Can you get an erection without a prostate? Yes, here's how

Can you get an erection without a prostate? The short answer is yes, getting an erection without a prostate is possible. This article explains how erections work after prostate removal, why erectile dysfunction (ED) is common during recovery, and what treatments can help.

We also cover how orgasm and sex may change after surgery, plus a general timeline for when many people feel ready to have sex again.

Erections depend on nerves and blood flow, not the prostate itself. They happen when nerves signal blood vessels in the penis to fill with blood, and those structures can still work after the prostate is removed.

The cavernous nerves, which run along both sides of the prostate, release nitric oxide.

This chemical allows the smooth muscle in the penis to relax so blood can flow in and create an erection. If these nerves remain functional, erections are still possible.

Prostate surgery can temporarily disrupt this process. Once the prostate is removed, the nerves may be stretched or injured. When this happens, they release less nitric oxide, which makes erections difficult or impossible, at first. If the nerves recover, erections can return, sometimes with support from medications or devices.

Medications and other treatments can support blood flow and help preserve erectile tissue while the nerves recover.

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During prostate removal surgery (called radical prostatectomy), the prostate gland is removed, and changes to sexual function can begin immediately afterward. Nearly everyone experiences ED right after surgery. Nighttime, morning, and sexually stimulated erections usually disappear at this stage.

This early loss of erections isn’t caused by major damage to penile blood vessels. Instead, the sudden change typically happens because the erection-related nerves are temporarily disrupted during surgery.

The nerve disruption (aka neurapraxia) occurs when the cavernous nerves that run along the prostate are injured during the operation. Even when surgeons use techniques to minimize nerve disruption, these nerves may stop functioning normally for a period of time.

Recovery is slow and can take up to two years. During this period, natural erections may be weak or absent. As the nerve injury gradually resolves, nighttime erections may return, followed by improvements in normal erections. 

Yes, it’s possible to have sex without a prostate. After the prostate is removed, erections depend almost entirely on how well the erection-related nerves and surrounding tissue recover.

These nerves normally support erections by maintaining healthy oxygen levels in penile tissue through regular erections, especially nighttime erections. When erections stop after surgery, oxygen levels in the penis drop.

Nerve-sparing surgery can help because it reduces how much the cavernous nerves are disrupted during prostate removal. When these nerves are preserved, even if temporarily injured, they have a better chance of recovering function.

Without nerve sparing, people almost always develop ED after prostate surgery. Keep in mind, nerve-sparing techniques lower the risk of long-term erectile problems, but they don’t eliminate them entirely.

That doesn’t mean sex is impossible. With time, support, and rehabilitation, many people resume sexual activity even if their experience looks different than before.

Orgasms can still occur after prostate removal, even though ejaculation no longer occurs

After removing the prostate, orgasms often change because the prostate and seminal vesicles, which create and release most of the fluid in semen, are removed during surgery. As a result, ejaculation no longer occurs in the traditional sense.

Most people experience what’s commonly called a dry orgasm, meaning orgasm happens without the release of ejaculatory fluid. The sensation of this orgasm may feel different. Some report reduced intensity, delayed orgasm, or difficulty reaching orgasm after surgery.

Other orgasm-related changes can also occur. Some people experience urine leakage at orgasm, known as climacturia. Pain during orgasm has also been reported and may be related to tightening in the bladder neck or pelvic floor during orgasm.

Many people adjust to these changes over time and continue to have pleasurable sexual experiences after prostate surgery.

Sex after prostate surgery is possible — it can just take a bit of time before you’re back to bedroom activities.  

Recovery happens in phases, and expectations often change over time. Here’s an idea of what you might expect:

• First few weeks: Sexual activity is uncommon. Some erectile rehabilitation approaches may begin as early as three weeks after surgery, even though natural erections are not expected yet.

• Around six months: Most people start attempting sex with medical support, such as medications or devices, though many still need assistance to have intercourse.

• Around 12 months: Over 80% of people who were sexually active before surgery have resumed penetrative sex by this time point, often with ongoing treatment rather than fully natural erections.

Remember, this timeline reflects typical recovery patterns rather than strict rules, and individual experiences can vary.

ED after prostate removal is rarely caused by just one factor. It can happen for several reasons, including: 

Nerve damage

One of the main causes of erectile dysfunction after prostatectomy is nerve injury. The cavernous nerves that trigger erections run very close to the prostate and can be stretched, bruised, or partially damaged during surgery.

This temporarily reduces the release of nitric oxide, a key chemical needed for the smooth muscle in the penis to relax so blood can flow in and cause an erection. Nerve recovery can take up to two years.

Vascular changes

Vascular changes can also play an important role. When erections are absent during nerve recovery, blood flow and oxygen levels in the penis decrease. Over time, this lack of oxygen can lead to scarring and structural changes in the erectile tissue.

These changes may reduce penile elasticity and contribute to venous leak, which makes erections harder to achieve even after nerves begin to recover. (Venous leakage can also lead to position-dependent ED.) But with the right treatments, many of these vascular changes can be minimized or even improved over time.

