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Erection & penile tissue

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User
Posted 05 Nov 2019 at 14:29

Hi,

At last after 10 months from my Radical Prostatectomy, I just dribble and so I want to move on to the other function of the penis.

I understand it is important to preserve the penile tissue if you do not want the penis to remain shortened - sometimes mine completely disappears!

It has been suggested that I use a vacuum pump, but frankly I do not want to spend 20 minutes each day using it; although sex is very important I have better things to do each week than spend over 2 hours in the hope it will help - and as I am on Warfarin there is less chance it will do any good anyway!

I can have orgasms but they say that it will not help me get erections and so masturbation with a limp penis is not going to helping preserve penile tissue - true/false?

The alternative is injections, which should/may give me an erection, but will it help the tissues?

Thoughts/advice would be much appreciated
Many thanks, Chris

User
Posted 05 Nov 2019 at 22:15

Injections (or any of the alprostadil vasodilator drugs) tend to be dished out at the rate of once a week for having actual sex. Occasionally people have got more for the purpose of penile rehabilitation rather than having sex, but not often. I think to preserve penile structures, you should be aiming for erections more often than one a week. Reaching orgasm is not necessary for this purpose, but go for it too if you want to.

The RP will have lost you some length anyway, typically 1" - 2". This is due to shortening the urethra, because you lost the part of it inside the prostate, and to rejoin to the bladder, some is pulled in and the bladder neck is pulled down to meet.

If you don't have regular erections (and this applies both after RP, and also in the case of loss of libido for men on hormone therapy), the corpus cavernosum (erectile parts of the penis) start forming fibrous tissue, which reduces elasticity. This causes less expansion both in length and girth, and can cause less hardness too. The flaccid penis is ischemic (short of blood flow - only 30% of similar body tissues) and relies on regular erections to get a periodic good blood supply to the tissues.

Of course, it's up to you how much effort you put in, and how important it is to you to try and prevent your penis getting shorter. Once fibrous tissue forms in the corpus cavernosum, that's not reversible, although you might get a reversal of some very recent shortening when you start using a pump.

Something else that may help (but is difficult to get in many areas) is a daily low dose (5mg) tadalafil prescription.

What I would suggest is that you get a referral to an ED clinic, and they can go through the options, and what's available in your area. There may be some special considerations relating to being on an anti-coagulant too.

User
Posted 06 Nov 2019 at 09:35

I am on hormone's and just finished chemo awaiting radiotherapy.  I went to the ED clinic and was prescribed 5 mg of tadalafil daily which helped. ( I do need 10/15mg + need to really focus on the job in hand to get fully hard). 6 weeks after I had a follow up where I managed to get a pump on prescription, I cannot express how useful this is when keeping everything in working order. I use it 10 mins a day with the daily tadalafil and I am more than happy. I have more girth than before and my length has not shortened at all ( I have had not RP mind ), mentally it reassures me that if I end up on hormones for a long time my tackle will still be in shape. I place a lot of importance on intimacy in a relationship so I have made a lot of effort to keep everything as it used to be even though it can be hard mentally as well as physically.

 

User
Posted 06 Nov 2019 at 20:03
All great posts here and good information. In my opinion the pump is absolutely essential and has led to me having really good intimacy again. I can imagine without my regime I would be nowhere near as recovered as I am today 4 1/2 yrs on. I still use it every other day whilst I shave. A really good pump and full erection for 15 mins whilst I’m doing my face. I don’t use messy lube , just soap and water and rinse the tube out after. Very very simple but a life ( erection ) saver. Many men don’t realize that pre-treatment they were getting many many erections per day and night , and without these they are suffering permanent tissue damage. So pump pump pump when you can. Even though I was quite regular , I still ended up losing around a 1 1/2 inches. It stayed normal for ages and then seemed to just shorten suddenly. I agree with the increased girth though, and I hear that’s very important :-))
User
Posted 02 Jan 2020 at 08:39

I went through the Urology dept - give them a ring as it will be much quicker than the referral route - good luck

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User
Posted 05 Nov 2019 at 21:17

I can't really answer your question about tissues but 3 years after the op which was hoped to be right side nerve sparing, and with no treatment, tablets or pumps, I've found:

- it needs manipulation and the right thoughts to have any response.  It does nothing by itself.

- it responds better the more inclined I'm positioned.  Standing is best.  It could be just a gravity effect as it can get larger if I strain on the loo which I don't recall before the op.

- standing, it can be quite hard and enlarged, lying down it's sort of hard but not bigger.

- it's temperamental but so is my urge, I don't think my urge is all it was.

- the first inkling of an arousal can cause a drop of urine sometimes more but it's only at initiation.  The better the urge/response the more quantity it leaks.

