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Sex after Prostate surgery

User
Posted 27 May 2019 at 11:48

Hello all,

I’ve recently been diagnosed with PC at 44 and will be having the operation to remove the prostate later this year.

Can I ask what sex will be like after the operation and will I definitely require pills/injections to combat ED?

Will orgasms feel the same?

Thank you.

 

Edited by member 27 May 2019 at 12:58  | Reason: Added extra questions

User
Posted 27 May 2019 at 14:50

Welcome to the forum. We're all sorry you're part of this elite group, but you'll get loads of support and information here. You might want to update your profile bio with details of your diagnosis and treatment, as that enables others to give you better targeted advice.

A big factor for sex will be if you can have nerve sparing surgery or not. Nerves controlling erection run down the rear and bottom surface of the prostate, and if the cancer doesn't come too close to the prostate surface in these locations, then they can generally be spared. Sometimes, they can be partially spared even if all of them can't. Your urologist/surgeon will be able to tell you how much nerve sparing they expect to be able to do, but they won't know for sure until they open you up, so there are no guarantees before you have the operation.

Even if they are spared, they won't work immediately after the operation, so you will almost certainly have no erections to start with. Recovery is gradual generally takes many months, but can be up to a couple of years. Having frequent erections is actually essential for maintaining the structure of the penis, so is important you embark on a program of Penile Rehabilitation as soon as your surgeon gives the OK (probably a few weeks after the op), which forces periodic erections (e.g. using a penis pump) even though you can't do so naturally, or you will limit the extent to which you will be able to get erections later when the nerves recover. Ask for an appointment with the Erectile Dysfunction (ED) clinic now, and they will go through all this with you, and/or ask here and we can go through it in more detail. You may also be able to get a prescription for a low dose PDE5 inhibitor (such as daily 5mg Tadalafil) which will help preserve the penis tissues over a period of no/fewer erections than normal, and may help achieve better erections earlier.

If nerves cannot be spared, or don't recover even if spared, then the options for erections are less satisfactory, but not impossible. Pills/injections are possible options, as are implants, or using penis pump with rubber rings. Some people have reported finding the implants fantastic.

Orgasms will be dry and feel different as a consequence. Some people report they feel better, some people that they are not as good. An erection is not necessary in order to orgasm, something to bear in mind during the period you can't get a natural erection.

Penis shrinkage is an issue after most prostate cancer treatments. Reports here suggest people lose 1.5"-2" of erect length in the case of prostatectomy. This is because you lose the length of urethra through the prostate, and the urethra has to be reconnected to the bladder. Hence it's doubly important to undertake Penis Rehabilitation during the period of no/reduced erections, or you will lose even more due to lack of use. This reduction might mean some positions you used before won't work as well.

User
Posted 27 May 2019 at 19:42

1 - some men regain erections quite quickly; we have had two members who claimed to have normal erections within a few days of the op but this is extremely rare

2 - 80% of men who have full nerve sparing can get an erection (either naturally or using chemical / mechanical assistance) at 12 months post op.

3 - the NHS requires urologists to publish their data on continence and erectile function at 12 month point but note that in the data, ‘regaining EF’ does not necessarily mean that the erection is sufficiently rigid for penetration

4 - even with full nerve sparing, approximately 10% of men will never have an erection again. With partial nerve sparing or non nerve sparing the proportion rises significantly.

5 - there are good reasons that this is called the couples disease; has your wife / partner been fully consulted and have you discussed together the implications?

Here is our story - might help https://community.prostatecanceruk.org/posts/t9839-One-wife-s-story-of-ED

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

User
Posted 27 May 2019 at 18:55
Maybe click my picture and read my profile. I was 48 at surgery. There is a great post on here called ā€œ erecting the erection-medication ā€œ. See if you can find it. Iā€™m not cured but had nerve sparing. Im 4 yrs post op and it took 2 1/2 yrs to get normal function back. I still grieve for what I lost tbh. You need to take control of your recovery as you may be ignored. Ideally you should try for daily 5mg Cialis ( Tadalafil ) as soon as you can get it , and after 10 weeks you and a good vacuum pump need to become very very best friends to prevent loss of penis function and size as much as possible. Good luck

If life gives you lemons , then make lemonade

User
Posted 27 May 2019 at 19:17

If it's any comfort to you, I now have dry orgasms as a result of having had prostate radiotherapy, and to me they feel exactly the same as they did before, just minus the messy bit!

Cheers,

Chris

 

User
Posted 27 May 2019 at 19:27
You haven't shared your rationale for having the op as opposed to other treatment or even no treatment.

It is important you make your decision fully informed of the all the potential consequences and understand nothing is garuanteed.

So make sure you do not qualify for active survielence

Research the other treatments and ask for second opinions from an Oncologist if you can.

Remember each Doc will have their own preferences and these may not align with your best interests.

.

User
Posted 27 May 2019 at 21:39

Originally Posted by: Online Community Member

Hi,

I already have 2 daughters so luckily that doesn’t apply to me.

