Painful Orgasms Post Prostatectomy Surgery Recovery

User

Posted 27 Jun 2022 at 22:03

Little background first: I had Retzius Sparing Bilateral Nerve Sparing Robotic Prostatectomy 26 days ago at the age of 53. World class surgeon (over 1,000 surgeries under his belt if not closer to 2,000). Everything went well. Clean Post Surgery Pathology report. Moderate incontinence (2-3 pads a day when catheter out 1 week post-surgery, now at 1-2 pads a day depending on activity level, continence recovery is particularly quick with the Retzius Sparing technique. Could probably go pad free while sleeping).

Prior to surgery my EF was as good as when in my 20's. Got a high quality vacuum device and started using it once or twice a day each time doing two cycles of erect 4-5 minutes, followed by a minute rest period. Feeling took some getting used, not overly painful, just a little uncomfortable but now after a week it feels pretty good/natural to use it. Also on 5mg Cialis a day to help keep things well oxygenated and aid in recovery time. I fully understand it's typically minimum 6 months to get hard without pump (and that's optimistic) and can take up to 2 years to reach recovery pinnacle. So I'm patient on the erection side of things.

RN said no orgasms for 4 weeks after surgery, "it will hurt." So I jumped the gun by 2 days as I knew orgasm and erection recovery are two different animals. So I was curious as to where I was at. Took about 3 times as long, about 10 minutes versus 3 to reach orgasm. Great build up, but not as strong of a "surge" but about 2-3 seconds after the climax, OUCH! Very painful spasm coming from somewhere near the perineum area felt like. No pain in around the penis. It felt like the same location I feel some moderate discomfort when I finish urinating, almost like you feel this very subtle pain like you need to pee more but you don't. So I'm guessing it's bladder or urethra sphincter spasms, not pelvic floor muscle spams? (the Retzius technique doesn't go in through the pelvic muscles so I have very little to no soreness at 26 days post surgery in my perineum area even sitting at a computer all day.)

I'm frustrated as the Urologist (I will be consulting the RN later this week) didn't really talk about this issue. There's little discussion of it on PCa boards around the world. But it seems from a few studies and a couple threads I found, (a) it's fairly common early on with your first few orgasms and (b) it resolves over time - like a year to completely go away!?!?

So I'm sitting here totally clueless and scared to try to orgasm again! Should I give another 2-4 weeks rest before trying it again or is part of getting rid of the pain faster to have more frequent orgasms (one a day or every other day) and just power through the pain at first, as it will diminish for quickly with the "exercise" and not having orgasms will just delay the pain going away?

User

Posted 14 Nov 2022 at 23:16

Thanks Andy. Is there anything I can take to help rid or reduce this problem or am I to suffer with it for the rest of my life?

User

Posted 15 Nov 2022 at 21:18

There are two sphincters - one is always removed during RP and the other may be left fairly untouched, may be removed and repositioned (that happened to my husband) or may remain in place but get a bit battered during the process.

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

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User

Posted 28 Jun 2022 at 00:37

The RP has resulted in lots of damage to pelvic structures that won't have fully healed in 28 days. Orgasm results in uncontrolled muscle contractions over the whole area - it would be remarkable if it wasn't painful at this point.

As for should you do it or not - I had painful erections just after my HDR brachy because my urethra didn't seem to stretch to the erection length. I asked the same question of my clinicians, and no one had a clue. I went ahead thinking I didn't want any adhesions to form and make this permenent. However, no one had been cutting through my muscles, urethras, etc and needing them to heal, so I would be more cautious in the case of a prostatectomy.

User

Posted 28 Jun 2022 at 01:06

The nurse said it would hurt but you tried it anyway and it hurt? There may not have been a lot of information from your surgeon but there are plenty of posts on the topic here - it seems from the statistics that surgeons publish that some do downplay the side effects. As Andy says, an orgasm involves a series of rhythmic muscle actions in the pelvic area where there are a lot of cut, burnt and bruised nerve endings which will take time to heal and are probably still sending very confused messages to your brain. That should certainly improve with time. However, for many men, dry orgasm is much more intense than prior to RP and orgasms can continue to be painful for months if not years.

Orgasm isn't going to do any actual damage - my husband had his first orgasm on the day his catheter was removed. Avoiding it isn't going to delay or speed up the process of it not hurting anymore. It comes down to whether you can feel randy knowing it might hurt afterwards.

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

User

Posted 28 Jun 2022 at 01:43

Originally Posted by: Online Community Member

The nurse said it would hurt but you tried it anyway and it hurt?

The nurse was recommending don't do it earlier than 4 weeks, okay, I did it in 3 weeks 5 days. LOL. Like 2 days is going to make a night and day difference. But I get your point. I was expecting some sort of weird feeling/moderate pain, but this was for about 4 seconds like getting electric shock therapy to my perineum area. (crying laughing)

Originally Posted by: Online Community Member

...orgasms can continue to be painful for ... years.

