Erectile Dysfunction After Prostate Surgery: What You Need to Know

If you’re recovering from prostate surgery and noticing changes in your sexual function, you’re far from alone. Erectile dysfunction (ED) and urinary incontinence are two of the most common challenges men face after a prostatectomy, often affecting quality of life in ways that aren’t always discussed openly.

But here’s the good news: with a clear understanding of what’s happening in your body, and the right support, recovery is absolutely possible.

Key Takeaways

• ED and incontinence are common after prostate surgery, but recovery is achievable.
• Pelvic floor physiotherapy, especially early and with biofeedback, significantly aids erectile function recovery.
• Recovery takes 6-12 months (up to two years), with medication often used for support.

Why Does Erectile Dysfunction Happen After Prostate Surgery?

Prostate surgery, most commonly a radical prostatectomy, is a procedure to remove all or part of the prostate gland and is typically performed to treat prostate cancer or, less commonly, severe benign prostatic hyperplasia (BPH). 

The prostate is a small gland located just below the bladder and in front of the rectum, surrounding the upper part of the urethra – the tube that carries urine and semen out of the body. It plays an important role in producing seminal fluid. 

Because of its location and relationship to surrounding nerves and muscles, particularly those involved in bladder control and sexual function, prostate surgery can cause temporary disruption in nerve function, known as neuropraxia.

What is Neuropraxia?

Neuropraxia is a temporary “shutdown” of a nerve without structural damage. It can occur due to stretching, compression, or surgical trauma. In the context of prostate surgery, the trauma of removing cancerous tissue near these nerves is enough to interfere with signal transmission, even when the nerves aren’t actually cut.

“It’s as if the nerve has been stunned. It hasn’t been severed, but it’s not communicating as it should – and that can take weeks or months to recover,” says Jack Roberts, pelvic health physiotherapist at Complete Physio.

Nerve Sparing Surgical Techniques

During a radical prostatectomy, one of your surgeon’s goals will be to minimise damage to the nerves that control erections, allowing for a greater chance of regaining sexual function after surgery. This is achieved by using a nerve-sparing surgical technique.

During the procedure, surgeons carefully dissect and preserve the neurovascular bundles, which are located near the prostate and contain the nerves that control erections. 

How Physiotherapy Helps With Erectile Dysfunction Recovery

Men’s health physiotherapy offers an evidence-based, non-invasive approach to managing erectile dysfunction (ED), particularly when it is related to pelvic floor dysfunction. 

The pelvic floor muscles, especially the ischiocavernosus and bulbocavernosus, play a key role in achieving and maintaining erections by supporting blood flow to the penis and assisting in the rigidity and venous occlusion needed for sexual function. 

After surgery such as a prostatectomy, or due to prolonged sitting, stress, or ageing, these muscles can become weaker, or don’t contract and fire correctly, contributing to ED. 

A specialist men’s health physiotherapist can assess muscle tone, strength, and coordination, and guide patients through a personalised pelvic floor exercise program. 

At Complete Physio, this involves:

• Teaching correct muscle activation using real-time ultrasound
• Improving blood flow to penile tissues through targeted exercises
• Reducing overactivity or compensation from surrounding muscles

“It’s like learning a new skill. Most men have never consciously used their pelvic floor muscles, so we have to teach activation, coordination, and eventually strength—just like with any muscle,” Jack says.

This may be supported by biofeedback, real-time ultrasound imaging, and education on lifestyle and posture to optimise pelvic function. 

Physiotherapy not only targets the physical aspects of ED but also provides reassurance and improved body awareness, helping men regain confidence and control over their sexual health.

Factors That Influence Erectile Function Recovery

Several factors affect how quickly and fully erectile function returns:

• Type of surgery: Whether the surgeon used unilateral or bilateral nerve-sparing techniques.
• Extent of nerve preservation: If both nerve bundles are preserved, recovery is typically quicker.
• Age and pre-surgical function: Younger men and those with strong function pre-op tend to recover better.
• Timing and quality of rehabilitation: Starting pelvic floor physiotherapy early can make a big difference.

The Importance of Pre-Operative Training

We strongly recommend starting physiotherapy 4-6 weeks before surgery. Known as “pre-hab”, this early preparation helps in several ways:

• Establishes motor memory before surgical trauma occurs
• Improves outcomes post-op by priming the muscles
• Increases patient confidence through familiarity with the exercises

If you’re waiting for your operation date, now is the time to get started.

Call us on 020 7482 3875 or book online.

What Happens After Surgery?

After surgery, patients typically have a catheter in place for 7-10 days. Once removed, we reassess using ultrasound to understand how the pelvic floor is functioning.

Depending on healing, the next steps may involve:

• Continued isolated muscle activation
• Progressing to endurance and strength-focused exercises
• Coordination drills to support both urinary and sexual function

It’s a tailored approach, designed to support your specific stage of recovery.

When Does Erectile Function Return?

