Sex after Prostate Surgery
What is important to know, first and foremost, is that most men with normal sexual function, who have very early or early prostate cancer, regain erectile function and can have satisfying sex lives after robotic prostatectomy at Mount Sinai. However, it is a gradual process – one that can take up to 12 months for most men and include erectile dysfunction (ED) along the way.
The fact that the majority of our patients regain sexual function after surgery is due to the detailed nerve preservation technique that is an integral part of Advanced Robotic Technique (ART™) prostatectomy, developed and practiced by Dr. Ashutosh (Ash) K. Tewari, Chairman of the Department of Urology at Mount Sinai. The ART technique is unique in terms of pre-operative imaging and planning, awareness and sensitivity to extended neural pathways and neural branches during surgery, intra-operative monitoring of a completely “athermal” approach (no use of cautery or heat energy), and pioneering work around “traction free” techniques practiced in his surgeries. Each one of these small steps ultimately contributes to the superior outcomes in ART, which is considered to be a textbook standard for outcomes and precision in nerve preservation. Dr. Tewari and his team of researchers have made key discoveries that have won several awards from the urological community for advancing the field of nerve sparing.
Penile rehabilitation can play an important role in speeding the ability to resume sexual functioning. Studies show that going for too long without blood flow to the penis may damage muscle and tissue within, thereby affecting a man’s ability to have erections again on his own. The goal of penile rehabilitation is to keep the penile tissue and muscles oxygenated and stretched to preserve erectile function while the nerves in the penis fully recover. At Mount Sinai, we encourage our patients to start working on penile rehabilitation even before surgery.
Pre-operative visits could include early evaluation, penile Doppler studies (a test of blood flow into and out of the penis), and testosterone level estimations, if our experts feel that your particular case could benefit from these evaluations. Occasionally, we start penile rehabilitation using medications a few weeks before surgery. This approach, in certain cases, may enhance the blood supply to the penis and serve as a jump start for sexual rehabilitation, which could have been a lower priority due to recent biopsy and/or a cancer diagnosis.
Post-operative rehabilitation usually starts a few weeks later and may include the following treatment options, as well as other approaches, to maximize your chances of recovery.
- Intra-urethral suppository (also known as MUSE®): MUSE (alprostadil) may be prescribed to encourage erections anywhere from two weeks to three months after surgery. MUSE consists of a medicated pellet that is placed in the urinary opening using a disposable plastic applicator. MUSE works by opening the blood vessels to increase blood flow to the penis.
- Oral medications: These include a number of prescription medications taken by mouth – such as Cialis® (tadalafil), Levitra® (vardenafil), and Viagra® (sildenafil citrate) – that may help improve blood flow to the penis.
- Vacuum device therapies (or vacuum pumps): These are mechanical devices (a plastic cylinder placed over the penis with a battery-operated or manual pump) that draw blood into the penis to achieve an erection.
- Penile implants: A permanent device surgically placed inside the penis, a penile implant can be a satisfying option for patients and their partners when drug treatments and other therapies do not resolve erectile dysfunction. A very small proportion of patients actually may benefit form a penile implant or other surgical treatments.
We are committed to working with you and your partner to find the best therapy for you as a couple.
We Can Help
At the Department of Urology at Mount Sinai, we have a dedicated team of specialists, led by Natan Bar-Chama, MD, and Doron S. Stember, MD, who have expertise in erectile dysfunction and can further assist you. In addition, we have a dedicated staff member Leslie Schlachter, PA, who will coordinate the sexual recovery plan that is individualized to your specific case. For more information, please call 212-241-9955.