This is what I'm trying to find out if there's anything I can do to avoid. I read somewhere if it doesn't resolve in a year, supposedly Flomax can help? Guess I'll cross that bridge if I get to it.

In the meantime, I feel like I need a stiff drink or something before I try next time to take the edge off the pain, LOL. Oh whoops, alcohol not good for incontinence or cancer recurrence in general. Guess I'll just need to "tough it out" and see how things go.

I chatted with a couple other patients and so far the consensus is steering towards, this isn't that abnormal, you need more time to heal, and, stop forgetting to do your pelvic floor exercises.

Edited by member 28 Jun 2022 at 01:46 | Reason: Not specified

User

Posted 28 Jun 2022 at 10:47

Originally Posted by: Online Community Member

Very painful spasm coming from somewhere near the perineum area felt like. No pain in around the penis. It felt like the same location I feel some moderate discomfort when I finish urinating, almost like you feel this very subtle pain like you need to pee more but you don't.

Jaz , leaking urine when having an orgasm or having intercourse is a frequently reported issue. I wonder if your pain when having an orgasm is connected to a bit of urine leakage and having a similar effect to ending urinating.

Some guys say they get very intense painful orgasms. I describe mine as out of this world, although I have had pains in the perineum , I have never associated them with orgasms, it has either been from an infection or obstructions in the water works.

Have you had your urine tested for a possible infection.

Of course you are still healing.

Thanks Chris

User

Posted 13 Nov 2022 at 23:09

I have the same ongoing issue two years after RP. I take Tamsulosin 0.4mg daily which helps a little and my urologist (my third one) suggested botox shots in or around the bladder. That did give me more relief but it only last for months. I notice that i need to make sure I completely drain my bladder and have no bowel urges leading up to intercourse.

So basically I'm dealing with it but still no cure

User

Posted 14 Nov 2022 at 22:46

Tamsulosin (Flowmax) is an alpha blocker, which acts on the cells in the prostate and internal urinary sphincter. These are all removed during a RP, so there isn't anything left for Tamsulosin to act on.

It's also an uncontrolled blood pressure reducing drug, so if you come off it, check you blood pressure in case you need some blood pressure meds instead.

User

Posted 14 Nov 2022 at 23:16

Thanks Andy. Is there anything I can take to help rid or reduce this problem or am I to suffer with it for the rest of my life?

User

Posted 15 Nov 2022 at 13:33

Which problem are you wanting to resolve?

User

Posted 15 Nov 2022 at 21:02

Andy, I thought tamsulosin is designed to relax smooth muscle cells with some selectivity for the urinary system. After the prostate is removed there is still the rest of the urethra so Skip may find some benefit (which indeed he says he does).

My impression is that the amount of the internal urinary sphincter which is removed (or damaged) during prostatectomy is pretty variable depending on patient. At least, that is the simplest explanation for the different experiences of post-surgery continence which vary widely.

I am trying to think my way through possible implications of the drug's secondary effects on blood pressure. I have recently been diagnosed with somewhat high blood pressure (GP measurement when I was in for unrelated procedure) and have been trying to rationalise that. Could there have been a rebound when I came off tamsulosin (for presumed benign prostatic hyperplasia) prior to prostatectomy (once prostate cancer diagnosed); or it is a side effect of other things, like taking tadalafil post-surgery and recently having hormone therapy in association with salvage radiotherapy; or is it just one of those penalties of getting older?

User

Posted 15 Nov 2022 at 21:18

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

User

Posted 20 Nov 2022 at 19:56

Hi I have found my brain saying not to pee while having intercourse then orgasm and conflict of interest at my sphincter early days it was nippy after orgasm ! Have discovered a nice real ale ipa relaxes me and no orgasmic pain.

Perhaps is should be prescribed !

Edited by member 20 Nov 2022 at 19:57 | Reason: Not specified

User

Posted 08 Dec 2022 at 11:54

Originally Posted by: Online Community Member

... I fully understand it's typically minimum 6 months to get hard without pump (and that's optimistic) and can take up to 2 years to reach recovery pinnacle. So I'm patient on the erection side of things....

Just a shout out on the 2 year boundary: I was told the same, and was pretty disappointed when I reached 2 years and my erections were still going up and down a bit like a yo-yo.

What I have learned is that some men's erectile function improves further over several years and 2 years is not a limit. I am nearly at 3 years post prostatectomy and still finding my erectile function continues to improve.

And by the way, Jazj, I hope and trust that your painful orgasms are a thing of the past. I had a few in the early weeks but that went away fairly quickly.

User

Posted 08 Dec 2022 at 20:41

Hi chaps I am at year three and no erections so just rely on pump.
also just started injections with mixed results.
Something that helped orgasmic pain was small tin of beer! Seemed to relax sphincter.

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