Wein of Hospital of U Penn, lucky enough have Viagra come on the market one month before I would need it, fortunate enough to then progress to not needing it, then unlucky enough to need radiation and again luckier still to get IMRT radiation rather than the older kind that left you impotent.
I agree with the blogger who says that the orgasms are different, sometimes longer and more intense.
I occasionally use LEVITRA, my favorite, for extra texture.
Oh yeah. You must have a lover who understands and is will to get into the fact that urine is antiseptic because post prostitectomy, urine is the new semen.
I am approaching 9.5 years since prostate surgery, which I underwent at the age of 51. I have been healthy with regard to the malignancy since. Viagra, etc., are a help in being able to have intercourse. My biggest problem is that when I ejaculate I frequently discharge urine, which is a total turnoff to my wife, and which is a growing concern. I’ve not received any reassurances or constructive suggestions from my urologist, who, on at least one occasion, remarked, “At least you’re ejaculating something.”
As to the enjoyment of sex, I find much more enjoyment, when that happens, which is too rare. I write that off to increased maturity, without the prostate surgery being a factor. But, it makes me wish that I learned before what I know now.
Finally, after years of good bladder control, except for the sudden onset of intense urgency, things are getting a bit less predictable. Early on, my urologist commented about the geezers who told him that since the surgery you can never trust a fart [to not include the discharge of urine]. As I progress, or digress, towards geezerhood, that seems to be the case.
— Joseph