- I still believe it's improving but it's slow.

During treatment I almost stopped all sexual activity and whether that caused problems I don't know but it seems to work in the right circumstances.

User
Posted 05 Nov 2019 at 22:15

Injections (or any of the alprostadil vasodilator drugs) tend to be dished out at the rate of once a week for having actual sex. Occasionally people have got more for the purpose of penile rehabilitation rather than having sex, but not often. I think to preserve penile structures, you should be aiming for erections more often than one a week. Reaching orgasm is not necessary for this purpose, but go for it too if you want to.

The RP will have lost you some length anyway, typically 1" - 2". This is due to shortening the urethra, because you lost the part of it inside the prostate, and to rejoin to the bladder, some is pulled in and the bladder neck is pulled down to meet.

If you don't have regular erections (and this applies both after RP, and also in the case of loss of libido for men on hormone therapy), the corpus cavernosum (erectile parts of the penis) start forming fibrous tissue, which reduces elasticity. This causes less expansion both in length and girth, and can cause less hardness too. The flaccid penis is ischemic (short of blood flow - only 30% of similar body tissues) and relies on regular erections to get a periodic good blood supply to the tissues.

Of course, it's up to you how much effort you put in, and how important it is to you to try and prevent your penis getting shorter. Once fibrous tissue forms in the corpus cavernosum, that's not reversible, although you might get a reversal of some very recent shortening when you start using a pump.

Something else that may help (but is difficult to get in many areas) is a daily low dose (5mg) tadalafil prescription.

What I would suggest is that you get a referral to an ED clinic, and they can go through the options, and what's available in your area. There may be some special considerations relating to being on an anti-coagulant too.

User
Posted 06 Nov 2019 at 09:35

I am on hormone's and just finished chemo awaiting radiotherapy.  I went to the ED clinic and was prescribed 5 mg of tadalafil daily which helped. ( I do need 10/15mg + need to really focus on the job in hand to get fully hard). 6 weeks after I had a follow up where I managed to get a pump on prescription, I cannot express how useful this is when keeping everything in working order. I use it 10 mins a day with the daily tadalafil and I am more than happy. I have more girth than before and my length has not shortened at all ( I have had not RP mind ), mentally it reassures me that if I end up on hormones for a long time my tackle will still be in shape. I place a lot of importance on intimacy in a relationship so I have made a lot of effort to keep everything as it used to be even though it can be hard mentally as well as physically.

 

User
Posted 06 Nov 2019 at 19:29
Chris

Most advise using a pump for rehabilitation. That advice from what I have read varies from once per week to three times per day with five inflations and deflations per session with a couple of minutes between each.

I find it no real chore to wake up 20 minutes early, make a coffee and sit in bed for 20 minutes using the pump, then again 20 minutes before bed watching TV.

I was lucky not to lose any length at all through RARP and 2.5 years on with only partial erection possible with meds, still no atrophy at all. ED is still slowly improving.

I struggled to get a prescription pump for the first 2 years and bought several cheap ones from Amazon. I still use one of those as well as the Somaerect. It is lighter and because the pump part is separate I can stand at the wash basin and shave while it hangs on. The ones I bought came with the squashy ball type pump part which didn't last. I bought a slightly longer tube and better scissor type pump part which is lighter seperately and this means I can hang the actual pump part in the basin or on the cabinate door to reduce the weight hanging/sucking on. It can also be used in the bath or shower. The pump came with a plastic soft liner which I trimmed back to about 50 mm long so that it just forms a seal or you can buy a seperate seal piece. Now it fits mostly without touching the sides so no lube needed. There is lots of choice on line and mine cost less than 40 quid all together. I find it's necessary to shave or trim close to get a good seal. Hope this helps.

Good luck with your recovery

Cheers

Bill

User
Posted 06 Nov 2019 at 20:03
All great posts here and good information. In my opinion the pump is absolutely essential and has led to me having really good intimacy again. I can imagine without my regime I would be nowhere near as recovered as I am today 4 1/2 yrs on. I still use it every other day whilst I shave. A really good pump and full erection for 15 mins whilst I’m doing my face. I don’t use messy lube , just soap and water and rinse the tube out after. Very very simple but a life ( erection ) saver. Many men don’t realize that pre-treatment they were getting many many erections per day and night , and without these they are suffering permanent tissue damage. So pump pump pump when you can. Even though I was quite regular , I still ended up losing around a 1 1/2 inches. It stayed normal for ages and then seemed to just shorten suddenly. I agree with the increased girth though, and I hear that’s very important :-))
User
Posted 02 Jan 2020 at 08:15

On a practical note, can I ask who what the best route is for referral to an ED specialist/clinic? Is this through the hospital or through GP etc. Thanks

User
Posted 02 Jan 2020 at 08:39

I went through the Urology dept - give them a ring as it will be much quicker than the referral route - good luck

User
Posted 02 Jan 2020 at 09:57

Originally Posted by: Online Community Member
It has been suggested that I use a vacuum pump, but frankly I do not want to spend 20 minutes each day using it; although sex is very important I have better things to do each week than spend over 2 hours in the hope it will help - and as I am on Warfarin there is less chance it will do any good anyway!

