Erectile Dysfunction, Climacturia and Penile-length Shortening - What your consultants don’t tell yo

Erectile Dysfunction, Climacturia and Penile-length Shortening - What your consultants don’t tell you!

 I have been doing some research into the outcomes of RARP with respect to Erectile Dysfunction (ED) and incontinence, including arousal climacturia  -  leakage and/or ejaculation of urine when sexually excited during foreplay and/or at orgasms, and  penile-length shortening.  I had bilateral nerve sparing prostatectomy fourteen years ago and have suffered from ED, minor incontinence but serious arousal climaturia. My bilateral nerve-sparing prostatectomy was performed by an excellent, kind and highly experienced urologist in a private hospital in London but I wasn’t warned about the side effects in any helpful detail. However I have no regret that I chose RARP. It is a pity that most consultants, even those paid privately, take very little direct interest in the problems caused as a result of the treatments they carry out!

A research paper, https://www.liebertpub.com/doi/10.1089/end.2022.0106, reports that, following RARPs, 85% of men suffer some level of ED.  Also a study based on 800 men indicates that 40% experience arousal climaturia and 50% penile-length shortening. Those considering RARP treatment may find it useful to read the paper. Despite these statistics I think that given right conditions, and a competent surgeon, RARP is not a bad option.

Dealing with Climacturia and Reduced Penile Length

This has a devastating effect, both psychological and physical, on couples’ relationships and sex lives. Regular use of a medical-grade vacuum erection device (VED) can have a significant positive effect – because the urethra and penile tissue are both stretchable - over time. After my surgery, I felt that my flaccid penis had shrunk considerably. We have been using VEDs for many years now, if there were any penile-length shortening I have never felt it. I have never measured the length of my erect penis before (yes, I would say so, wouldn’t I!) but I always thought that I was average. I, but more objectively, my wife thinks that over time I have recovered the length, if I had lost any.  In fact my she often thinks that I tend to be over enthusiastic with my VED and asks me to dial it down a bit. 

Arousal climacturia is more difficult to deal with because it inhibits foreplay and ejaculation of urine is obviously unpleasant and can make love making quite difficult and unromantic. I have continued to experience serious arousal climacturia, but because I put on constricting ring/s on my penis after using a VED, at orgasm nothing can get through. Many men who use injections and PDE5 (Viagra etc) inhibitors have to deal with this problem. If they haven’t tried, it is worth putting on a ring to make love making less messy; it would also maintain your erections longer! The other advantage that we made ourselves avail to is enjoying oral sex which we never practised before; once you put the ring on and wash and dry yourself it is no longer an unpleasant experience for your wife/partner. Anyone interested in how we managed to turn what could have been a complete disaster - having had prostate cancer - into a very positive experience for us by increasing our repertoire of positions and variety of sex and may like to follow this link:

https://community.prostatecanceruk.org/posts/t28948-Re-establishing-Sex-Life

Use of VEDS and ring/s gives you a strong, reliable and designer- lengthwise – erections for 30 minutes! The main drawback of lack of spontaneity can be overcome by good communication, imagination and desire to please each other. It works for us and we are able to continue enjoying our intimate  life well in our old age. 

Edited by member 18 May 2025 at 21:41  | Reason: Not specified