Did your surgeon discuss impact of prostate removal on orgasm?

@rlpostrp I lost my wife after 50yrs of marriage. Felt young at 72. Met someone. The only reason I decided to pursue the injections. I cant speak for everyone but I have no other treatments since surgery. I keep my testosterone at 600. I have plenty of drive. That needle prick seemed like a small price to pay for a 3 hour erection.

OMG..."3 HOURS"??? You could invite the whole senior living neighborhood for "a round"! Haha!

It is my understanding that when surgeons perform an RP they remove the prostate including that portion of the urethra that it encloses along with related lymph nodes and seminal vesicle. They then have to pull up the end of the cut urethra to reattach it. (This is also where some shortening of the external portion of the penis occurs). The nerves that control the erection run along the side of the prostate and this portion of the nerves is lost when the prostate is removed. When the urethra is reattached I assume that hopefully the nerves ends are realigned and eventually regain their initial function. A poor realignment could explain why some men never regain full (or partial) function. It would probably help for a Urology surgeon to read this and confirm or correct this.

@tootall10 "This is also where some shortening of the external portion of the penis occurs"

I thought that was the case but my surgeon poo-pooed it. He said that it's because when nerves are cut, there is absolutely no restriction to blood leaving the penis, which was slightly restricted before, giving a slightly longer (although flaccid) penis.

@readandlearn
My Urologist said that pulling the urethra to reconnect it pulled in on the outside and left it say 1/4" to 3/4" shorter. I'm no expert but I'd say it would be no big deal for a horse... either way. And it sounds like when the nerves are cut - you lose.

Yes, I had a robust conversation with my doctor and his assistant about what to expect. I had my prostate removed roughly 7 months ago, and my doctor told me to expect orgasms starting about 3 to 4 months post surgery despite not being able to get a full erection, and to "use it or lose it". I bought a penis pump (wonderful device) and am now able to arouse myself, but i have not got up the courage to start dating and face having the "talk" with a woman. But I am 56 and really outgoing, so I will need to do it sooner rather than later. I do kegels often, have a great diet and luckily my spirits have not suffered too much.

I am happy that my length seems to be recovering, and though not as sensitive as before, I do feel pleasure in my penis nerve endings. It is my understanding that I am still "early" in my recovery, and I look forward to something close to a full recovery of sexual function and ability. There is hope!

@tootall10 Nearly right.
The prostate is removed, but the lymph nodes aren't generally removed unless there's some indication that the cancer has breached the prostate wall & towards the lymph nodes - where they can spread to hip bones, blood vessels or beyond. The seminal vesicle is removed.

Like the lymph nodes, the nerves aren't always removed & they do make an effort to preserve one (or both) bundles running alongside the prostate.
This is also dependent on if cancerous cells are found or suspected outside the prostate.

My understanding is that the urethra is pulled up to meet the new end of the bladder. This may result in shortening of the penis. (insert 'and I've still got plenty left' joke).

@peterj116
Thank you. This helps.

@pesquallie See a sexual health doctor. I lost orgasms and some sensitivity during ADT treatment but they returned and were weak. The doctor put me on a low-dose PDE5 inhibitor for two years, and sent me to pelvic floor rehab. Now, 15 months after ADT, they're 80-90% as good as they were before. It was work to get there but well worth it to have a sex life again!

A book you might find helpful is "Saving Your Sex Life: A Guide for Men with Prostate Cancer" by John Mulhall. He is the sexual rehab doctor at Memorial Sloan Kettering in NYC. The book is slightly dated, but he is working on a newer revision.

My experience...

My urologist did not discuss the sexual impacts of surgery but my reading about the surgery told me all about it,

It took about 12 months after surgery (nerve sparing) for erections to "return.."

What changed?

Greater physical and mental stimulation required
Orgasms were dry
Initially some urine releasing when orgasming but that went away.

What was my "penile rehab therapy?"

Simple, 5 mg daily Cialis
Masturbation

There is wide array of choice when it comes to PRT, like escalation, start with the basics and work your way "up,"

If you have a willing partner, that helps, I have a wife but she has not been involved, going on nine years... It may cause you to think differently about sex, foreplay for instance! That and more than just penile-vaginal penetration. That's a good thing I think given most of us likely thought of sex in those terms.

UCSF lays it out pretty well - https://www.ucsfhealth.org/conditions/erectile-dysfunction

Kevin