Many men requiring urinary catheterisation worry about potential effects on sexual function, particularly erectile dysfunction (ED). Do catheters cause erectile dysfunction? The reassuring answer is that catheterisation itself does not typically cause long-term erectile dysfunction in most patients. Whilst temporary changes in erectile function may occur due to inflammation, psychological factors, or physical discomfort during catheter use, these usually resolve after catheter removal. However, the underlying medical condition necessitating catheterisation—such as prostate disease, neurological disorders, or diabetes—may itself affect erectile function. Understanding the distinction between catheter-related concerns and underlying health conditions is essential for appropriate management and realistic recovery expectations.

Can Catheter Use Lead to Erectile Dysfunction?

Urinary catheterisation is a common medical procedure used to drain urine from the bladder when normal voiding is not possible. Many men undergoing catheterisation worry about potential effects on sexual function, particularly erectile dysfunction (ED), which is defined as a persistent difficulty in achieving or maintaining an erection sufficient for sexual intercourse, typically lasting for at least three months.

There is no definitive evidence that catheterisation itself causes long-term erectile dysfunction in most patients. However, several factors associated with catheterisation may temporarily or, in rare cases, persistently affect erectile function. These include the underlying medical condition requiring catheterisation, psychological factors related to the procedure, physical trauma during insertion or removal, and complications such as urethral stricture or infection.

The duration and type of catheterisation play important roles. Short-term catheterisation following routine surgery typically resolves without lasting sexual effects, whereas long-term indwelling catheters may be associated with more complex outcomes. It is crucial to distinguish between erectile difficulties caused by the catheter itself and those resulting from the underlying health condition, such as prostate disease, neurological disorders, or diabetes, which may have necessitated catheterisation in the first place.

Most men experience a return to baseline erectile function once the catheter is removed and any associated inflammation or discomfort resolves, though recovery expectations should be tailored to the individual situation. For example, men catheterised after prostate surgery may have a longer recovery period than those with short-term postoperative catheters. Understanding the temporary nature of most catheter-related sexual concerns can help alleviate anxiety, which itself can contribute to erectile difficulties.

How Urinary Catheters May Affect Sexual Function

The mechanisms by which catheterisation might influence erectile function are multifactorial and often interrelated. Physical trauma during catheter insertion represents one potential pathway, particularly if the procedure is difficult or requires multiple attempts. The urethra contains delicate tissue, and whilst skilled insertion minimises risk, trauma can lead to inflammation, scarring, or in some cases, urethral stricture formation, which may indirectly affect sexual function.

Psychological factors constitute a significant component of catheter-related erectile concerns. The experience of catheterisation can be distressing, and anxiety about the procedure, body image concerns with an indwelling catheter, or fear of pain during sexual activity can all contribute to performance anxiety. This psychological burden may manifest as erectile difficulties even when no physical damage has occurred. Psychological ED often responds well to reassurance and, when necessary, psychological interventions such as cognitive behavioural therapy.

Inflammation and infection represent additional mechanisms. Catheter-associated urinary tract infections (CAUTIs) are relatively common, particularly with long-term catheterisation. According to NICE guidance, infection can cause discomfort, systemic illness, and local inflammation that temporarily impairs erectile function. The inflammatory response may affect the vascular and neurological structures involved in achieving and maintaining erections.

Most commonly, the underlying condition requiring catheterisation—such as spinal cord injury, radical prostatectomy, or neurological disease—is the primary cause of erectile dysfunction rather than the catheter itself. These conditions may directly affect the nerves, blood vessels, or muscles necessary for normal erectile function, with the catheter representing a necessary intervention rather than the cause of sexual difficulties.

Types of Catheters and Their Impact on Erections

Different catheter types carry varying implications for sexual function. Understanding these distinctions helps patients and clinicians anticipate and manage potential concerns appropriately.

Intermittent self-catheterisation (ISC) involves inserting a catheter several times daily to empty the bladder, then immediately removing it. This approach is widely used for neurogenic bladder dysfunction and urinary retention. ISC generally has minimal impact on erectile function because the urethra is not continuously occupied. However, initial anxiety about the technique and concerns about urethral trauma may temporarily affect sexual confidence. Most men adapt well to ISC, and evidence suggests it has less impact on long-term erectile function compared to indwelling catheters when performed correctly.

Indwelling urethral catheters (Foley catheters) remain in the bladder continuously, held in place by an inflated balloon. These are commonly used post-operatively or for patients with chronic retention. The continuous presence of a foreign body in the urethra may cause ongoing irritation and discomfort, potentially affecting sexual desire and function. The catheter physically occupies the urethra, and whilst sexual activity is not strictly contraindicated, many men feel uncomfortable attempting intercourse with an indwelling catheter in place. NHS guidance suggests discussing positioning, taping the catheter, and using a smaller leg bag during intimacy. The psychological impact of having a visible drainage bag can also affect intimacy and sexual confidence.

