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User

Posted 11 Mar 2026 at 00:13

I had RARP six years ago and have tried a pump and tadalafil which both give me a satisfactory induced erection. However, I do get a fully hard natural erection at night during my sleep but am not able to get a hard erection whilst I am awake. Any ideas why this should happen at night apart from wanting to pee and will I eventually get a fully hard erection during the day?

User

Posted 11 Mar 2026 at 07:11

The RARP has degraded your erection capability and after 6 years it is unlikely to improve further.

I have found the practical impact of this is more intense mental stimulation is required to achieve "an effect".

So pre rarp I might have got a real boner just from having a smutty thought, now it needs full on sexual stimulation to get "half cocked".

Practically this means if I want penetrative sex I will need assistance from a cock ring. Fortunately for me this works well, other guys use the pills, injections or pumps for assistance.

It's an unfortunate consequence for most men post RARP

User

Posted 11 Mar 2026 at 16:16

Hi Oriental Peter

francij1 is right. Unless you are lucky, post prostatectomy natural erections range from zero to normal (rare). You can hope that in the long run your situation can return to normal but even if it doesn't you should not despair because it is possible to re-establish your sex life, no matter how bad your prognosis turns out to be. I was your age when I had my prostatectomy, over 15 years ago. I had nerve sparing surgery but I suffer from total ED and arousal climacturia. This hasn't stopped us enjoying sex because we no longer rely on natural erections - I have been using vacuum pumps and constricting rings to give me strong reliable erection for 30 minutes. Of course it takes away the spontaneity but we have re-established our sex life, with imagination we have modified our love making with many unexpected benefits. Have a look at the following link which may cheer you up!

https://community.prostatecanceruk.org/posts/t28948-Re-establishing-Sex-Life

Good luck.

'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.' Richard Feynman (1918-1988) Nobel Prize laureate

User

Posted 16 Mar 2026 at 21:15

Originally Posted by: Online Community Member

The test you've done is exactly the test which is used to identify if the problem is physiological or psychological, and the good nocturnal erections but poor erections when desired suggest it's more likely to be psychological.

You should go to your GP and explain this, and ask for a referral to a psychosexual counselor. If you still have contacts with the urology clinical nurse specialists, try asking them too - they might get faster access. Meanwhile, ask to try some max dose Tadalafil (20mg) particularly if you were using a lower dose before.

User

Posted 20 Apr 2026 at 06:51

Dear Colleagues,

that's an interesting one .... same for me!

During my recovery, the nocturnal erections came back first and were much stronger than what I could get during sex - at least w/o pumps, pills and rings (PPR).

Next thing I noticed was that I went fully errect, but only very close to orgasm (again w/o PPR).

Psychological matters are quite unlikely in my case (but of course not fully impossible). I'm convinced that the difference between nocturnal and "action" events is physical in my case, so I asked my urologist:

Two-fold answer:

1) No, there should be no physical difference for the two events, at least we as doctors don't know about it

2) Yes, very many men tell us this story after an RPx ...

So, the old difference between theory and practice: In theory there is no, but in pratice there is.

Anyway, I took the difference in stiffness as a good sign that a decent recovery is possible, that there are different mechanisms in erections nocturnal and during action, and that those two mechanisms simply have different time scales in recovery and I simply have to wait.

What happend: Nocturnal errection did not recover any further during the last 6 months, but during sex things still improve, although slowly.

So, if this is the case for you as well: Be patient!

.... "w/o PPR" does include daily Tadalafil, but no extra Sildenafil before sex. I take Tadalafil stricly every day .....

Very best, Henrik

Edited by member 20 Apr 2026 at 07:03 | Reason: Not specified

User

Posted 20 Apr 2026 at 13:44

Probably worth trying one of the PDE5 inhibitors in this case (Sildenafil/Viagra, Tadalafil/Cialis, etc). In effect, they amplify the signal from the erection nerves, and may well produce a better erection on demand. That in turn might reduce any anxiety from concern about quality of erections, and reduce the need for any erectile support.