Chris,

Rereading this thread, and some data I picked up, having since been to a pump clinic (as they're aptly known), pumps shouldn't be used if you are on blood thinners (at least, it's the first question they ask, and I suspect you don't get any further if you are).

This would suggest you should push for 5mg daily low dose Tadalafil instead of a pump, for penile rehabilitation.

Edited by member 02 Jan 2020 at 09:58  | Reason: Not specified

User
Posted 02 Jan 2020 at 10:26

you have hit it on the head Andy, I take warfarin - but would you believe it the ED doc in Reading hospital did not agree and was all for pushing me to have one!

I was already taking the Tadalafil as I talked our GP into giving it to me because the hospital was not giving me an appointment - it actually took the hospital over 10 months to give me an ED appointment; I fear the NHS are really understaffed and it is difficult for them to do all the follow up treatment. 

But look on the bright side - they have given me life, I just have to get use to it being a little different now and perhaps for a few years.

Happy New year to all - make 2020 a special peaceful and successful year
All the best, Chris

User
Posted 02 Jan 2020 at 10:50

Chris,

I just checked in the instructions. It says:
If you have Sickle Cell Anemia, Leukemia, or are on blood thinning medications, consult your physician before using this product.

So, it might not be a complete block on using a VED (Vacuum Erection Device), but clearly advice from a clinician who understands the issue is required.

If tadalafil works, it's better than a VED because it generates an erection in the whole penis, whereas the VED only generates an erection in the exposed part of the penis, although it will help blood flow in the whole penis.

You say you are treated in Reading. Just to make you aware of the Reading Prostate Cancer Support Group if you aren't already. Our next meeting is this Friday (3rd Jan 2020) in the evening, and you would be really welcome. Partners are welcome too.

User
Posted 02 Jan 2020 at 10:51
The pump can be used by men on warfarin. It is probably safer than injectables.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 02 Jan 2020 at 10:53

"If tadalafil works, it's better than a VED because it generates an erection in the whole penis, whereas the VED only generates an erection in the exposed part of the penis, although it will help blood flow in the whole penis."

But tadalafil can't replicate the multiple erections in the same way the pump can. A combination of both would be better.

Edited by member 02 Jan 2020 at 10:54  | Reason: Not specified

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

User
Posted 02 Jan 2020 at 11:15

Originally Posted by: Online Community Member
But tadalafil can't replicate the multiple erections in the same way the pump can. A combination of both would be better.

I agree, if you can get both. But if you can only get one or the other, and daily tadalafil works for you, the pump clinic guy told me not to swap daily tadalafil for the pump.

For some time, I had no idea what you should be aiming for in terms of erections for penile rehabilitation, and it doesn't seem to be documented anywhere. However, just recently, I got two figures from two different people. I don't place a lot of clinical significance behind the figures (I've no idea how they were arrived at), but they do sound plausible:

10 mins once a day, or
20 mins every other day.

Try to do it at least every other day. With the pump, doing it several times is better than just one long one (as Lyn said).

Edited by member 02 Jan 2020 at 11:16  | Reason: Not specified

User
Posted 02 Jan 2020 at 13:26

Zoe, our ED nurse, told John to use the pump twice a day, pumping and releasing for 5 repetitions each time. She also said that pumping and releasing a number of times was much more important than pumping once and holding the engorgement for a period of time. The exception to that would be if using the band(s) for penetrative sex, in which case the maximum time for engorgement is 30 minutes (no more than 20 minutes if you have circulation problems).

My greatest support in the early years was from Adrian who used only the pump - it is worth reading some of his old posts as no-one on here now seems to use it as routinely and successfully as he did. 

https://community.prostatecanceruk.org/default.aspx?g=profile&u=2280

 

 

Edited by member 02 Jan 2020 at 13:30  | Reason: to add link to profile

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

User
Posted 05 Jan 2020 at 12:29

I am on Apixaban and was vary wary of trying a pump. I was told to have a go  but very carefully. The first few weeks I went for partial inflation then got braver and went the full monty. Now I have no qualms at all. Been using for 18 months with no problems. 

This is my own personal experience but it shows it is not a no no for everyone on blood thinners. 

 
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