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Impotence - Impotence and prostate cancer

Auteur : Docteur Marc Galiano - Date de dernière mise à jour : 3 September 2015

Why are there erectile problems after treatment for prostate cancer?

The prostate is a gland located at the outlet of the bladder; it rests on the rectum.
The prostate has two main functions: it secretes the enzymes and molecules that are essential for reproduction. It plays a role in trapping bacteria and, in this way, protects the testes from infection.
The nerves that make an erection possible are in more or less close contact with the bottom and sides of the prostate. This is why all the techniques that are designed to treat the whole prostate (surgery, brachytherapy, radiotherapy, Ablatherm and cryotherapy) have a more or less significant impact on erections.

There are three main mechanisms that can explain your total or partial inability to get an erection after treatment for prostate cancer (ablation, radiation or cryotherapy).

– Physical damage to the erector nerves. The nerves pass in contact with the prostate at its rear and side.
You must understand that when the prostate is removed (even with the greatest care and highest precision) these nerves can be damaged or deliberately cut by your surgeon to avoid leaving cancer inside.
You must also understand that the rays or cryotherapy can overflow from the prostate and damage the erector nerves. Consequently, the impulses between the brain and the penis are cut and, therefore, there are no more erections.

– Venous leak: your penis fills with blood but it no longer remains trapped in the corpora cavernosa. Consequently, the erection lacks firmness or disappears when you change position (usually when switching to lying down), as if the seal no longer works.
What kind of treatment?

– Psychological impact of the disease. Too often overlooked or underestimated by the patient and the doctor, the psychological impact of prostate cancer is important. Indeed, anxiety is important because you need to handle, in a short time, your choice of treatment, its consequences, your job and your family. This situation of stress is responsible for the secretion of molecules by your body that decrease, and even prevent, erection and libido.

These three mechanisms may be involved to varying degrees depending on each patient and the treatment chosen to treat your prostate cancer.

What can be done to regain erections after a radical prostatectomy?

You urologist will propose a treatment to you that will facilitate your recovery and allow you to have a sex life with a hard penis.
Conventional protocols for re-oxygenation of the corpora cavernosa after radical prostatectomy include intracavernosal injections 2 to 3 times per week, PDE5 inhibitors in small doses every 2 days until resumption of normal erections and daily use of the vacuum. Recovery takes 2 years, on average.
Beyond this time, if recovery does not occur, there is little chance for it to come back.


Doctor Marc Galiano


2 rue Dupuytren
75006 PARIS