Erectile Dysfunction After Prostatectomy: How Physiotherapy Supports Recovery

PhysioMatters
42 minutes ago
4 min read

Erectile dysfunction (ED) is one of the most common concerns men have after prostate cancer surgery. Although radical prostatectomy can successfully treat prostate cancer, the procedure may affect the nerves, blood vessels, pelvic floor muscles, and erectile tissues involved in achieving and maintaining an erection.

While recovery takes time, many men are surprised to learn that physiotherapy may play a supportive role in restoring sexual function alongside medical treatment.

Why Does Erectile Dysfunction Occur After Prostate Surgery?

The nerves responsible for erections run very close to the prostate gland. Even with modern nerve-sparing surgical techniques, these delicate nerves can become stretched, irritated, or affected during surgery.

As a result, men may experience:

Difficulty achieving an erection
Difficulty maintaining an erection
Reduced penile rigidity
Changes in orgasm
Reduced confidence during intimacy
Urinary leakage during sexual activity, also known as climacturia

Recovery can take several months, and for some men up to two years or longer, depending on age, baseline erectile function, overall health, cancer treatment, and whether nerve-sparing surgery was performed.

It is also important to understand that erectile recovery is not always immediate or predictable. Some men recover erections naturally over time, while others may need medical support, devices, physiotherapy, or a combination of approaches.

Can Physiotherapy Improve Erectile Function?

In some cases, yes.

Research suggests that pelvic floor muscle training may support erectile function by improving the strength, timing, and coordination of the muscles involved in erection and ejaculation.

The pelvic floor muscles, particularly the bulbocavernosus and ischiocavernosus muscles, play a role during erection. These muscles help increase penile rigidity and may assist with the compression of veins that help maintain an erection.

Improving pelvic floor muscle function may help some men improve erectile quality, sexual confidence, and control during intimacy. It may also support recovery in men who experience both erectile dysfunction and urinary leakage after prostate surgery.

However, physiotherapy should be viewed as one part of a broader recovery plan. Evidence for pelvic floor muscle training after prostatectomy is promising, but research is still evolving, and results vary between individuals.

Physiotherapy is often most useful when combined with a comprehensive penile rehabilitation programme, which may include medication, vacuum erection devices, or other treatments prescribed by your urologist.

What Does Physiotherapy Involve?

At PhysioMatters Singapore, treatment begins with a detailed assessment of your pelvic floor function, breathing pattern, posture, movement, symptoms, and recovery goals.

Your rehabilitation programme may include:

Pelvic floor muscle assessment
Individualised pelvic floor strengthening
Pelvic floor relaxation and coordination training
Breathing and core coordination
Progressive exercise prescription
Education on bladder and bowel habits
Strategies for urinary leakage during intimacy
Lifestyle advice to support vascular health
Guidance alongside your medical penile rehabilitation programme

Every programme is tailored to your stage of recovery and personal goals.

For example, a man who is recovering early after surgery may need help learning how to correctly activate and relax the pelvic floor muscles. Another man who is further along in recovery may need more advanced strengthening,

coordination, and confidence-building strategies.

Recovery Is More Than Physical

Erectile dysfunction can affect confidence, relationships, identity, and emotional wellbeing. Many men feel embarrassed discussing these concerns, but ED after prostate surgery is very common and help is available.

Some men also experience anxiety about intimacy, worry about performance, or avoid sexual activity because they are unsure what is safe or realistic during recovery.

These concerns are valid. Recovery after prostatectomy often involves both physical and emotional adjustment.

Seeking help early allows rehabilitation and medical support to begin sooner. It can also give you a clearer understanding of what is expected, what may improve with time, and which treatment options may be appropriate for your situation.

A Team Approach to Recovery

Physiotherapy forms one part of a multidisciplinary recovery programme alongside your urologist, GP, and, when appropriate, medications or vacuum erection devices.

Medical treatments such as PDE5 inhibitors, vacuum erection devices, injections, or other options may be discussed with your urologist depending on your symptoms, surgery type, medical history, and goals.

Physiotherapy can support this process by improving pelvic floor function, movement confidence, continence, and overall rehabilitation after surgery.

At PhysioMatters Singapore, we provide evidence-informed men’s pelvic health physiotherapy in a professional and supportive environment. Our goal is to help you regain confidence, improve pelvic floor function, and support your return to an active, fulfilling life.

If you are recovering from prostate surgery and experiencing erectile dysfunction or urinary leakage, Danielle and Xan are here to help.

Quick Summary

Erectile dysfunction is common after radical prostatectomy because the nerves, blood vessels, and tissues involved in erections can be affected during surgery. Pelvic floor physiotherapy may support erectile recovery by improving pelvic floor strength, coordination, continence, and confidence, especially when combined with medical penile rehabilitation guided by a urologist.

References

Dorey, G., Speakman, M. J., Feneley, R. C. L., Swinkels, A., & Dunn, C. D. (2005). Pelvic floor exercises for erectile dysfunction after radical prostatectomy: A randomised controlled trial. BJU International, 95(4), 595–597.
Milios, J. E., & Ackland, T. R. (2020). Pelvic floor muscle training and erectile function following radical prostatectomy: A review of current evidence. Sexual Medicine Reviews, 8(4), 587–596.
European Association of Urology. (2025). EAU Guidelines on Sexual and Reproductive Health.
European Association of Urology. (2025). EAU Guidelines on Non-neurogenic Male Lower Urinary Tract Symptoms.