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drugs - which ones are best for ED

Posted 08 Feb 2015 at 12:44

Hello all,

We are having a struggle understanding which drugs are best. Most of our information has come from this forum or the helpline, but we still find ourselves a little confused and hope you can help.

Four weeks post op, we saw the continence/ED nurse. At our request, she put him on sildenafil 50mg. After joining this forum, I discovered that the general opinion was that 5mg Cialis was the initial drug of choice. We went back to see her ten days ago, and although she said there was no difference apart from the time the drug acted for, she agreed the OH shyould take it. She aslo gave him a vacuum pump (which he uses for exercise but detests)

So here is my question.

What is the perfect after care for someone who has had robotic RP? If money was no object, which drugs should he be taking, and at what point, to give him the best chance?

Is the cialis just for short term use? My OH has decided he doesn't want to try sex until he is continent. He is on three pads a day at present. I understand that the sildenafil is just for 'action'. When he decides the time is right to try for a night of unbridled passion, should he stop taking the Cialis and take the sildenafil instead? Or do the drugs go hand in hand - can they be taken together?

It would be great if I could get all this straight in my head, so when he asks I know. I am trying to stay as positive as possible and sound like I know all the answers, so when he has a bad day (and there have been a few) I can sound confident when I tell him it's normal!

Posted 08 Feb 2015 at 19:37

Hello Louise.
I hope somebody with more knowledge replies to you soon but in the meantime, I'm pretty sure you don't take both drugs together.

I can understand that he doesn't want intimacy while he still has incontinence.
The other point I feel I might be able to comment on is the "night of passion". You may have meant that tongue in cheek, and I sincerely hope that it is indeed a night like that for you but...,...

Sildenafil (Viagra) does not work on it's own. ie it will not produce a voluntary erection so if he (or you) think that he takes one, waits the required 30-60 minutes they'll be no holding him you might be a tad disappointed.

I don't know your ages, or what it was like for you before PCa, but for some men, the mere fact that they have to use a "prop" is a bit of a passion killer and he may well need much encouragement from you.
Sildenafil works with mental and physical stimulation. He will need (and I am sure he receives) much love and support from you. Not only has he had to undergo something as horrible as an operation, he may presently be feeling less of a man and a burden because of the incontinence. He will probably take some persuading that you still love him and need and desire him even as he is.
I've said it on a number of occasions but men are a funny breed. They certainly think differently I feel to most women.

As for everything else - well it is normal. It's currently HIS normal.

Just be there, be patient and caring and understanding - even when you are gritting you teeth because he just isn't listening to you!!

Good luck and best wishes

Edited by member 08 Feb 2015 at 20:58  | Reason: Not specified

We can't control the winds - but we can adjust our sails
Posted 08 Feb 2015 at 20:33

I had robotic RP, not sure there is a simple answer to you question and all the options are confusing.I was told my nerves had not been sparred, but when I explained to my surgeon last week that I get some movement and stirrings he has put me on daily 100 mg of Sildenafil.

Even when incontinence is under control leakage and ejaculating urine is possible. Emptying the bladder and using a condom can be a help.

Sandra is quite right we are a funny breed.

Thanks Chris

Posted 08 Feb 2015 at 23:44

What would be the ideal?

- Taking 2.5mg or 5mg Cialis daily for up to two years to aid nerve repair
- using the pump (without the rings) every day to replicate the normal erections that men have on waking, during the day or during their sleep
- regularly stimulating the penis, rubbing / stroking etc to encourage blood flow and pulling it gently to help maintain length
- once he is continent (or with a condom), using the pump with rings to try intercourse - some men find this very successful and avoids the need for any chemicals
- Once he is ready, trying Viagra or Levitra when he is feeling randy - this needs patience to work out what dose works best, how long it takes to work for him (Viagra is supposed to work in a couple of hours and Levitra much quicker but John found 3-4 hours later could be more successful) and that kind of thing
- Alternatively (and possibly before trying the Viagra / Levitra), taking 4 Cialis all at once in advance of a special event. But this may need a lot of warning - John would take 4 Cialis at bedtime for sex the next morning ... or 4 Cialis in the morning for sex that evening as it is a slow release chemical
- If none of the tablets work and he can't get on with the pump & rings, the next step would be Caverject injections or Muse pellets. These do not require the man to be aroused - they either work or they don't work and are not reliant on emotions.

The medical advice is that Viagra & Levitra must not be taken within 24 hours of the Cialis but for men with proper ED, they can be taken in the same day with medical advice & supervision and instructions on what to do in the case of priapism including how long to wait before going to A&E.
None of the tablets should be taken the same day as Caverject or Muse.

In the meantime, I think mutual masturbation and oral sex are perfectly possible and you may have to instigate these rather than wait for him to be brave.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

Posted 09 Feb 2015 at 19:18
Thanks for the responses.

Yes, the night of passion was very tongue in cheek. I don't think for a single second we will be that lucky. I'm prepared for the long haul, and I think he may just be starting to realise that a long haul is what it will be.

It's very encouraging to read that in spite of no nerve sparing, there is hope. OH has one set of nerves, so fingers crossed.

It's difficult to tell if he is doing the stroking/rubbing etc. he is not at all keen for me to do it because of the incontinence, and gets quite shirty if I ask him if he's done his 'physio'. He doesn't like to discuss it.

He's still very tired at night (he slept thirteen hours last night) and there doesn't seem to be time. I am trying to persuade him that one bodily fluid is the same as another, but he really doesn't seem to want me to touch at the moment, and I am respecting that

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