Suprapubic catheters are inserted through the abdominal wall directly into the bladder, bypassing the urethra entirely. This approach may be preferable for long-term catheterisation and generally has less impact on erectile function compared to urethral catheters, as the penis and urethra remain unobstructed. Men with suprapubic catheters often report greater comfort during sexual activity, though body image concerns and the underlying medical condition remain relevant factors.

Urinary sheaths (external catheters) fit over the penis like a condom and collect urine externally. These avoid urethral instrumentation entirely and typically have minimal direct impact on erectile function, though skin irritation or allergic reactions to adhesives may cause local discomfort.

Preventing and Managing Erectile Problems After Catheterisation

Proactive strategies can minimise the risk of catheter-related erectile difficulties and support recovery of normal sexual function following catheterisation.

Skilled catheter insertion by trained healthcare professionals is fundamental. Proper technique, adequate lubrication, and appropriate catheter sizing reduce the risk of urethral trauma. Patients should ensure catheterisation is performed by experienced practitioners, particularly if repeated procedures are necessary. For those requiring long-term catheterisation, education about proper catheter care and hygiene helps prevent complications such as infection that might indirectly affect sexual function.

Early mobilisation and catheter removal when clinically appropriate supports faster recovery. Healthcare teams should regularly review the ongoing need for catheterisation, as prolonged unnecessary catheter use increases complication risks. NICE Quality Standard QS61 emphasises that indwelling urinary catheters should be removed as soon as they are no longer clinically necessary.

Pelvic floor physiotherapy may help some men experiencing erectile difficulties following catheterisation, particularly after prostate surgery or in cases of pelvic floor dysfunction. Physiotherapists specialising in men's health can provide exercises to strengthen pelvic floor muscles, which play a role in erectile rigidity and ejaculatory control.

Addressing psychological factors is equally important. Open communication with partners about concerns, realistic expectations about recovery timelines, and professional psychological support when needed can significantly improve outcomes. Cognitive behavioural therapy (CBT) has demonstrated effectiveness for psychological erectile dysfunction and may be available through NHS referral pathways.

Pharmacological options may be appropriate for persistent erectile difficulties. Phosphodiesterase type 5 (PDE5) inhibitors such as sildenafil, tadalafil, or vardenafil are first-line treatments for erectile dysfunction and may be prescribed once catheterisation-related inflammation has resolved. These medications enhance the natural erectile response by increasing blood flow to the penis. They are contraindicated in patients taking nitrates or riociguat and should be used with caution in those taking alpha-blockers or with significant cardiovascular disease. They should be prescribed by a healthcare professional who can assess suitability and potential drug interactions.

Vacuum erection devices, intracavernosal injections, or intraurethral therapies represent alternative options for men who cannot use or do not respond to oral medications. These should be discussed with a specialist in sexual medicine or urology. Injection therapies require proper training and carry a risk of priapism (prolonged, painful erection).

Patients are encouraged to report any suspected side effects of erectile dysfunction medicines via the MHRA Yellow Card Scheme.

When to Seek Medical Advice About Erectile Dysfunction

Knowing when to contact a healthcare professional is crucial for appropriate management of erectile difficulties following catheterisation.

Patients should seek medical advice if erectile dysfunction persists beyond three months after catheter removal, as this timeframe typically allows for resolution of inflammation and psychological adjustment. However, earlier consultation is appropriate if symptoms are distressing or accompanied by other concerns. Whilst some temporary change in erectile function is not uncommon immediately following catheterisation, persistent difficulties warrant evaluation to identify underlying causes and discuss treatment options.

Immediate medical attention is required if you experience severe pain, inability to urinate after catheter removal, visible blood in urine beyond the first 24 hours post-removal, signs of infection (fever, rigors, offensive-smelling urine, or increased confusion in older adults), or a painful, persistent erection lasting more than four hours (priapism). For priapism, call 999 or go to A&E immediately as this constitutes a medical emergency.

Routine GP consultation is appropriate for gradually worsening erectile function, erectile difficulties accompanied by other urinary symptoms (weak stream, frequency, urgency), loss of morning erections, or significant psychological distress related to sexual function. Your GP can perform an initial assessment, including blood pressure measurement, blood tests for diabetes (glucose/HbA1c), cholesterol levels, and possibly morning testosterone if indicated. They will review medications that might contribute to erectile dysfunction, check for underlying conditions, and refer to specialist services when appropriate.

Specialist urology referral may be necessary if there are concerns about urethral stricture (narrowing), recurrent urinary tract infections, or complex catheterisation needs. Sexual medicine specialists can provide comprehensive assessment and advanced treatment options for persistent erectile dysfunction.

NICE guidelines recommend a holistic approach to erectile dysfunction assessment, including cardiovascular risk evaluation, as ED can be an early marker of cardiovascular disease. Therefore, erectile difficulties following catheterisation should not be dismissed but rather viewed as an opportunity for comprehensive health review. Open communication with healthcare professionals enables appropriate investigation, reassurance when concerns are unfounded, and effective treatment when intervention is needed.

Frequently Asked Questions