Is there a way to restore erections if the nerves or blood supply of the penis has been damaged?

Blood supply: If a blockage in the main artery that brings blood to the penis is causing an erection problem, surgery may help. The surgeon can take an artery that usually supplies blood to the abdominal wall (inside your belly) and re-route it to the tiny blood vessels inside the penis. But results have been disappointing in men who have poor circulation, diabetes, or other artery diseases. Still, some men may be helped if they have damage that blocked the artery to the penis, and are otherwise healthy.

Nerve supply: During the first 3 to 12 months after radical prostatectomy, most men will not be able to get an erection without using medicines or other treatments. The effect of this operation on a man’s ability to get an erection is related to his age and whether nerve-sparing surgery was done. Nearly all men who have a radical prostatectomy should expect some decrease in their ability for a few months after surgery. After a year or 2, most men have some return in their ability to have an erection, but younger men may retain more of their ability. Some experts use treatments to improve erections soon after surgery to try to speed recovery and help heal minor short-term damage to the nerves and blood supply. (See “Early sexual rehabilitation after surgery” in the “Erections and pelvic surgery to treat cancer” section.)

After standard radical prostatectomy, there are wide ranges of impotency rates in men, depending on their age. If the surgeon does not remove or damage the nerves on either side of the prostate, the impotence rate drops as low as 25% and 30% for men under 60, and as low as 10% for men under 50. The impotence rate is higher for men over 70, even if nerves on both sides are not damaged or removed. After surgery, there is no ejaculation of semen. (See “Removal of the prostate gland and seminal vesicles can cause ‘dry’ orgasm” in the “Ejaculation and cancer treatment” section.) But even with a dry orgasm, the sensation should still be pleasurable.

New research is looking at transplanting nerves to restore erections, but more research is needed to find out how well it will work. (See “Damage to nerve bundles that allow blood flow to the penis” in the “Erections and pelvic surgery to treat cancer” section.)

Though surgery to correct blood-flow problems has been disappointing so far, 3 non-surgical treatments have become widely used: penile injection therapy, urethral pellets, and vacuum devices. We will also discuss surgical options, called implants.