The prostate isn’t just a gland involved in urination — it’s a core part of the male reproductive system.
One of the most common — and completely understandable — concerns men have after being diagnosed with prostate cancer isn’t just about the cancer itself. It’s about what life will look like after treatment.
For many men, particularly those who are younger or still sexually active, the impact of surgery on sexual function is one of the biggest worries. Understandably, the thought of losing part of what makes you feel like yourself — physically, emotionally, and intimately — can be deeply unsettling.
In this newsletter, I want to walk you through what happens after a radical prostatectomy (surgical removal of the prostate), what you can expect in terms of recovery, and most importantly, how we can help you move forward — with confidence, clarity, and options that fit your unique situation.
ou’re preparing for surgery or currently in recovery, speak with your GP or urologist about your options. We’re here to work alongside them, offering additional support to help you regain confidence and quality of life.
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Why Does Prostate Surgery Affect Sexual Function?
The prostate gland is not just a small, tucked-away organ that deals with urination. It plays a central role in the male reproductive system. It produces seminal fluid — the substance that nourishes and carries sperm during ejaculation — and is located deep within the pelvis, in a tightly packed area surrounded by critical nerves, blood vessels, and muscles.
These include:
The pelvic floor muscles, which help control urination and provide support to the bladder.
The neurovascular bundles, often referred to as the “erection nerves,” which sit like delicate ribbons along the back of the prostate. These nerves are essential for getting and maintaining an erection.
During prostate cancer surgery, our primary aim is always to remove the cancer safely and completely. However, in doing so, we often must operate very close to — or even through — these vital nerves. Whenever possible, we perform nerve-sparing surgery, which means we take extra care to preserve the erectile nerves on one or both sides of the prostate.
But in some cases, especially when the cancer is aggressive or located near these nerves, preserving them may not be possible. In such instances, there can be a direct impact on a man’s ability to achieve erections naturally.
The Four Main Changes You May Notice After Surgery
Let’s break down what happens to sexual function after a radical prostatectomy:
✅ Erectile Dysfunction (ED)
This is common after surgery. Erections may be weaker or absent at first. Recovery is often gradual, depending on your age, nerve preservation during surgery, and general health (especially things like smoking, diabetes, and blood pressure).
✅ Dry Ejaculation
Post-surgery, you will no longer ejaculate semen — this is permanent. Many men still experience orgasm, but the sensation may feel different. Some say it's less intense, some say it’s unchanged, and others report it’s more intense — responses vary.
✅ Shortening of the Penis
Without regular erections (which usually occur during sleep), the tissue can stiffen and contract slightly, causing minor penile shortening. This is a physical change that can be reduced with early rehabilitation.
✅ Climacturia (Leaking Urine During Orgasm)
For some men, especially in early recovery, urination during orgasm can occur. It often improves with time and pelvic floor therapy.
What Can We Do About It?
The good news is that you’re not alone — and you have options. Recovering your sexual function is not just a possibility, it’s a priority.
Oral Medications
We approach recovery using a comprehensive and personalised rehabilitation strategy, which may include:
Early penile rehabilitation, including medications like Viagra or Cialis to stimulate blood flow
Vacuum erection devices (VEDs) to encourage tissue oxygenation and prevent atrophy
Pelvic floor physiotherapy, which can improve blood flow, muscle control, and overall pelvic health
Counselling or sex therapy, to support emotional wellbeing and intimacy with your partner
Injection therapy or penile implants, for those who need additional help later on
Every man’s journey is different — but with guidance, support, and access to the right tools, we can help you regain function, confidence, and connection.
What About Intimacy and Relationships?
Every man’s journey is different, and so is every couple’s. My best advice? Talk openly with your partner. Understand that healing takes time — emotionally and physically — and that intimacy can evolve.
Support, reassurance, and patience go a long way.
Final Thoughts
Recovering your sex life after prostate surgery is not only possible — it’s a priority we share with you. With the right strategies and a personalised approach, you can overcome both the physical and emotional challenges and return to a fulfilling life.
If you’re preparing for surgery or currently in recovery, speak with your GP or urologist about your options. We’re here to work alongside them, offering additional support to help you regain confidence and quality of life.