Sex After Prostate Surgery: What Men and Partners Need to Know
For men, and their partners, navigating intimacy after prostate cancer treatment
I want to be honest about something first. I don’t know what it’s like to have a prostate, to get and hold an erection, or to receive a cancer diagnosis. I haven’t lived any of that, and I won’t pretend to.
What I do know, from training and from years of client work, is what can happen after prostate surgery or treatment, and how to help rebuild intimacy when the body has changed. Post-prostatectomy recovery is about more than erections. So this post isn’t written from the inside of prostate cancer. It’s written from what I can actually offer you.
Erectile dysfunction after prostate surgery: what happens
After a radical prostatectomy, many men are told to expect erectile dysfunction, and for a lot of men that’s exactly what happens. The nerves and blood vessels that control erection run right alongside the prostate. Surgery, even nerve-sparing surgery, can bruise, stretch or cut them.
But “damaged” doesn’t always mean “gone.”
Penile rehabilitation, using things like PDE5 inhibitors (Viagra-type medications), vacuum erection devices and injection therapy, is based on a fairly simple idea. Tissue that doesn’t get blood flow for a long time can start to lose elasticity and function, so getting blood moving through it early may help preserve what’s left.
The evidence on how much this improves long-term erections is genuinely mixed. Some studies support it, some don’t, and a Cochrane review found the quality of the research is mostly low. I won’t oversell it to you. What I can tell you is that keeping blood flow and gentle stimulation going to the nerves that are still intact is a reasonable thing to explore with your urologist. Alongside, not instead of, rethinking what sex means for you now.
Sex was never only about penetration
Here’s where my actual expertise in working with men comes in. A huge amount of what I do, with any client, prostate or no prostate, is help people expand the idea of what “sex” is, way beyond “penetration”, and explore how penetration can look now. Those two words are usually fused together from the very first sex ed class, which rarely goes beyond how to make a baby and how not to get an STI. It’s a fusion that hurts everyone’s access to pleasure, not just men recovering from prostate treatment.
I can teach you how to bring your partner to full arousal and orgasm without a firm erection anywhere in the room. That includes touch, rhythm, pressure, breath, and paying attention to what their body is actually telling you, rather than what porn or convention taught you sex is supposed to look like.
This isn’t a consolation prize. In a trial at MD Anderson Cancer Center (the CAREss trial), couples who received sexual counselling after prostate cancer treatment improved their sex lives, while couples waiting for counselling did not.
In my experience, the couples who do best are the ones who redefine what “sex” means together, rather than waiting to get back to what it used to be.
What I’ve seen in my work
In my work, I have helped men have full-body, energetic orgasms when they had very little sensation left in their penis, but a lot of sensation in the rest of their body. I have also worked with men whose nerves were described as “offline” after surgery, but who turned out to have nerves that were more like shell-shocked. Still connected, but sending and receiving confused signals. In my experience, if there is still a connection, we can often help improve it.
Is it a quick journey? No. If your spine had been through this kind of invasive treatment, you wouldn’t expect to walk the next day either. It’s a journey with homework and practices, and with challenging the stigma around pleasure along the way.
I’m not saying your erection will be what it was. But your sex life can still be better than it ever was.
Grief is part of this, and it’s allowed to be big
Prostate cancer touches a lot more than the prostate. Men with prostate cancer have described a real sense of loss: of identity, of masculinity, of confidence, of control over their own future. That grief is not an overreaction. It’s a common response.
Part of my work is holding space for that grief. The anger, the confusion, the sadness about a body that used to work one way and doesn’t anymore. You’re allowed to be furious about this. You’re allowed to mourn it.
In my experience, men who try to push through it quietly, on their own, often struggle more, and research on men’s experiences points the same way. Getting that grief moving, instead of burying it, is part of how you get your intimate life back, not a detour from it.
The relationship can survive this, and sometimes it gets better
This is the part I most want you to hear. Couples counselling and structured sexual support after prostate cancer treatment have solid research behind them. In the CAREss trial, men’s sexual function improved with counselling, and the improvement lasted for up to a year.
It also found that a good outcome wasn’t only about physical recovery. Finding a medical treatment that works mattered, and so did having a partner who also wanted the sex life to get better.
That’s what I support couples with, as an intimacy coach. Not chasing the erection you had at 30, but building the kind of communication, touch and shared language that lets two people stay close through a body that has changed.
Some couples come out the other side of this closer than they went in, because they were finally forced to talk about what they want, instead of assuming.
Where to start
If this is you, or your partner, here’s what I’d say. Talk to your urologist about the medical side (medication, vacuum devices, timing), and talk to someone like me about the intimacy side. They’re not competing tracks, they work best together.
I offer pelvic floor bodywork in person in Melbourne, focused on circulation, sensation and reconnecting with pleasure. If you’re not in Melbourne, I can also teach you many of these somatic practices online. It’s not quite the same as hands-on work, but it can still make a real difference. Coaching for men and couples is available both in Melbourne and online, so you can work with me wherever you are.
“Since experiencing nerve damage when my prostate was removed (due to cancer diagnosis), I am no longer able to achieve an erection... Most particularly, if you are a male challenged by erectile dysfunction, Ami is the practitioner for you. No judgement and no performance issues, simply a lovely indulgence in self pleasure.”
Anonymous, Melbourne, December 2025
For medical information and support, the Prostate Cancer Foundation of Australia has a helpful page on sexual health and wellbeing after prostate cancer.
You haven’t lost your sex life. It’s going to look different, and different is allowed to be good.
References
Matheson, L., Nayoan, J., Rivas, C., Brett, J., Wright, P., Butcher, H., Gavin, A., Glaser, A., Watson, E., & Wagland, R. (2020). A qualitative exploration of prostate cancer survivors experiencing psychological distress: Loss of self, function, connection, and control. Oncology Nursing Forum, 47(3), 318–330.
Philippou, Y. A., Jung, J. H., Steggall, M. J., O’Driscoll, S. T., Bakker, C. J., Bodie, J. A., & Dahm, P. (2018). Penile rehabilitation for postprostatectomy erectile dysfunction. Cochrane Database of Systematic Reviews, Issue 10, CD012414.
Schover, L. R., Canada, A. L., Yuan, Y., Sui, D., Neese, L., Jenkins, R., & Rhodes, M. M. (2012). A randomized trial of internet-based versus traditional sexual counseling for couples after localized prostate cancer treatment. Cancer, 118(2), 500–509.
