ED after papillon+EBT (failed), followed by APR surgery


Please see my profile for my journey to date. It has been a little over a month since my APR surgery.

Just before surgery I was already experiencing a slightly diminished quality of erection, and intercourse would fail on occasion if I was distracted before penetration for any reason. That said,  "things still worked" for the most part, although I did have some pretty nasty pain/discomfort upon climax... but not so bad I'd turn down an opportunity.

Since surgery I have not been able to achieve an erection... EXCEPT on three occasions, when waking up. I woke up and my penis was as hard as it's ever been. On each occasion the erections slowly subsided, in the usual way they would for most any man with a well functioning penis.

I can still achieve orgasm and ejaculation if I masturbate, which I have been doing 2 to 3 times a week. I have read online that this can help with penile rehabilitation. I have not tried sex with my partner yet, but, whilst I can achieve orgasm, I can only achieve a decent semi erect penis when masturbating, no matter what I do or how long I take.

My surgeon hasn't given me much advice in this area, but to be fair he is likely being sensitive to the fact that either my mother or fiance has attended all my follow up appointments. I did raise it with him in three first appointment, explaining that there was some function but not great, and he just said he was happy to hear that...

Given that I have woken on three occasions with a very satisfactorily hard erection, is it likely that I will recover fully once the bruised nerve bundles have had time to settle down? If so, what is the average recovery time?

Could it be that the effects I'm seeing are likely not to do with surgery but rather a continued progression of the EBT symptoms I was noticing before surgery?

If it is a result of the radiotherapy, does that mean it's permanent and likely to get worse (i.e. is radiation damage a slow working and permanent one way effect of EBT)? If it radiotherapy ED effects do reverse, what is the average recovery time?

Thanks in advance for any and all replies.



  • The incidence of erectile dysfunction is high following external beam radiotherapy (EBRT) but not always permanent. There is no ‘average recovery time’ as each person’s circumstance really is unique.  Yes, the effects of EBRT can occur over several months after initial treatment and there can likewise be gradual improvement. What is great to read is that you have had some hard erections on waking, especially as surgery was only early December. It really is still early days NMTB in your recovery, your sexual function including these erections so far sounds promising. You mention experiencing ‘diminished erections before surgery if you were distracted’, this is normal. The pain you experienced at climax could have been a contributory factor with your diminished erections.   The brain is the biggest sex organ and if our minds wander it can affect arousal.  Reading your profile, you mention ‘mental rewiring’ and therefore you may find it helpful to understand a bit more about erections.

    It is normal for men to experience early morning and night time (nocturnal) erections that come and go throughout the night. This is due to parasympathetic nerves working whilst you are sleeping. Experiencing a loss of erection as you have mentioned ‘slow subsiding on waking’ is also normal. What can happen when there is a sudden loss of erection, your sympathetic nervous system kicks in as you have fearful thoughts about maybe losing it and therefore the erection can go when you want it to stay! It’s the ‘Fight or flight’ response (when frightened or anxious) causing this. Being relaxed is necessary to help with arousal, obtaining and maintaining an erection, having an orgasm, having an orgasm without an erection and ejaculating. Incorporating this knowledge when masturbating can help your ‘mental rewiring’ and when being sexually active with your partner. Think about more foreplay and take the focus of the penis by exploring the rest of the body.

    Being proactive with early penile rehabilitation can be beneficial. To improve your erections as they are ‘semi erect’ you could speak to the healthcare team looking after you about trying treatments for erectile dysfunction. A cancer diagnosis and subsequent management can have an impact emotionally, as well as physically for an individual and within a relationship. Talking with your fiancé about how you are feeling and enabling your fiancé to do the same can help with addressing sexuality. You may adapt and think of ways to express intimacy during these early days. I wish you all the best.