Erection problems are one of the most common effects of prostate cancer treatment, and one of the hardest to talk about. The good news is that there is a lot of help available, and starting early makes a difference. This guide explains why each treatment affects erections, what recovery can look like, and the options for getting your sex life back.
Why each treatment affects erections
Surgery (radical prostatectomy)
Two bundles of nerves that control erections run right alongside the prostate. Removing the prostate often affects these nerves, and almost all men have problems getting an erection after the operation1. “Nerve-sparing” surgery tries to protect them, which can lower the risk, but it is not always possible if the cancer is close to the nerves1.
European urology guidelines say the main factors in how well erections recover are your age, how good your erections were before surgery, whether the nerves could be preserved, and the surgeon’s experience2. The evidence on whether robotic surgery gives better results than open surgery is still unclear2.
After the prostate is removed, you no longer ejaculate semen. You can still have an orgasm, but it is a “dry” one1.
Radiotherapy
Radiotherapy to the prostate can also damage the nerves that control erections. Unlike after surgery, erection problems often develop slowly, and it might be a few years before you notice them1. Studies show erection problems become more common in the years after radiotherapy and brachytherapy (internal radiotherapy)2.
Hormone therapy
Hormone therapy lowers testosterone or blocks its effects, because testosterone helps prostate cancer grow3. Lower testosterone can affect your ability to get and keep an erection, how intense orgasms feel, and your interest in sex1. It is given as injections and tablets3; tablets used in prostate cancer include bicalutamide, abiraterone and enzalutamide.
If low sex drive is a problem, Cancer Research UK suggests asking your doctor about intermittent hormone therapy, where treatment is paused for set periods; some studies suggest it can reduce sexual problems4. Whether that is safe for you depends on your cancer, so it is a decision for your cancer team.
Monitoring and newer treatments
In a large UK trial (ProtecT), erections declined over six years in every group, including men whose cancer was only monitored, but they declined most after surgery2. Newer, more targeted treatments such as high-intensity focused ultrasound and cryotherapy are reported to have less effect on erections2.
What recovery can look like after surgery
Some men get erections back after surgery, but it can take time. Others need support or treatment for erections for the rest of their lives1. Nobody can predict exactly which group you will be in, so it helps to plan for treatment rather than wait and see.
Penile rehabilitation: what it means and what the evidence shows
“Penile rehabilitation” means using treatments soon after surgery to help you have erections while the nerves recover. The European guidelines say2:
- Start early. Erection treatment should begin at the earliest opportunity after surgery or other curative prostate cancer treatment.
- No single best plan. The data do not support any one specific rehabilitation regimen.
- Be realistic. Rehabilitation with tablets helps men have sex during recovery, but it has not been shown to increase the chance of erections returning on their own.
Treatments that can help
- ED tablets (PDE5 inhibitors), such as tadalafil and sildenafil, are the first choice after nerve-sparing surgery2. They need arousal to work1. They tend to work best in men who still have sexual desire, so they may help less during hormone therapy, though specialists often think they are worth trying1. Daily low-dose tadalafil is one option; see daily vs on-demand tadalafil.
- A vacuum pump draws blood into the penis. Used early after surgery it is helpful and safe, and combining it with tablets can work better than either alone2. A constriction ring keeps the erection firm but should not stay on for more than 30 minutes, and a blue tinge to the penis is normal1.
- Alprostadil, as a cream at the tip of the penis, a pellet placed in the urethra, or an injection into the shaft of the penis1. Injections are usually the next step if tablets do not work2.
- A penile implant, usually considered when other treatments have not worked2.
- Counselling or sex therapy, on your own or with a partner1.
If tablets do not seem to work, it is worth checking how you are taking them; see Viagra not working? If you also take an alpha-blocker such as tamsulosin for urinary symptoms, your ED tablet should start at a low dose5; our guide to tamsulosin vs finasteride explains these medicines.
Other sexual changes worth talking about
Prostate cancer treatment can change more than erections. The European guidelines recommend that doctors discuss lower sexual desire, changes in orgasm, no ejaculation, curving of the penis and changes in penis size2. After surgery, some men leak urine when aroused or at orgasm, which is temporary for some4. These are common, and your specialist nurse or urologist will have heard it all before.
Sex, intimacy and partners
Tiredness, anxiety about the cancer and loss of confidence can all lower interest in sex, as well as the treatment itself4. Talking openly with your partner, and with a counsellor if it helps, can take some of the pressure off4. Intimacy does not have to mean penetrative sex, especially while you are recovering.
Is ED a sign of prostate cancer?
Not usually on its own. Prostate cancer often has no symptoms at first. When it does, changes in the way you pee are the most common. Erectile dysfunction is listed among other possible symptoms6, but ED has many more common causes, such as stress, diabetes, high blood pressure and some medicines7. If you are worried, see a doctor, who can check both.
For the medicines used to treat prostate cancer, see our prostate cancer medicines page and our guide to generic abiraterone. Our ED medicines page lists treatments such as Tadarise 5 mg (tadalafil).
Frequently asked questions
How long does erectile dysfunction last after a prostatectomy?
It varies. Some men get erections back over time, while others need treatment long term. Your age, erections before surgery and whether the nerves were spared all play a part. Starting treatment early helps you stay sexually active during recovery.
Does Cialis help after prostate surgery?
ED tablets such as tadalafil (Cialis) are the first choice after nerve-sparing surgery, and they help many men have erections during recovery. They have not been shown to make erections come back on their own any sooner.
Does hormone therapy cause erectile dysfunction?
It can. Lower testosterone can affect erections, orgasms and sex drive. Ask your team whether intermittent hormone therapy is an option for you if this is a problem.
Can radiotherapy cause ED years later?
Yes. After radiotherapy, erection problems often develop slowly and may not appear for a few years.
Will I still have orgasms after my prostate is removed?
Yes, most men can still have orgasms, but they are “dry” because no semen comes out. Some men find they feel different.
Can I take Viagra while on hormone therapy?
Often yes, if your doctor agrees. ED tablets work best when there is sexual desire, so they may help less during hormone therapy, but many specialists think they are worth trying.
Sources & references
- Cancer Research UK. Sex and erection problems after prostate cancer treatment. Last reviewed 7 August 2025.
- European Association of Urology. EAU Guidelines on Sexual and Reproductive Health: Management of erectile dysfunction.
- NHS. Treatment for prostate cancer. Page last reviewed 31 July 2025.
- Cancer Research UK. Less interest in sex (libido) and prostate cancer. Last reviewed 4 September 2025.
- US National Library of Medicine, DailyMed. Cialis (tadalafil) prescribing information.
- NHS. Symptoms of prostate cancer. Page last reviewed 31 July 2025.
- NHS. Erectile dysfunction (impotence). Page last reviewed 28 July 2023.
Related reading
- What is erectile dysfunction?
- Tadalafil medicines
- Abiraterone medicines
- Enzalutamide medicines
- Bicalutamide medicines
This content is for informational purposes only and is not medical advice. Decisions about prostate cancer treatment and sexual recovery should be made with your cancer and urology team. Used as prescribed by a licensed medical professional.
Simran Jha is a licensed clinical pharmacist with 17 years of experience. She holds a B.Pharm and M.Pharm from Dr. YSR University of Health Sciences. At OnlineMeds, she reviews medicine and health content to help ensure it is accurate, evidence-based, and easy to understand.