šŸ‘šŸ»

Hi, sorry to see you here, and happy that you have 2 daughters.  But, it still maybe worth considering sperm banking.  None of us know what will happen in our lives or to our relationships or to our partners. The question I would ask myself in your shoes is, what if...........something happened to me or my partner and I wanted children with A N Other?

If you Google vasectomy reversal stats, see how many men try to have that when their relationships fail and they meet A N Other.  Or their partner passes on, and they meet A N Other, and want children. 

I appreciate that this is a sensitive area.  And I don't wish or seek to offend.  So ignore the post, or complain and I will remove it if you wish.  But if my situation had happened to me at 44, I definitely would have banked sperm, in light of how life developed for me. 

atb

dave 

 

Do all you can to help yourself, then make the best of your time. :-)
User
Posted 28 May 2019 at 00:25

hi

to answer your specific questions. 

everyone is different.  you won't necessary need pills or injections.

You will however need patience and keep the penis healthy otherwise atrophy and permanent internal 'damage'

Please make sure you and your partner are fully informed of all outcomes.

I had non nerve sparing and was therefore expecting and we had been informed of very likely negative outcome.

However as Chris and many other post,  never give up. It took nearly 3 years and now more than satisfied with no meds or pump. I'm 4yrs post op . I am probably very fortunate.  I was told nerves do slowly grow.  

pde5 meds.  did nothing for me. As consultate explained about 9 months afterwards I had no active nerve signals.  

The only negative is occasional urine leakage around orgasm or before.

 

You are young. I assume you have already decided on surgery then ?

There's a wealth of info on this site.  Incidentally a colleague had a penile implant on NHS and he's extremely pleased.   It was something we decided we would not consider.

There's always a solution

see also 

http://community.prostatecanceruk.org/posts/t11500-Is-that-the-end-of-sex-for-me-and-my-partner

 

Edited by member 28 May 2019 at 00:31  | Reason: Not specified

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User
Posted 27 May 2019 at 14:05

Are you having nerve sparing or non nerve sparing

User
Posted 27 May 2019 at 14:15

Good question, all I remember is the consultant saying ‘I will try and spare the nerves’??

How does that work?

User
Posted 27 May 2019 at 14:50

Welcome to the forum. We're all sorry you're part of this elite group, but you'll get loads of support and information here. You might want to update your profile bio with details of your diagnosis and treatment, as that enables others to give you better targeted advice.

A big factor for sex will be if you can have nerve sparing surgery or not. Nerves controlling erection run down the rear and bottom surface of the prostate, and if the cancer doesn't come too close to the prostate surface in these locations, then they can generally be spared. Sometimes, they can be partially spared even if all of them can't. Your urologist/surgeon will be able to tell you how much nerve sparing they expect to be able to do, but they won't know for sure until they open you up, so there are no guarantees before you have the operation.

Even if they are spared, they won't work immediately after the operation, so you will almost certainly have no erections to start with. Recovery is gradual generally takes many months, but can be up to a couple of years. Having frequent erections is actually essential for maintaining the structure of the penis, so is important you embark on a program of Penile Rehabilitation as soon as your surgeon gives the OK (probably a few weeks after the op), which forces periodic erections (e.g. using a penis pump) even though you can't do so naturally, or you will limit the extent to which you will be able to get erections later when the nerves recover. Ask for an appointment with the Erectile Dysfunction (ED) clinic now, and they will go through all this with you, and/or ask here and we can go through it in more detail. You may also be able to get a prescription for a low dose PDE5 inhibitor (such as daily 5mg Tadalafil) which will help preserve the penis tissues over a period of no/fewer erections than normal, and may help achieve better erections earlier.

If nerves cannot be spared, or don't recover even if spared, then the options for erections are less satisfactory, but not impossible. Pills/injections are possible options, as are implants, or using penis pump with rubber rings. Some people have reported finding the implants fantastic.

Orgasms will be dry and feel different as a consequence. Some people report they feel better, some people that they are not as good. An erection is not necessary in order to orgasm, something to bear in mind during the period you can't get a natural erection.

Penis shrinkage is an issue after most prostate cancer treatments. Reports here suggest people lose 1.5"-2" of erect length in the case of prostatectomy. This is because you lose the length of urethra through the prostate, and the urethra has to be reconnected to the bladder. Hence it's doubly important to undertake Penis Rehabilitation during the period of no/reduced erections, or you will lose even more due to lack of use. This reduction might mean some positions you used before won't work as well.

User
Posted 27 May 2019 at 17:00

Thank you Andy62, you have explained so much more than my consultant.

I’m glad I joined the group today and will search more threads on the community pages should any concerns arise before my operation.

I will also update my diagnosis as per your comments.

Thank you again.

User
Posted 27 May 2019 at 17:47

Another thing, given your young age, have you considered sperm banking before your operation, or has anyone discussed it with you? I don't know what the criteria are for being eligible, but you might want to ask, as you will be infertile afterwards. (Well, it might be possible to extract sperm directly from a testicle for in vitro fertilisation, but I would assume anything like this is unlikely to work, not to mention a difficult and very expensive procedure for a partner.)

