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Surgery, radiation therapy, and hormonal therapy for prostate cancer all have impacts on sexual function, each in different ways. Patients should take time to seek out a doctor who not only understands their sexual health goals but who has extensive experience treating patients with the disease, advises Memorial Sloan Kettering Cancer Center sexual health specialist, John Mulhall, MD.
How does surgery cause erectile dysfunction? The only operations that directly cause erectile dysfunction are those that are performed in the pelvis. Radical Prostatectomy, Radical Cystectomy for bladder cancer and Radical rectal surgery for rectal cancer. The way they do that is through three mechanisms. The first, nerve damage. These nerves supply the erection tissue that runs right alongside the prostate. It’s best to think of those nerves as tiny fiber optic cables buried inside saran wrap pasted over in front of the prostate. To get the prostate out, and bladder out, for bladder cancer, that saran wrap needs to be divided, unfolded, and then pulled aside.
Even in the hands of an experienced surgeon, when he or she comes out after surgery and says, ‘the nerves look pristine, this is the best nerves surgery I’ve ever done’, those nerves have been handled and they go to sleep because of bruising and swelling.
When these nerves go to sleep, they often go to sleep for a full year after surgery and it takes them up to another year to recover from that. That’s why many men, do not recover erections after prostate surgery for eighteen to twenty-four months.