Surgical removal of the prostate contains an increased likelihood that patients will experience erectile dysfunction. Impotence is common when nerve-sparing techniques are not used. Although erection and ejaculation are affected, penile sensation and the ability to achieve orgasm remain intact. Continence and potency may improve depending on the amount of trauma and the patient's age at the time of the procedure, but progress is frequently slow. Potency is greatly affected by the psychological attitude of the patient. The sensation of orgasm may be altered and no semen is produced, but there may be a few drops of fluid from the bulbourethral glands.
On the other hand nerve-sparing surgery reduces the risk of erectile dysfunction. Nerve-sparing surgery attempts to protect the cavernous nerves of penis, which control erection. These nerves are very fine and fragile and run next to the prostate and may be destroyed during surgery, leading to impotence. If the cancer is clinically unlikely to have spread beyond the prostate, nerve-sparing surgery should be offered to minimize impotency and to speed up urinary control.
However, the experience and the skill of the nerve-sparing surgeon, as well as any surgeon are critical determinants of the likelihood of positive erectile function of the patient.
Following a prostatectomy, patients will not be able to ejaculate semen due to the nature of the procedure, resulting in infertility.