Erectile dysfunction is a common experience for many middle-aged men, most commonly due to physical causes, in particular simple aging and associated low testosterone levels.

There are several critical surgery procedures that can result in erectile dysfunction as well however.

The most common is prostate removal surgery or prostatectomy, where vital nerves controlling penile bloodflow may be damaged or even destroyed. As a result up to 80% of men will lose erectile function after prostate removal surgery.

How Surgery Can Cause Erectile Dysfunction

Basically, any surgery involving removal of tissue in or near the genital region can 

potentially damage or destroy nerves critical to good erectile function. Other forms of common treatments that can have similar effects too include:

  • Radiation therapy from external beam.
  • Bracytherapy (radiation therapy using a ‘seed implant’
  • Hormone therapy.

It’s not just the direct function of the nerves, carrying signals from brain to genitals, that’s at stake though. The penile cavernosal nerve is a key source of synthesis for nitric oxide, a vital molecule critical to erectile function specifically and also good sexual function in general.

Protein Offers New Treatment Hope

The oddly named ‘Sonic Hedgehog’ protein may bring a new option for men affected by erectile dysfunction after surgery.

Recent research from Northwestern University’s Feinberg School of Medicine indicates damaged nerves may regenerate much faster with the use of the so-called Sonic Hedgehog protein, delivered to the affected site via a nanofibre gel.

So effective is the new treatment, it appears to actually reduce post-surgery penile muscle damage by 63%. The researchers believe the treatment may soon prove applicable to nerve damage from non-surgical causes too, such as diabetes.

Robotic Surgery Techniques

In an attempt to minimise nerve damage after surgery, medical scientists have also 

developed new robotic surgery techniques. In robot-assisted prostate removal

 surgery, for example, a specific visual device called a laparoscope enables minimally invasive surgery using only 5 to 6 small parts of entry instead of the usual completely open retropubic or perineal prostatectomy sites. Using three-dimensional magnified images from the laparoscope, the surgeon uses a control console that offers a finer degree of control via the robotic instruments, whilst at the same time filtering tremors and scaling movements down.

This means less manipulation, better visualisation, and more precision. And as a result, significantly reduced accidental nerve damage. As technique is new however, robust evidence as to the difference robotic surgery techniques can make are still pending.

On a related note, there is however good evidence that experienced, gentler surgeons can make a big difference to erectile function post surgery. In June 2012 the journal European Urology undertook a study which found that doctors who had performed at least 1000 surgeries, and actively sought to improve and update their surgical technique, delivered significantly better post-surgery outcomes for erectile function than those who did not meet these criteria.

Sex after Surgery

While in the past men were advised ‘to wait and see’ for recovery of erectile function after surgery, new research suggests a better philosophy is ‘use it or lose it’!

The most common forms of erectile dysfunction treatment post surgery are:

  • Erectile dysfunction drugs, such as common PDE-5 inhibitors Levitra, Cialis, Viagra, Stendra and Staxyn ( a new form of Levitra’s active ingredient, Vardenafil).
  • Intracavernous injection therapy  (penile injections)
  • Vacuum constriction devices
  • Herbal remedies
  • Penile prosthetics
  • Intraurethral treatment

Some other good general recovery tips are:

1. Don’t leave things to chance. Sexual function is an important part of your life, so take action, plan ahead! If you’re about to undergo prostate surgery, talk frankly with your doctor about all your concerns and options. Get help finding an experienced surgeon, preferably familiar with robotic surgery techniques. Talk through your options for recovery post-surgery too, and make sure you follow through with them diligently!

2. Communicate with your partner. Don’t fall for the temptation of a stoic, silent 

approach.  Have an honest discussion with your partner if you’re having problems, or feeling frustrated. The same goes for your doctor too! Ignoring the problem will not help anything.

3. Consider all your options. Make sure you have an honest discussion with your doctor or specialist about all the potential treatment options, the pros and cons of each for you, and give them a good try. You’ll never know what’ll work for you until you do!

4. Be patient as well as pro-active. To avoid frustration, discuss with your doctor what reasonable time frames to expect on the road to recovery. Don’t be afraid to take things slowly in the bedroom either, at least the first few times. Remember, depending on the extent of nerve damage, things may feel a little different to before. This is normal after such surgeries.

5. And lastly, use it or lose it! Don’t delay! The road to recovery after surgery may present challenges, but the best advice is to face them head-on. Take the first step today.

If you feel you’re not coping as well with recovery post-surgery as you’d like, there’s plenty of great Aussie sexual health specialists who can give you a helping hand available here.