Psychological factors

There’s also an emotional side that matters just as much. Losing erections after surgery can affect confidence and create anxiety around sex.

Some people start to avoid sexual activity altogether, not because they’ve lost interest, but because repeated difficulty can feel discouraging or stressful. That emotional strain can linger, even as the body begins to heal, and it can affect both partners. Seeing a sex therapist may help with these issues. 

Medications like Viagra (sildenafil) and Cialis (tadalafil) are often used after prostate surgery. They’re familiar, easy to use, and can be effective for many people over time.

• These medications support the body’s natural erection process. Viagra, Cialis, and similar drugs work by helping nitric oxide stay active longer in the penis. Nitric oxide allows the muscles in the penis to relax so blood can flow in and create an erection.

• They rely on nerve recovery to work well. Because the nerves that release nitric oxide are temporarily injured after surgery, the medications may not appear to work until those nerves heal.

• This is why early  response rates are often low. In the first six months after surgery, only about 12%–17% of people respond to these medications. This is expected, and it doesn’t predict how well they may work later or mean that the medications aren’t helping.

• Effectiveness often improves with time. As nerves gradually heal, these medications tend to become more effective.

• Results differ from person to person. Age, the extent of nerve injury, how long it’s been since surgery, and the dosage used can all influence outcomes. 

A healthcare provider can help decide if these medications are appropriate for you and how to use them safely. Drugs like Viagra and Cialis should never be taken with nitrates, as this can cause a severe drop in blood pressure. These include medications for chest pain (like nitroglycerin) and drugs such as nitrites ("poppers").

Certain medications can slow down the breakdown of Viagra in the body, leading to an increased risk of side effects. These include CYP3A4 inhibitors, such as ritonavir, saquinavir, erythromycin, and antifungals (ketoconazole, itraconazole). Grapefruit juice can also similarly affect how Viagra and Cialis work.

If you take medications for high blood pressure, particularly alpha-blockers such as doxazosin or tamsulosin (used for prostate conditions), Viagra may cause a further drop in blood pressure.

Though not everyone is eligible for oral ED medications, not to worry. There are numerous other options available for erectile support.

When pills don’t work well, especially early in recovery, other treatments can help support erections and protect penile tissue while nerves heal.

Penile injections are commonly used during this period. Unlike oral medications, injections don’t rely on nerve signaling to create an erection. Because of this, they’re often effective even when nerve recovery is incomplete and are widely used in penile rehabilitation programs.

Vacuum erection devices are another option. They draw blood into the penis mechanically and may help improve erectile function over time.

Combination therapy is also common. Using more than one approach — like injections plus a vacuum device or oral medication with another treatment — can improve results when a single option isn’t enough.

If erections haven’t returned after about 24 months, and other treatments aren’t working, penile implant surgery can be discussed as a potential option.

Of course, there is no one timeline regarding when to introduce different treatments for erectile support after prostate surgery. A healthcare provider can help guide timing based on your individual recovery and personal goals.

So, can you have sex after prostate removal? Yes! Starting to have sex again after prostate surgery can feel uncertain at first. It’s normal for you and your partner to ease into it slowly. This phase is less about “getting back to normal” and more about learning what works now.

Here’s what to keep in mind:

• Erections may look different at first. They can be weaker or require medication or other support while your body heals. This is common in recovery.

• Orgasms can feel unfamiliar. Orgasms often still happen, but without ejaculation so the sensation may feel different. Getting an orgasm may also take longer than it used to.

• Anxiety is common. Worry about performance or disappointing a partner can make things harder, even when physical recovery is underway. Try to give yourself a little grace — you just had surgery and your body is recovering. 

• Intimacy doesn’t have to center on penetration. It might be helpful to focus on touch, closeness, and connection while your body recovers and you rebuild your confidence.

• Talking about it can help. A simple heads-up to a partner can make sex feel less stressful for both of you. You can say something like, “I’m still recovering; we may not be able to have sex the way we usually do, but we can focus on what feels good for both of us.” 

• Pleasure can improve with experimentation. Trying different types of stimulation (e.g. manual, oral) or taking more time with foreplay can help you find what feels best as your body recovers.

If sex feels frustrating or if it’s causing you emotional distress, a healthcare provider can help clarify what’s normal during recovery and what options may help moving forward.

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Sex after prostate removal often looks different for everyone, especially at first. But many people are still able to have erections and satisfying sexual experiences over time. Here’s what to remember:

• The prostate isn’t required for erections. Erections rely on nerves and blood vessels. If those systems recover and respond, erections can still happen, with or without additional treatment.

• Recovery is gradual. Nerve healing can take up to two years, and early difficulties don’t predict long-term outcomes. Medications, injections, and devices are commonly used to help maintain tissue health and improve erectile function while the body heals.

• Sexual experience may change, but it doesn’t end. Orgasms may feel different after prostate surgery, and ejaculation usually doesn’t occur the way it used to. But desire, pleasure, and intimacy can still be part of life after surgery.

With time, support, and the right treatment plan, many people find a version of sexual function that works for them, even if it isn’t exactly the same as before.