Sex After Surgery: What can I expect?

I wish I had used a vacuum erection device [VED, some have referred to it as a penile pump] for penile rehabilitation starting soon after surgery. I think MDs tend to rely on the pills, and there is also a tensioning device (RestoreX), but I have been most impressed with the simplicity and effectiveness of the VED--not for sexual play but for restoring the smooth muscle (and preventing its atrophy.) Even the cheap ones on Amazon work just fine, but you might have to search for the muscle rehabilitation protocols.
But the truth is that we just can't learn everything so quickly. At this stage, you are prepping for the surgery, hoping you can fit in a visit to a physical therapist specializing in pelvic floor, and hoping for a good outcome on the pathology. There is just a lot to learn and that all takes time in addition to the physical processing, emotional processing, and relational processing....

Thanks Bob! Good luck on your journey too!

I had bilateral NS RALP in late June 2024 by an excellent surgeon. I'm 70 and in good health at 188 lbs, 5'11". I had a catheter for 1 week, and good recovery since surgery. I'm just over 7 weeks since surgery. Now to your question about sexual function. Before surgery I was already using viagra, so I wasn't starting from a pristine state. So far (with help from viagra) I've had partial erections (maybe 60% or so of firmness) and have managed (marginal) intercourse with my wife a few times. At this point, I'm happy that I'm getting any response at all, but it's far from satisfactory. I did climax once which really surprised me and my wife. Of course it's a dry climax. Everything I've read indicates that if function resumes, it's going to take months (not days) except for a small percentage of (usually younger) guys. That said, it's still a bit scary. Two things that help me deal with it mentally: first, a very supportive and understanding wife, which helps a LOT. Second is that I've decided that, while I do intend to take it one step at a time and give my body some time to recover, at some point I will pursue the various options available these days to treat it. That said, I'm trying not to get impatient and rush things (but neither do I want to wait too long). From what I've read those nerves were traumatized and they need some time to heal. I do intend to discuss all this with the surgeon at our appointment at 3 months and ask him to recommend a urologist who's proficient in penile rehab. That's about all I have to say at this point. However, I'd be remiss if I didn't mention that overall I feel great. I'm back at the gym, eating and sleeping well, I'm continent, and everything else (other than sexual function) is doing well. So overall I'm a pretty happy camper and very grateful.

Forget sex but be glad you are alive!

Returning to "normal activities" took some time for me. My nerves weren't able to be spared during my RP at the end of October. Erections slowly came back and are a work in progress. Daily Cialis, no penile rehab, but slowly I am on the right track. I suggest lots of communication with your partner, experimentation and (obviously) keeping your "eye on the prize", meaning: you're alive & cancer free. Much better than the alternative in my opinion. Wishing you the best!!!

I'll echo @robertmizek. This is a scary thing, but you're going to be alright. I am 54 and on week 5 post RALP. Like you, I had 3+4; my cancer was aggressive. In my opinion, the catheter sucked. The day I got it out was a wonderful day. Each week has gotten better. I'll note that I've had some bladder issues - need to go more often and very painful when it fills up. But those issues seem to be improving weekly. Good luck. You're going to be fine.

I had surgery about 7months ago had Gleason 3+4 so far so good my PSA has been no detectable so far

My experience, study of one.

I had surgery in March 2014, nerve sparing.

My urologist had me on daily cialis, 5 mg. It was probably 6-12 months before I began to regain erectile function. By 12-18 months I was more or less fully functional albeit:

Getting an erection was no longer "spontaneous", required physical, visual and mental stimulation.

As we all know, no ejaculation.

Early on I had to ensure the bladder was empty but that went away.

Recovery from surgery can also be a function of baseline abilities.

The use it or lose it rule applies, whether that masturbation, a VED....you can experience orgasm without a full erection...!

It does cause you (and your partner, hopefully!) to rethink sex, foreplay.... vice a focus on penetrative intercourse

UCSF has a pretty in depth guide - https://urology.ucsf.edu/sites/urology.ucsf.edu/files/uploaded-files/attachments/sduro0095_managing_erectile_dysfunction-a_patient_guide_.pdf

When I had SRT for BCR my radiologist warned me it could cause ED, nope (to my wife's dismay)

Having a partner who is all in on the recovery, patient, understanding and a participant in the process is a big plus.

Alas, mine was a solo effort.

Kevin

For most guys - it comes back ,,,it just takes time . So give it some time . Learn what pills work for you and pump can be very effective post surgery with Dr's OK . Let us know how surgery went and biopsy !

With respect to the Blue Pill and other RXs, wondering if there is a sweet spot for efficacy on dosage amounts? Increasing the milligrams also raises flushing, stuffiness as many of us know. I'm figuring each to his own ability when dealing with PC.