Edited by member 20 Apr 2026 at 13:46 | Reason: Not specified

User

Posted 21 Apr 2026 at 22:09

Interesting. After I had surgery with nerves spared on only one side I eventually recovered reasonable erectile function. However after salvage radiotherapy (including androgen deprivation therapy) I had many more issues. As things are I am in a similar situation to Oriental Peter, I can wake in the night with a proper erection - so I know the mechanism still works - but it doesn't happen when I am awake. I am not subjectively aware of any change in psychology during that time.

It took a couple of years to get to that level of function, and I rationalise it as related to the fact I have only had a slow and partial recovery of testosterone levels since the treatment stopped. Unfortunately no one thought to measure my starting testosterone but I retained my libido so I assume it was in the region of 20 nmol/l. Readings two to three years after coming off the androgen suppression were marginal, in the range 10-12 nmol/l. I have been taking tadalafil ever since surgery; I did raise with the consultant whether I should have testosterone supplementation but the answer came back not.

I am not sure this is very helpful to Oriental Peter, other than to know he is not alone!

User

Posted 22 Apr 2026 at 10:51

Hi from France,

My husband had cystoprostatectomy in August 2022 with preservation of erection nerves. He took daily 5 mg of tadalafil. That was enough for intercourse since january 2023. Now he takes tadalafil or sildenafil or vardanafil (this last has less side-effetcs such as stomach burning for him) once or twice a week. He has several strong erection every night. On demand erections of quality also occur but it takes 15-20 minutes foreplay. When the nocturnal erections are present it means that anatomically everything is OK. BUT the psychological aspect is always stronger. When I plan to have sex the result is always much quicker than when my husband makes the decision. So, the key of obtaining good results is perhaps in the hands of your partner.

Have a nice day

Catherine

User

Posted 22 Apr 2026 at 11:01

I couldn't agree more. The brain is a powerful thing. I see very little mention of the role of partners.

User

Posted 22 Apr 2026 at 11:15

Apparently there are physiological differences between night and day time erections. I have checked the science sources used by this AI reply:

Nocturnal erections can return after prostatectomy while daytime, voluntary erections remain difficult because night erections are involuntary and triggered by deep sleep stages rather than conscious neural pathways. This indicates the nerves are recovering but not yet strong enough to facilitate blood flow under voluntary psychological arousal, a condition known as neuropraxia, or nerve stunning

Automatic vs. Voluntary Signal: Nocturnal erections (Nocturnal Penile Tumescence - NPTR) occur during REM sleep and are partially autonomous, requiring less neural input than conscious, daytime stimulation

Daytime erections require stronger blood flow to fill the corpora cavernosa. If nerves are not fully functional, they cannot relax the muscles enough to allow sufficient blood inflow during the day, whereas the body manages this better during sleep.

Nocturnal erections are a positive sign that nerve pathways are not completely destroyed and that recovery of daytime function is possible over time.

I had non nerve sparing RARP three years ago, and have unfortunately not had a natural erection, including nocturnal ones, ever since.

I think this would be the case for most men who've had no nerves spared.

However, all is not lost. Invicorp basically skips the need for nerve signals of any kind to get an erection. Chemically it does what the my nerves used to and induces blood directly to my penis and holds it there.

Edited by member 22 Apr 2026 at 11:25 | Reason: Additional text

User

Posted 22 Apr 2026 at 13:01

Antoinette,

I agree that we need to acknowledge the role of partners! Without my darling wife I doubt I would be as well recovered. In the early days after the op she was my best nurse and even encouraged me to get back to normal with my sex drive. I had my nerves removed and will most likely never have an erection again but together we have explored so many different ways around this and our love life is amazing.

Recently, I have added Skin Cancer to PC and she was the one who took the brunt of my worry and bad moods. In the end she had to have a heart to heart with me. That shook me out of my downward spiral and I am now back making every day as magical as I can. Thankfully the latest news on the skin cancer is that it's a type that is unlikely to spread and it will shortly be removed.

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