Deep Dive

The Intimate Comeback: Sex and Recovery After Prostate Cancer

For many men, prostate cancer treatment marks a turning point – not just medically, but sexually. 

The disease may be gone, but questions remain. 

Can I still enjoy sex? Will I feel like myself again? How do I talk about it?

These aren’t side issues. They’re central. 

Because intimacy is part of health, and regaining control over your sexual function is part of recovery.

What You Should Know

Prostate surgery and radiation affect nerves, blood vessels, and hormones. That means:

• Erections may be weaker or absent
  

• Ejaculation may change or stop
  

• Desire may fluctuate

None of this means you’re done. It means it’s time to adapt.

What You Can Do

Sexual recovery is possible. And for many men, it starts with understanding the tools available:

• PDE5 inhibitors (Viagra, Cialis): useful if some nerve function remains
  

• Injections: fast-acting and effective when pills don’t work
  

• Vacuum erection devices: help maintain tissue health and support blood flow
  

• Penile implants: long-term option with high satisfaction rates
  

• Pelvic floor therapy: improves blood flow, strength, and control

The sooner you start exploring solutions, the better your outcomes.

Talking With Your Partner

Your partner isn’t looking for perfection – they’re looking for connection. So be direct:

• “Here’s what’s changed.”
  

• “Here’s what I’m working on.”
  

• “Here’s what I’d still like to enjoy together.”

Many couples discover a new kind of closeness when they stop avoiding the topic and start experimenting again – with patience, humor, and curiosity.

Partners may feel confused, guilty, or afraid to say the wrong thing. 

Honesty works both ways – and many couples find that naming these shifts out loud brings relief.

What to Expect Over Time

• Months 1–3: Recovery begins. Men who had nerve-sparing surgery may start seeing signs of spontaneous erections return. 

  Tools like pumps or medications can help maintain tissue health in the meantime.

• Months 3–6: Gradual improvement continues. You may regain some function or adjust to new aids. 

  If no progress, this may be the right time to consider next steps.

• Up to 18 months: After nerve-sparing surgery, it’s possible for erectile function to continue improving for over a year. 

  But you don’t have to just wait – proactive treatment can support and accelerate the process.

• Radiation patients: Function may dip in the early months after treatment, often returning to baseline within 3–6 months. 

  A slower, gradual decline can follow over the years – but not for everyone, and many retain function long term.

• After 6 months: Time to reassess. 

Consider options like injections, implants, or pelvic floor therapy if needed.

There’s no single timeline. But there is progress – if you claim it.

And while this issue focuses on sexual recovery, many men also struggle with urinary leakage after treatment. 

That’s a separate but equally important issue – we’ll cover that in detail in an upcoming issue.

Before You Begin Treatment

I often tell men in consultation: it’s absolutely okay to seek help for ED after cancer treatment.

That’s not selfish or ungrateful – it’s exactly why you pursued treatment in the first place. 

To live. To thrive. To be whole.

But many men are told to wait. Or they don’t know what’s available. 

Months pass, and dysfunction becomes a daily reminder of the cancer they survived. 

That tension – grateful to be alive, frustrated by what’s missing – is hard to carry.

If you’re preparing for treatment or early in recovery, speak with your surgeon or team about preserving sexual function. 

Ask about nerve-sparing techniques, rehabilitation plans, and timelines. 

If your recovery plateaus, revisit the topic. Your care doesn’t stop when the cancer is gone.

Proactive Sexual Recovery

There’s a lot you can do – especially if you start early:

• Use a vacuum erection device (VED) daily for 10 minutes to maintain tissue pliability and prevent shrinkage
  

• Take a low-dose PDE5 inhibitor like Viagra or Cialis daily if you had nerve-sparing surgery or radiation – this may support blood flow and prevent fibrosis
  

• Be consistent. These are not short-term fixes, but long-term strategies

You don’t have to want all of this right now. Even asking the question is a beginning.

A Note on Testosterone Therapy

If you were on testosterone replacement therapy (TRT) before diagnosis, you were likely asked to stop. 

That sudden drop can feel miserable – low energy, low mood, low libido.

Restarting TRT after cancer is possible for many men, but it requires a careful, individualized conversation with your oncologist or urologist. 

There’s no one-size-fits-all answer. Don’t guess – ask.

Hormone Blocking (ADT)

Some men undergo hormone-blocking treatment – called androgen deprivation therapy (ADT) – during radiation. 

It’s temporary but tough – causing fatigue, emotional blunting, low desire.

Know that it’s part of the treatment plan, not the end of your sexual health. 

With time and guidance, your levels can recover, and so can you.

Final Word

You’re not a different man. You’re the same man, adapting to new realities. 

Sexuality after prostate cancer isn’t about going back – it’s about moving forward with new information, new options, and the same right to pleasure and connection.

Whether you’re in a relationship, dating, or still working through these questions on your own, you deserve clarity and options.

You don’t need to become someone else. 

You just need to come back to yourself – with the tools and support to do it on your terms.

Start where you are. Talk to your team. Try what works.

And know this: sexual recovery is real, achievable, and worth your attention.