Post Prostatectomy Rehab

As rehabilitation professionals, we must ask ourselves: Are we fully educating our patients on all available rehab techniques beyond just Kegels? Here’s an evidence-based overview of penile rehabilitation following radical prostatectomy, emphasizing the importance of a comprehensive approach to restore erectile function and maintain overall penile health.

Understanding Penile Rehabilitation
Penile rehabilitation focuses on enhancing blood flow to the penis after radical prostatectomy (removal of the prostate). Even with nerve-sparing techniques, the cavernous nerves—essential for erections—can sustain trauma. This injury, known as neuropraxia, may require up to two years to recover from, potentially leading to temporary or prolonged changes in erectile function.

Why Rehabilitation Is Critical

• Preservation of Function: Rehabilitation helps sustain blood flow and minimizes the risk of venous leakage, where the veins fail to maintain blood within the penis.
• Preventing penile atrophy: The "use it or lose it" principle is fundamental in penile rehabilitation.
• Prevention of Fibrosis: Consistent treatment can reduce the formation of scar tissue (fibrosis), which may otherwise contribute to conditions such as Peyronie’s disease.
• Maintenance of Penile Length: Emerging evidence suggests that a well-structured rehabilitation program may help restore or maintain penile length, which is compromised after surgery.

Key Rehabilitation Techniques

1. Mechanical Devices:
   • Penile Pump/Vacuum Device: Utilizes negative pressure to draw blood into the penis, assisting in achieving an erection.
2. Medications:
   • Intracavernosal Injections: Direct injection of medications like Trimix or Caverject into the penis to induce an erection.
   • Low-Dose PDE5 Inhibitors: Daily administration of drugs such as Viagra or Cialis is used to enhance blood flow and protect the endothelial cells lining blood vessels. It’s important to note that these drugs depend on functional erectile nerves to produce an erection, so their role is primarily to provide vascular support.
3. Sexual Activity:
   • Regular Arousal and Orgasm: Encouraging regular sexual activity, whether through masturbation or with a partner, is beneficial. Even without an erection, achieving orgasm (which will be dry post-surgery due to the removal of the prostate and seminal vesicles) can significantly improve blood flow.
4. Pelvic Floor Exercises:
   • Strengthening Muscles: Targeting the pelvic floor muscles can enhance blood flow and support neural arousal signals, contributing to improved erectile function.
5. Cardiovascular Exercise:
   • Overall Circulation: Regular cardiovascular workouts are crucial for heart health and circulation, which in turn supports erectile health.

Remember, as rehab professionals, education is our most important treatment. Educate patients on all the available options they can be utilizing.

Final Considerations for Providers
While these strategies show considerable promise, recovery is a gradual process, and patient outcomes may vary. It is essential to have open, detailed discussions with patients about these options. Tailoring a rehabilitation program that addresses each individual’s needs and recovery trajectory can significantly impact both their sexual function and overall vascular health after prostate surgery.

By expanding our education and ensuring our patients are well-informed about all available rehabilitation options, we can optimize recovery and improve long-term outcomes.

If you would like to learn more about this topic and other topics in sexual medicine, then join Tara Sullivan in Sexual Medicine in Pelvic Rehab on May 3-4, 2025. This course provides thorough introduction to pelvic floor sexual function, dysfunction and treatment interventions for males and females of all sexual orientations, as well as an evidence-based perspective on the value of physical therapy interventions for patients with chronic pelvic pain related to sexual conditions, disorders, and multiple approaches for the treatment of sexual dysfunction including understanding medical diagnosis and management.

Mechanical Devices (Penile Pump/Vacuum Devices)

Medications: Intracavernosal Injections and PDE5 Inhibitors (also relevant to sexual activity)

Burnett, A. L., Nehra, A., Breau, R. H., Culkin, D. J., Faraday, M. M., Hakim, L. S., Heidelbaugh, J., Khera, M., McVary, K. T., Miner, M. M., … & Shindel, A. W. (2018). Erectile dysfunction: AUA guideline. The Journal of Urology, 200(6), 633–641. https://doi.org/10.1097/JU.0000000000000626

Sexual Activity (Regular Arousal and Orgasm): This concept is also emphasized in the AUA guideline above, which supports the role of ongoing sexual activity in penile rehabilitation.

Burnett, A. L., Nehra, A., Breau, R. H., Culkin, D. J., Faraday, M. M., Hakim, L. S., Heidelbaugh, J., Khera, M., McVary, K. T., Miner, M. M., … & Shindel, A. W. (2018). Erectile dysfunction: AUA guideline. The Journal of Urology, 200(6), 633–641. https://doi.org/10.1097/JU.0000000000000626

Pelvic Floor Exercises

Cardiovascular Exercise (Physical Activity)

Silva, A. B., Sousa, N., Azevedo, L. F., & Martins, C. (2017). Physical activity and exercise for erectile dysfunction: Systematic review and meta-analysis. British Journal of Sports Medicine, 51(20), 1419–1424. https://doi.org/10.1136/bjsports-2016-096418

AUTHOR BIO
Tara Sullivan, PT, DPT, PRPC, WCS, IF

Dr. Tara Sullivan, PT, PRPC, WCS, IF (she/her) started in the healthcare field as a massage therapist practicing for over ten years, including three years of teaching massage and anatomy & physiology. During that time, she attended college at Oregon State University earning her Bachelor of Science degree in Exercise and Sport Science, and she continued to earn her Masters of Science in Human Movement and Doctorate in Physical Therapy from A.T. Still University. Dr. Tara has specialized in Pelvic Floor Dysfunction (PFD) treating bowel, bladder, sexual dysfunctions, and pelvic pain exclusively since 2012. She has earned her Pelvic Rehabilitation Practitioner Certification (PRPC) deeming her an expert in the field of pelvic rehabilitation, treating men, women, and children. Dr. Sullivan is also a board-certified clinical specialist in women’s health (WCS) through the APTA and a Fellow of the International Society for the Study of Women's Sexual Health (IF).

Dr. Tara established the pelvic health program at HonorHealth in Scottsdale and expanded the practice to 12 locations across the valley. She continues treating patients with her hands-on, individualized approach, taking the time to listen and educate them, empowering them to return to a healthy and improved quality of life. Dr. Tara has developed and taught several pelvic health courses and lectures at local universities in Arizona, including Northern Arizona University, Franklin Pierce University, and Midwestern University. In 2019, she joined the faculty team at Herman & Wallace, teaching continuing education courses for rehab therapists and other healthcare providers interested in the pelvic health specialty, including a course she authored - Sexual Medicine in Pelvic Rehab, and co-authored Pain Science for the Chronic Pelvic Pain Population. Dr. Tara is very passionate about creating awareness of Pelvic Floor Dysfunction and launched her website pelvicfloorspecialist.com to continue educating the public and other healthcare professionals.

In March 2024, Dr. Tara left HonorHealth and founded her company Mind to Body Healing (M2B) to continue spreading awareness on pelvic health, mentor other healthcare providers, and incorporate sexual counseling into her pelvic floor physical therapy practice. She has partnered with Co-Owner Dr. Kylee Austin, PT.