Erectile Dysfunction After Surgery for Rectal Cancer

Dec 12, 2014 0 Comments in Erectile Dysfunction by
Erectile Dysfunction After Surgery for Rectal Cancer

Erectile Dysfunction After Surgery for Rectal Cancer

Transient or permanent erectile dysfunction is fairly common after major pelvic surgeries or procedures. According to a new study reported in the peer reviewed journal Annals of Surgery (1), investigators reported that 45% males experience some degree of erectile dysfunction after surgical resection of colorectal cancer.

Besides erectile dysfunction, other frequently reported sexual issues in post-operative males are (1):

  • 32% reports impotency (partial impotence is more common and is reported in 52% males)
  • 47% reports poor libido
  • Ejaculatory dysfunction is reported in 43%
  • Orgasmic issues reported in 41%

What Causes Erectile Dysfunction After Surgical Resection of Rectal Cancer?

Morning Erection ImageThere are a number of physiological as well as psychological factors that may lead to erectile dysfunction. Few most statistically significant ones are:

  • Damage to major blood vessels during the procedure
  • Injury to vital nerves that are required for optimal erection
  • Psychological issues such as negative body image, formation of scar tissue and related complications, response of the individual to cancer status etc.
  • – Loss of interest in sexual activity due to poor health, low energy levels (attributed to advanced illness, metastatic lesions or side effect of chemotherapeutic drugs)

Other surgery related factors that may influence the pathophysiology of erectile dysfunction are;

  • – Staging of cancer (advanced cancers are associated with poor prognosis)
  • – Nature of procedure performed for the management of cancer: Pre-surgical radiotherapy, followed by surgery is considered a superior approach over surgical intervention alone in association with erectile dysfunction (4). Likewise, procedures like colostomy or osteotomy are more frequently associated with erectile dysfunction. According to report published in the Journal of Sexual Medicine (5), 77% patients report ED after colostomy procedures.
  • – Pain or discomfort in the penis, testicles or surrounding pelvic region due to stretching of scar tissue or adhesion formation.
  • – Follow-up treatments (such as chemotherapy and radiotherapy) are also associated with ED due to poor energy levels and fatigue. Prevalence of ED in patients who receive adjuvant radiotherapy after colorectal surgery is 88.5% (5)

Risk Factors That May Influence ED After Procedure

Prostate Cancer and Erectile DysfunctionThere are a number of factors that may increase the risk of erectile dysfunction depending upon (or independent of) the nature of procedure performed for tumor resection.

  • – Physiological aging: Aging it itself a recognized risk factor that may contribute to the development (or worsening of) erectile dysfunction. A number of times, it has been observed that people notice an already existing ED after such procedures.
  • – Diabetes or other chronic metabolic issues: Co-existence of diabetes and other metabolic issues like obesity can further worsen ED. All such cases may responds moderately to lifestyle modification, glycemic control and weight reduction.
  • – Previous history of erectile issues: Individuals who have poor libido or impaired sexual activity prior to procedure are also more likely to experience ED after surgeries.

Other related factors include:

  • – Quality of relationship with the partner
  • – Adaptation to the current health status (depressed males are more likely to experience ED)
  • – Pre-procedure libido – individuals with poor overall libido generally develops ED more frequently than normal counterparts.

How to Manage ED After Resection of Colorectal Cancer?

Prostate Removal & Impotency

Study conducted by Donovan and associates (3) reported that most cases of post-surgical erectile dysfunction resolves spontaneously after 2-4 years, with or without interventions.

It is highly recommended to discuss with your primary care provider regarding:

  • -The risk of developing ED in your case
  • -Treatment options in your case

Often times, the management options are pretty similar to conventional cases; such as:

  • -Phosphodiesterase inhibitors (or Viagra/ Sildenafil) are usually considered the first-line of therapy. Investigators suggested that sexual function can be optimally restored with PDE inhibitors alone in post-surgery patients (and in 78% cases, it is often the only treatment needed). Caution is needed if you have active cardiovascular issues.
  • -Males who experience ED due to poor libido or sexual desires can get benefitted to testosterone therapy (3).
  • -More stubborn cases of ED responds fairly well to second line therapies like intracavernosal prostaglandin E1 injections.
  • -Psychological counseling: If the cause of ED is psychological (feeling of weakness, embarrassment and anxiety etc.), the management decisions mainly rests on psychological counseling.
  • -Certain options are reserved for more severe cases of ED; such as penile injections, Vacuum devices, penile prostheses etc.

Some less effective solutions that may help indirectly by improving your overall health are:

  • -Vitamin and herbal supplements boost mental and physical energy levels and are highly effective if you are on chemotherapeutic drugs for management of metastatic lesions
  • -Weight reduction and exercise also helps in building the stamina and optimizing energy levels.

To sum up, there are a number of methods and interventional tools that may help you in regaining your interest in sexual intercourse. It is highly recommended to discuss your complaints with a registered healthcare professional instead of self-treating/ managing your symptoms.


  1. Hendren, S. K., O’Connor, B. I., Liu, M., Asano, T., Cohen, Z., Swallow, C. J., … & McLeod, R. S. (2005). Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Annals of surgery, 242(2), 212.
  2. Breukink, S. O., & Donovan, K. A. (2013). Physical and psychological effects of treatment on sexual functioning in colorectal cancer survivors. The journal of sexual medicine, 10(S1), 74-83.
  3. Donovan, K. A., Thompson, L. M., & Hoffe, S. E. (2010). Sexual function in colorectal cancer survivors. Cancer control: journal of the Moffitt Cancer Center, 17(1), 44.
  4. Song, P. H., Yun, S. M., Kim, J. H., & Moon, K. H. (2010). Comparison of the erectile function in male patients with rectal cancer treated by preoperative radiotherapy followed by surgery and surgery alone. International journal of colorectal disease, 25(5), 619-624.
  5. Zugor, V., Miskovic, I., Lausen, B., Matzel, K., Hohenberger, W., Schreiber, M., … & Schott, G. E. (2010). Sexual dysfunction after rectal surgery: a retrospective study of men without disease recurrence. The journal of sexual medicine, 7(9), 3199-3205.