Sex After Surgery: What can I expect?

First of all welcome to the forum and the club no one wants to join. You’re going to be alright and we’re here for you.

I had surgery mid January 2024. Sex is a work in progress for me but I’ll share a few comments based on my experience. Get busy as soon as you feel well enough. Be patient and kind to yourself if things take a while. It probably will but the destination is worth the journey.

Climax feels different and without seminal vesicles you will no longer ejaculate so there is no “build up” and “release” and some describe it as a “dry”:orgasm. On the positive side it’s less messy and I’ll leave figuring out the advantages of that to you. Some men say it’s less intense. Some say it’s more intense. Your mileage may vary.

What’s your Gleason score?

Thanks... my Gleason score is 7 (3+4). With moderate aggressive cancer in multiple areas of the prostate. So focal treatment wasn't an option. Going with surgery because risk of reoccurrence down the road.

As someone whose prostate cancer reoccurred my personal opinion is that you made a good choice given your circumstances. Don’t hesitate to check back into the forum if we can answer anything regarding concerns you have regarding prepping for surgery, recovery, regaining urinary continence, etc. We’re here for you.

Make sure to learn about "penile rehabilitation." Some doctors are very good about this but I've heard others are not. It basically involves taking daily low-dose Viagra or Cialis to keep bloodflow going. If your doctor doesn't offer this, you should ask (unless, of course, these meds are contraindicated for you for some reason).

There's a good book, though keep in mind that it's a bit dated, called "Saving Your Sex Life: A Guide for Men With Prostate Cancer" by John P. Mulhall, MD. He is the director of sexual medicine at Memorial Sloan Kettering, which is a top cancer center. I had radiation and am currently on androgen deprivation therapy (ADT) so can't answer any specific questions about sex after surgery but it is covered extensively in the book.

Just bought the book! I had never previously heard of it. Thank you for the suggestion. I will probably learn something.

I'm 7 weeks out from my RARP at Mayo in Phoenix. Unfortunately, due to the aggressiveness and stage of my cancer, the procedure was non-nerve sparing, and the maximum tissue was removed to allow for the "best cancer surgery possible." In this case, there will be no errections without implants or shots. Additionally, the incontinence makes intimacy of any kind to messy (constant dribbling) to contemplate, so I focus on my wife's needs, not mine. I think you are making a wise decision as to surgery, but make sure you understand what the planned surgery will be (NS vs. NNS) and what the likelihood of impotence and incontinence will be after surgery. I think it is much more common than most urologists communicate to patients. Good luck on your journey!

Google "Penile rehabilitation after prostate cancer surgery". I did that and put together a program from all the info I found. Daily Viagra (generic, covered by my Kaiser Medicare plan), near daily use of a penis pump, and vibrator induced orgasms several times a week resulted in full return of function within 7 months. "Full" equals ability to penetrate and continue to orgasm for both my wife and I. I do use Viagra now 16 months post surgery, whereas I didn't before...I think I could do without, but haven't tried yet. BTW I'm 75 and otherwise in excellent health.

Hey Steve. Congrats on picking Mayo in Phoenix. They set a standard for care that few other medical systems worldwide can match. I applaud you for your commitment to your wife. Good man!

I’m stage 3 locally metastatic with aggressive Gleason 9. They did nerve sparing on one side but I was warned that I’d be dealing with severe ED for a while or permanently. 6 months post surgery and 4 weeks post radiation that’s mostly still the case as I’m also on Orgovyx and Zyyiga which severely impacts libido and doesn’t help the situation. My oncologist and surgeon both support the idea of my seeing a urologist that specializes in the treatment of ED. I already tried a VED and did not like that at all. I see the specialist later this month and am willing to try the tri-mix shot. I know a couple guys that have used the shot with good success. If that doesn’t work, I will consider an implant. I know two men that have received them and are quite happy with the quality of their sex lives. I’m not giving up.

As for the incontinence and climaturia issue, I suggest you consider getting an appointment with a physical therapist that specializes in pelvic floor rehabilitation. https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/pelvic-floor-physical-therapy-benefits I just started treatment yesterday and while my main concern is reducing urgency I’ve been told that I’ll also benefit somewhat sexually with increased blood flow and full resolution of the occasional climaturia that I experience.

Hang in there Steve! Never give up!

Bob

(the wife here): nerves were spared. After the initial healing from wound, catheterization etc, his orgasms were weird for him. No stamina before the orgasm and softer erections. Make sure you urinate before sex as leaks occur during orgasm, which I don't mind but he does . A good partnership and open communication is needed to sometimes just laugh about it. For him it was worse than for me: I prefer him alive.

You are awesome. Best wishes to both of you.