The Initial Recovery Window: 6-8 Weeks

Most men begin seeing signs of recovery within six to eight weeks post-surgery—although this is only the beginning. During this period, soft tissue heals, inflammation reduces, and blood flow starts to normalise. This is when the body starts “rebooting” the affected nerves and tissues.

“We usually recommend holding off on assessing true erectile function until at least six weeks post-op. Before that, there’s too much healing going on to get a clear picture,” Jack explains.

However, in rare cases, some patients wake up post-op with spontaneous erections. This typically occurs when both nerve bundles were successfully preserved, and the trauma to surrounding tissue was minimal.

When Is Medication Used for Post-Surgery Erectile Dysfunction?

If spontaneous recovery doesn’t occur within the first 4-6 weeks, your consultant may suggest pharmacological support.

Common Options Include:

• PDE5 inhibitors: Sildenafil (Viagra) or Tadalafil (Cialis), typically used first
• Penile injections: Such as alprostadil, for patients with severe nerve disruption

These medications work by enhancing blood flow to the penis, making it easier to achieve and maintain an erection. While injections are more invasive, they offer reliable results for those with significant nerve damage.

“Sometimes, the medication is needed long term. For others, it’s just a bridge until natural function returns,” says Jack.

What Is Penile Rehabilitation?

Penile rehabilitation typically involves a combination of strategies including pelvic floor exercises, medication, vacuum erection devices (VEDs), education and advice.

This holistic, therapeutic approach is aimed at preserving erectile function and penile tissue health during the recovery period following surgery. It’s about restoring confidence and function-not just achieving a physical erection. 

While individual outcomes vary, many men begin to see improvements in erectile function within 6 to 12 months, though full recovery can take up to two years. Early intervention and a structured plan guided by a specialist often lead to the best results.

Penile rehabilitation is a comprehensive approach combining:

• Pelvic floor therapy
• Medication (if needed)
• Sexual health education and counselling
• Realistic expectation management

At Complete Physio, we create personalised plans that evolve with your recovery to ensure that you feel supported through every stage of your rehabilitation.

What Exercises Help With Erectile Dysfunction?

While every patient’s plan is tailored, these foundational exercises are often part of a rehab protocol:

Stage 1: Muscle Activation

• Supine pelvic floor squeezes
• “Stop-the-flow” drills (only for awareness – not long term)
• Ultrasound-guided feedback sessions

Stage 2: Endurance and Coordination

• Sitting and standing pelvic holds
• Controlled activation during walking or squats

Stage 3: Strength and Functional Recovery

• Quick contractions for reflex response
• Integration into activities of daily living and intimacy

If you’ve never trained your pelvic floor, don’t worry – we’ll spend time with you making sure that you feel confident with the exercises and that your technique is correct. 

Other Tools We Use

Verbal Cueing and Biofeedback

Verbal cueing and biofeedback are essential techniques in men’s pelvic floor rehabilitation, helping patients learn how to correctly engage and relax their pelvic floor muscles. 

After surgery or injury, it’s common to lose awareness of these muscles, making activation challenging. Simple verbal cues like “lift and squeeze” or “imagine stopping the flow of urine”, can provide helpful guidance and improve exercise technique. 

Biofeedback enhances this process by offering real-time visual or auditory signals, often through sensors or ultrasound, to show how effectively the muscles are working. This feedback not only improves the accuracy of each contraction but also builds confidence and allows both the physiotherapist and patient to monitor progress more precisely over time.

Real-Time Ultrasound

At Complete Physio, we use real-time ultrasound as a powerful, non-invasive biofeedback tool to support pelvic floor assessment and rehabilitation. 

This technology enables our physiotherapists to visually assess pelvic floor movement using a transabdominal or transperineal approach, providing live imaging of how the muscles engage and relax.

 It’s particularly valuable for men experiencing urinary incontinence or erectile dysfunction when recovering from prostate surgery, where reconnecting with these muscles can be difficult. 

Real-time ultrasound offers immediate visual feedback, helping patients understand and perform pelvic floor exercises correctly. By combining this with expert verbal cueing, at Complete Physio, we can ensure that each treatment session is personalised, targeted, and effective in helping you restore pelvic floor strength and control.

Can Physiotherapy Really Help?

What the research says

Pelvic floor muscle training significantly helps improve erectile function in around 40–50% of men, with stronger results when paired with biofeedback, especially post-prostate surgery. 

A larger systematic review of ten trials concluded that pelvic floor muscle training, especially when combined with biofeedback, led to consistent improvements in erectile function versus controls

A randomized controlled trial of 55 men with ED (mean age ~59) who performed pelvic floor exercises with manometric biofeedback showed a 6.74‑point gain on the IIEF erectile function score at 3 months compared to controls (P = 0.004), with 40% regaining normal erectile function, 34.5% improving, and 25.5% showing no benefit at 6 months.

Another randomised controlled trial showed that the best results are seen when pelvic floor muscle training (PFMT) is performed for at least 3 months, with biofeedback enhancing muscle training.