Sexual Dysfunction after Prostate Surgery
Sexual dysfunction after prostate surgery is a common consequence of radical prostatectomy or transurethral resection. It includes erectile dysfunction, loss of ejaculation, and changes in orgasm quality due to nerve and tissue damage.
What is Sexual Dysfunction after Prostate Surgery?
Sexual dysfunction after prostate surgery is a common consequence of radical prostatectomy or transurethral resection. It includes erectile dysfunction, loss of ejaculation, and changes in orgasm quality due to nerve and tissue damage.
Prevalence: Affects 70-90% of men after radical prostatectomy; 30-50% after TURP
Symptoms and Signs
- •Erectile dysfunction after surgery
- •Absence of ejaculation (dry orgasm)
- •Decreased orgasm intensity
- •Urinary incontinence during orgasm (climacturia)
- •Penile shortening or curvature
- •Reduced sexual desire
Causes and Risk Factors
Common Causes
- →Damage to cavernous nerves during surgery
- →Removal of prostate affecting ejaculation
- →Vascular changes to penile blood supply
- →Psychological impact of cancer diagnosis
- →Hormonal changes if also on ADT
- →Scarring or structural changes
Risk Factors
- ⚠️Nerve-sparing vs non-nerve-sparing technique
- ⚠️Preoperative erectile function
- ⚠️Age at time of surgery
- ⚠️Surgeon experience
- ⚠️Adjuvant radiation or hormone therapy
Treatment Options
Expected Outcomes: Recovery varies; 40-70% return of erections with nerve-sparing; 2-3 year recovery period typical
Available Treatments:
- ✓Penile rehabilitation (PDE5 inhibitors early protocol)
- ✓Oral PDE5 inhibitors (sildenafil, tadalafil)
- ✓Intracavernosal injections
- ✓Vacuum erection devices
- ✓Penile implant surgery
- ✓Pelvic floor physical therapy
- ✓Psychosexual counseling
- ✓Climacturia management strategies
Prevention Tips
- →Choose experienced surgeon for nerve-sparing approach
- →Penile rehabilitation protocol starting early post-op
- →Preoperative counseling about realistic expectations
- →Manage cardiovascular risk factors before surgery
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