Preparing for Prostatectomy and Rehabilitation

Preparing for your Prostatectomy and Rehabilitation

When I had my prostatectomy over 12 years ago I had no help whatsoever pre- or post-surgery. My wife and I had to work everything out from first  principles! Although I am writing this with particular reference to prostatectomy, because of my personal experience, I think the aspects relating to rehabilitation and /or erectile dysfunction discussed here would be helpful to men who have undergone other treatments. I think that the benefits of vacuum erection devices (VEDs) for rehabilitation and ED are underestimated because most men following treatment need help. Even those who have been fortunate enough to  have had nerve-sparing surgeries either take a long time to regain erectile function, and even when they do, some realise their erections are not as strong or long-lasting enough for a satisfying sex life. Of course, some men, like me, do not wish or are unable to  benefit from the use of drugs or other invasive treatments for ED. Anecdotally I know many  men find that their erections never return to what they were following surgery or other treatments.

A prostatectomy is a major operation, and it is useful to be well prepared before the surgery and know about how to rehabilitate and re-establish your sex life. Here are thoughts from my own experience over many years and what I have gleaned from other members (pun unintended, until my wife pointed it out!). Normally, most men experience nocturnal erections and emissions, a biological necessity to keep the reproductive system healthy.  Therefore, following surgery it is important to replicate this natural process by using a VED and massaging the penis and scrotum and of course masturbation serves a useful additional help.

Preparation

- obtain a vacuum pump. You don’t need to buy an expensive one at this stage, a         

   cheap one (£20-£30 from a sex shop). Start using the pump to see how it feels

- shave or at least trim your pubic hair

- if you wear boxers change to briefs (bigger size than normal) to secure incontinence pads

   more easily

- get some Vaseline to rub around the penis because it may get irritated due to the catheter

- water proof sheet under the mattress cover, just in case

- you will most likely be constipated so have something handy to take. My urologist was   

  very helpful and inserted a suppository when I was very constipated.

- a lot of healing takes place in your head, being optimistic helps

Kegel Exercises

Rather than seeing a physiotherapist or buying a smart phone-operated probe to insert into your rectum, here is what I did twelve years ago following my prostatectomy when there was very little support before or after surgery.

- sit on the toilet, if you are incontinent, the urine will flow freely or drip.

- tell yourself you are going to stop the flow - this is intuitive - and you will squeeze the

  appropriate muscles (Kegel muscles) which control your urinary function; you may not 

  notice any effect at first; patience is a great virtue

- squeeze to try and stop the flow, count to ten, then relax

- repeat this ten times, three times a day.

- do not overdo it!

Initially you may not notice any change for a few days or a couple of weeks (as in my case) then gradually you will begin to feel the difference. It took me about three to four weeks to regain 99.9% control. Also massage your scrotum and penis gently (after the catheter is out!) as soon as you feel you have healed enough and feel confident, continue doing this as often as you feel safe doing it but don't overdo it. This will remind you of the pleasurable sensation you get when you handle your penis to masturbate or when your wife holds and caresses it during foreplay. Now it is time to masturbate! Most men think that if your penis is flaccid, and worse if you are leaking urine, you can’t masturbate – not true. Just roll back your foreskin (if you have any!), put a little lubricant on and rub the frenulum (this is the little bit of skin that attaches the foreskin to the main body of the penis, when you roll back the foreskin). When you orgasm you are most likely to spurt out urine, be ready with a flannel! My first orgasm was mind blowing and messy with the urine all over the place! Some men have dry orgasms.

How to use a vacuum pump for rehabilitation and for penetrative sex

Depending on your GP you may be able to obtain a medical grade pump, preferably a battery operated one (SOMAerect – imedicare.co.uk) on prescription. It would be very helpful if you discuss the process of rehabilitation with your wife/partner in detail. When you feel healed and confident enough start using the pump. Initially do not put the ring on. You have undergone a massive mental and physical trauma so be kind to yourself and be gentle. Your penis may be so flaccid that it may seem impossible to insert enough of the penis into the pump. Hold the pump firmly but not too heavily against your body. Then start pumping with the handle or press the on button on the battery-operated device. You will find that your scrotum tends to get sucked in (don’t panic, there is a vacuum release button if you feel pain!) but carry on until you feel your penis shows a sign of erection. Stop pumping, remove the pump and repeat the process while pulling your scrotum away from the base of the pump. Gradually your penis will get bigger every time you pump. Don’t rush. With a bit of practice within a few sessions you will achieve a strong erection. At   this point it is ideal to enjoy masturbating again to remind your penis and particularly your brain how it felt when you were young. Now is the time to put a ring on and start the process of creating an erection by a start-stop process when you will notice your penis growing even when you stop pumping. When you have achieved a reasonable size erection slip the ring on to your penis. Warning: when the ring ‘pings’ on to the penis it can be very uncomfortable but remember no pain no gain! Because of the ring on your penis it stops any leakage of urine and you are free to masturbate normally. Warning: Because of the ring at the base of the penis there is a ‘hinge’ effect and the penis waggles a lot. Take care when you or wife masturbates you or when attempting penetrative sex. If you make love to your wife from behind in spite of the ‘hinge’ effect you retain the control and in this position your wife can use a vibrator and with practice you can achieve simultaneous orgasms. Also because of the ring on your penis you don’t leak any urine and if you wish after achieving an erection you can clean yourself up for your wife to give you oral sex when you get into ‘69’ position so that you can use a vibrator on her giving you control of your wife’s orgasms. With experience you can achieve a strong sustainable erection for up to 30 minutes within three minutes of pumping. 30 minutes of penetrative or oral sex most men would only dream of! Our sex life is as good as and in some ways better than pre-surgery. Some men following surgery even if their nerves are spared, find that their erections are not as strong as pre-surgery and neither do they last long enough. Armed with your pump and the rings, you can return to having strong half hour lasting erections! Have a look at the following link which shows how we have re-established our sex life: https://community.prostatecanceruk.org/posts/t28948-Re-establishing-Sex-Life