User
Posted 27 May 2019 at 17:55

Hi,

I already have 2 daughters so luckily that doesn’t apply to me.

šŸ‘šŸ»

User
Posted 27 May 2019 at 18:55
Maybe click my picture and read my profile. I was 48 at surgery. There is a great post on here called ā€œ erecting the erection-medication ā€œ. See if you can find it. Iā€™m not cured but had nerve sparing. Im 4 yrs post op and it took 2 1/2 yrs to get normal function back. I still grieve for what I lost tbh. You need to take control of your recovery as you may be ignored. Ideally you should try for daily 5mg Cialis ( Tadalafil ) as soon as you can get it , and after 10 weeks you and a good vacuum pump need to become very very best friends to prevent loss of penis function and size as much as possible. Good luck

If life gives you lemons , then make lemonade

User
Posted 27 May 2019 at 19:17

If it's any comfort to you, I now have dry orgasms as a result of having had prostate radiotherapy, and to me they feel exactly the same as they did before, just minus the messy bit!

Cheers,

Chris

 

User
Posted 27 May 2019 at 19:27
You haven't shared your rationale for having the op as opposed to other treatment or even no treatment.

It is important you make your decision fully informed of the all the potential consequences and understand nothing is garuanteed.

So make sure you do not qualify for active survielence

Research the other treatments and ask for second opinions from an Oncologist if you can.

Remember each Doc will have their own preferences and these may not align with your best interests.

.

User
Posted 27 May 2019 at 19:42

1 - some men regain erections quite quickly; we have had two members who claimed to have normal erections within a few days of the op but this is extremely rare

2 - 80% of men who have full nerve sparing can get an erection (either naturally or using chemical / mechanical assistance) at 12 months post op.

3 - the NHS requires urologists to publish their data on continence and erectile function at 12 month point but note that in the data, ‘regaining EF’ does not necessarily mean that the erection is sufficiently rigid for penetration

4 - even with full nerve sparing, approximately 10% of men will never have an erection again. With partial nerve sparing or non nerve sparing the proportion rises significantly.

5 - there are good reasons that this is called the couples disease; has your wife / partner been fully consulted and have you discussed together the implications?

Here is our story - might help https://community.prostatecanceruk.org/posts/t9839-One-wife-s-story-of-ED

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

User
Posted 27 May 2019 at 21:39

Originally Posted by: Online Community Member

Hi,

I already have 2 daughters so luckily that doesn’t apply to me.

šŸ‘šŸ»

Hi, sorry to see you here, and happy that you have 2 daughters.  But, it still maybe worth considering sperm banking.  None of us know what will happen in our lives or to our relationships or to our partners. The question I would ask myself in your shoes is, what if...........something happened to me or my partner and I wanted children with A N Other?

If you Google vasectomy reversal stats, see how many men try to have that when their relationships fail and they meet A N Other.  Or their partner passes on, and they meet A N Other, and want children. 

I appreciate that this is a sensitive area.  And I don't wish or seek to offend.  So ignore the post, or complain and I will remove it if you wish.  But if my situation had happened to me at 44, I definitely would have banked sperm, in light of how life developed for me. 

atb

dave 

 

Do all you can to help yourself, then make the best of your time. :-)
User
Posted 27 May 2019 at 21:39

Originally Posted by: Online Community Member
There is a great post on here called “ erecting the erection-medication “. See if you can find it.

https://community.prostatecanceruk.org/posts/t10993-Erecting-the-Erection---Medication

Edited by member 27 May 2019 at 21:40  | Reason: Not specified

User
Posted 28 May 2019 at 00:25

hi

to answer your specific questions. 

everyone is different.  you won't necessary need pills or injections.

You will however need patience and keep the penis healthy otherwise atrophy and permanent internal 'damage'

Please make sure you and your partner are fully informed of all outcomes.

I had non nerve sparing and was therefore expecting and we had been informed of very likely negative outcome.

However as Chris and many other post,  never give up. It took nearly 3 years and now more than satisfied with no meds or pump. I'm 4yrs post op . I am probably very fortunate.  I was told nerves do slowly grow.  

pde5 meds.  did nothing for me. As consultate explained about 9 months afterwards I had no active nerve signals.  

The only negative is occasional urine leakage around orgasm or before.

 

You are young. I assume you have already decided on surgery then ?

There's a wealth of info on this site.  Incidentally a colleague had a penile implant on NHS and he's extremely pleased.   It was something we decided we would not consider.

There's always a solution

see also 

http://community.prostatecanceruk.org/posts/t11500-Is-that-the-end-of-sex-for-me-and-my-partner

 

Edited by member 28 May 2019 at 00:31  | Reason: Not specified

User
Posted 28 May 2019 at 12:50

Thank you all for your comments, I have definitely taken everything on board and will be researching more as a result.

I was told at 44 the cancer will grow so removal was my only option.

User
Posted 28 May 2019 at 13:31

Thanks Chris!šŸ‘šŸ»šŸ‘ŒšŸ»

 
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