Can Surgery Cause Erectile Dysfunction?

Prostate surgery, pelvic surgery, recovery timelines and treatment including penile rehabilitation.

Part of the Access Doctor Erectile Dysfunction guide.

Why Does Surgery Cause Erectile Dysfunction?

Radical Prostatectomy

The most common surgery-related cause of ED is radical prostatectomy — surgical removal of the prostate gland, typically for prostate cancer. Two small nerve bundles called the cavernous nerves run along each side of the prostate. These nerves carry the signals from the brain that trigger blood flow into the penis and initiate an erection. Even when cancer has not invaded these nerves, their close proximity to the prostate means they are at significant risk of stretching, bruising, or inadvertent damage during surgical dissection.

Other Surgeries That Can Cause ED

• Bladder surgery — particularly cystectomy (bladder removal)
• Colorectal surgery — particularly anterior resection for rectal cancer
• Pelvic fracture repair — trauma or repair can damage the pudendal artery or cavernous nerves
• TURP (transurethral resection of the prostate) — for BPH; lower risk than radical prostatectomy but not zero
• Aortic aneurysm repair — can disrupt blood supply to the pelvis
• Lumbar spinal surgery — can damage nerve pathways to the penis

Nerve-Sparing Prostatectomy

Where clinically appropriate, surgeons may perform a nerve-sparing prostatectomy, carefully dissecting around and preserving the cavernous nerves. When technically feasible and oncologically appropriate, this significantly improves the prognosis for erectile recovery. However:

• Nerve-sparing is not always possible if cancer is close to or has infiltrated the nerve bundles
• Even with nerve-sparing, nerve bruising during dissection causes temporary loss of erectile function in most men
• Full recovery, where it occurs, typically takes 12–24 months

Men planning a prostatectomy should discuss nerve-sparing options with their surgeon before the procedure.

Recovery Timeline After Prostate Surgery

Recovery depends on age, pre-operative erectile function, whether nerve-sparing was performed, surgical approach, and overall cardiovascular health.

Treatment Options for Post-Surgical ED

Penile Rehabilitation

Early, proactive treatment — typically starting once the catheter is removed after surgery — is thought to preserve erectile tissue health and support nerve recovery. This is called penile rehabilitation. Regular blood flow to the penis during recovery helps maintain oxygenation and elasticity of erectile tissue. Rehabilitation typically combines regular PDE5 inhibitor use (low-dose daily tadalafil or on-demand sildenafil), vacuum erection device use, and pelvic floor exercises.

Oral PDE5 Inhibitors

Sildenafil, tadalafil, and vardenafil all have evidence supporting their use in post-prostatectomy ED. Low-dose daily tadalafil (5mg) is commonly recommended for penile rehabilitation due to its continuous action. Note that PDE5 inhibitors work most effectively when at least some cavernous nerve function remains. For guidance on which medication to choose, see tadalafil vs sildenafil.

Pelvic Floor Exercises

Kegel exercises have good evidence for improving erectile function following prostate surgery and should ideally be started before surgery and continued post-operatively. For a step-by-step guide, see lifestyle changes for erectile dysfunction.

Vacuum Erection Devices

A vacuum erection device (VED) draws blood into the penis using negative pressure, creating an erection maintained by a constriction ring. VEDs are useful both as a rehabilitation tool and as an ongoing treatment — particularly where oral medications have limited effect due to significant nerve damage.

Penile Injection Therapy (Alprostadil)

Alprostadil injected directly into the corpus cavernosum causes vasodilation and an erection independent of nerve function — success rates of approximately 85%. This makes injection therapy particularly valuable for men with nerve-damaging surgery. It requires training and is typically initiated under urology supervision.

Surgical Penile Implants

If both cavernous nerves were removed or damaged beyond recovery and other treatments have been unsuccessful, a penile prosthesis provides a permanent solution. Satisfaction rates in appropriately selected patients are 90–95%. This is typically considered at 18–24 months post-surgery if other approaches have failed.