Sexual activity can be resumed within a month after a radical prostatectomy. I tell my patients to resume sexual activity as soon as they feel an interest and when their urinary control is adequate for sexual activity. Usually, erections do not begin to return spontaneously until 3 to 6 months, and they may continue to improve for up to 36 month after surgery. I encourage patients to induce erections sooner in the following ways: with Viagra-like medications. (I recommend Cialis 20 mg/day because it has a longer lasting effect, but this drug causes some men to have muscle cramps and they have to switch to another.There have been reports that these drugs might cause blindness in some men. This occurrence is rare and has not been causally linked to the drugs. Most of the patients who developed blindness had pre-existing eye problems or very abnormal blood lipids. To be safe, a patient should consult an ophthalmologist to see if there is any worry about taking these drugs that are called phosphodiesterase type 5 inhibitors. with a vacuum erection device with a MUSE suppository with injection therapy. Some experts in male sexual dysfunction believe that initiating erections in these ways improves the blood flow to the penis and hastens the return of spontaneous erection. Normally, men have one or more erections daily. The normal physiology of the penis is to have an infusion of well-oxygenated blood several times each day. It is probably not good for men to go for months without having any erections. Some experts suggest that lack of erections can cause atrophy of important structures such as the valves that trap blood in the penis during erection and can cause fibrosis (scarring) of the penile tissues. It is not uncommon to have pain with orgasm after a radical prostatectomy. This pain occurs because the deep pelvic muscles have not completely recovered from the trauma of surgery. Often, some discomfort persists for a long time; however, in most patients it resolves completely with time.