Dear Carol,

I was at a party the other night where for some reason I found myself in a deep conversation with a couple of guys about prostates... we talked about prostate health and prostate surgery first, but then we moved on to sex after prostate surgery. One of them said something about erections not happening without the prostate. (He’d known somebody who had his prostate removed.) I said it must be the surgery, because to my knowledge the prostate is involved in ejaculation (mixing up those fluids), but erection is a result of blood flow and the corpus cavernosa. Both men vehemently disagreed. What’s the scoop?

–Z

Dear Z,

Well, this is just one more example of something I see all the time: that is, people who have a particular body part but don’t know all that much about it. Here are a couple of fellas who’ve been walking around with prostates for most of their lives, and they get erections, and the guy without the prostate doesn’t get erections any more, and so the prostate must logically be necessary for the whole process to happen. Since there’s a fair amount of erectile dysfunction after prostate surgery, it’s not surprising this idea is out there, but it’s not correct. When the icebergs melt the tulips bloom in Central Park, too, but one doesn’t cause the other to happen.

Did you note that I said the men had been walking around with prostates for *most* of their lives? Prostatic tissue doesn’t actually develop into a functioning prostate until puberty arrives and the hormones hit. Pre-pubescent boys can’t truly be said to have a prostate yet, but plenty of them discover through the fine process of youthful trial and error that they can get erections. They don’t begin to ejaculate, though, until the prostate has matured and begins to do the fluid-mixing job to which you refer in your letter: getting the sperm into the semen, essentially, and the semen ready to go on its ejaculatory journey into the big world.

As you said, even though the guys didn’t take your word for it, erection is a different part of the system. At a signal from the brain (which can be triggered by touch, fantasy, or in some cases even fear or stress) the blood flows into the corpora cavernosa of the penis, causing it to become erect. Little valves shut the doors to the corpora cavernosa for a while so the guy can retain his erection (the chemical signal that makes those little valves work is the part of the erection process effected by Viagra). The whole deal is part neurochemical but part hydraulic, like the spillways of a dam. The prostate doesn’t come into the picture directly until ejaculation happens (or doesn’t, as the case may be). By the way, your expert fellas may also, like many men, believe that ejaculation equals orgasm... which it doesn’t. Men without prostates (or who do not easily ejaculate) can still achieve orgasmic peaks of sensation, provided they have not suffered so much nerve damage that the signal can’t get through.
And that’s where we come back to your party guys and the man they knew who’d lost his capacity to get hard, post-prostate surgery. He didn’t lose his erectile ability because the prostate was suddenly gone, he most likely lost it because the surgery affected the nerves through which the signal gets to the brain and back that the penis wants to get erect. This is a pretty common post-surgery problem, as I said (and it can affect guys who’ve had other kinds of pelvic surgery too). By the way, all these post-surgical effects can be seen in women’s sexual response too.

So these men’s friend most likely had a post-surgery complication that will permanently affect his ability to get hard, but there’s one other possible reason he began to suffer erectile problems after surgery... namely, he believed that would be the result of the surgery, and so it *was* the result. The penis is notoriously affected by psychogenic factors, and this belief (that you lose sexual functioning after prostate surgery) is so widespread that for some percentage of men it is very likely a self-fulfilling prophecy. Your conversationsalists, for example, are already talking themselves into believing they will lose their erections if they ever have their prostates removed. Sometimes men’s doctors will matter-of-factly tell them that’s what to expect. It’s no wonder more men don’t try to get the whole system back up and running, so to speak: they may already be frightened about cancer, traumatized by fear of losing sexual abilities (not to mention leaking urine, another post-surgery possibility), and out of touch with their sexual desire for all of these reasons. Plus many (though not all) prostate surgeries happen on older men, whose sexual response has likely altered somewhat with age, and one age-related change may be to lose erectile ability somewhat after not being sexually active for a while... as during a period of concern over health, hospitalization, and recovery. The news is that if a guy is open-minded about his future possibilities and willing to explore his post-prostate-surgery sexuality, he may be pleasantly surprised. And remember, whether or not erections are gone, orgasmic sensation may not be impaired, so it really pays a man in this position to be willing to explore this way. If he just gives up, it’s pretty certain his responsiveness won’t come back by itself. As well, post-surgery erotic functioning may be treatable with medications. A man who noticed these changes should certainly talk to his urologist about them.

One more thing: there’s some indication that men who regularly ejaculate may have fewer and less severe prostate problems as they age. And since it’s still National Masturbation Month, that’s a hopeful note to end on, don’t you think? If an ejaculation a day may keep the doctor away, that’s just one more reason to celebrate.