How to Improve Penile Nerve Function?

Penile nerve function plays a critical role in erectile response and sexual health. According to the 2025 EAU Guidelines, nerve damage can occur due to various causes including aging, surgical procedures (particularly radical prostatectomy), trauma, or medical conditions³. When nerve function is compromised, several evidence-based approaches may be considered to improve outcomes, though expectations should be managed realistically. For men who have undergone nerve-sparing radical prostatectomy, penile rehabilitation protocols have been widely studied. The guidelines indicate that while perioperative rehabilitation with PDE5 inhibitors may lead to better erectile function recovery compared to post-operative rehabilitation⁴, there is no conclusive evidence that penile rehabilitation itself significantly increases the chances of spontaneous recovery of erectile function⁵. Patient age, baseline erectile function, and quality of nerve-sparing technique are identified as key factors in preserving post-surgical erectile function⁶. Emerging treatments include intracavernous injection of platelet-rich plasma (PRP), which has been investigated in several clinical trials⁷. The regenerative effect of PRP is attributed to high concentrations of platelets containing growth factors including VEGF, EGF, IGF-1, PDGF, and FGF, which may stimulate angiogenesis and stem cell recruitment⁸. These mechanisms potentially support nerve regeneration and improved vascular supply essential for penile function. For patients with severe erectile dysfunction unresponsive to less invasive treatments, penile implants represent a highly effective solution⁹. The 2025 EAU Guidelines describe two main classes of penile implants: inflatable (two- and three-piece) and semi-rigid devices (malleable, mechanical, and soft flexible)¹⁰. While patients often prefer threepiece inflatable devices for more natural erections, the guidelines note there is no difference in terms of efficacy and safety among different penile implants or surgical approaches¹¹. These devices provide a mechanical solution when nerve function cannot be adequately restored. It’s important to note that treatment should be individualized based on the specific cause of nerve dysfunction, patient characteristics, and preferences. The guidelines emphasize that while various rehabilitation approaches exist, expectations should be realistic, particularly regarding spontaneous recovery of function¹². A comprehensive evaluation by a urologist specializing in sexual medicine is recommended to determine the most appropriate treatment strategy for improving penile nerve function.