Sex After Surgery: What can I expect?

@topf Yup, bouncing right back to boner-ville turns out not to be the norm.
You can spare the nerves but the trauma they endure may or may not be reversible.
If you have not already done so, try 100 mgs Viagra or Levitra; both worked a bit (but not enough) for me but Cialis was useless. Keep at it!
Phil

That depends....

If your surgery is nerve sparing, then erectile function may "return" in 12-18 months, albeit gradually.

If so, what may be different?

Generally, the SV are taken out so no ejaculation.

Erections may require greater physical and mental stimulation, aka, foreplay.

Early on you may experience urine leakage when orgasming, use the restroom just before and consider a condom.

Penile Rehab Therapy is the term you are looking for. In my experience our medical teams generally do not discuss that with you. They may prescribe a daily Cialis to assist in keeping blood flow...no, you're not going to experience a nocturnal wet dream,...! At age 57, the time I was diagnosed, those were distant memories anyway.

The foundation behind PRT is use it or lose it. So, Cialis is a start. It's graduated step program, if this, then that. Some get frustrated, rightfully so with pumps, shots...

So, you'll have to find what works for you and what you are comfortable with.

My experience...

Nerve sparing
Daily 5 mg Cialis
Self stimulation, masturbation.

I can achieve very good erections, though as I said, not by just looking, requires greater physical and mental stimulation.

Orgasms are just as intense, albeit dry.

I did have urine leakage early on, went away.

There is some pre-cum when I achieve erections.

UCSF provides comprehensive penile rehabilitation and sexual medicine services, focusing on regaining erectile function, increasing blood flow, and preventing tissue fibrosis, particularly after prostate cancer treatment or for Peyronie's disease.

Programs involve individualized care, including oral medications, vacuum erection devices (penile pumps), and intracavernosal injections, often utilizing a stepwise approach to recovery.

Key Components of UCSF Penile Rehab &
Sexual Health

Services:

Erectile Dysfunction (ED)

Care: Tailored treatment plans for ED, offering non-invasive, medical, and surgical options to re-establish intimacy.

Penile Rehabilitation Protocol: Specialized strategies to assist in regaining spontaneous erections and reducing penile shortening, often following prostatectomy.

Intracavernosal Injections:

Teaching patients to use vasodilator medications to increase penile blood flow, useful for patients with nerve damage.

Vacuum Erection Devices: Use of penile pumps to assist with erections.

Peyronie’s Disease Treatment: Management including pharmacological agents like Pentoxifylline and specialized surgical techniques like the 16-Dot Penile Plication.

Reconstructive Surgery: Expertise in genital reconstruction for Peyronie’s, trauma, or penile preservation through the Center for Reconstructive Urology.

Inflatable Penile Prosthesis: Surgical options for severe ED.

UCSF also focuses on specialized care through the Lifetime Congenital Urology Program and conducts extensive research on sexual wellness.

For personalized care, patients are encouraged to discuss priorities with UCSF providers to determine the best treatment pathway.

Now, if only my wife...

Kevin

Question for those who’ve been at this longer than I have (I’m four months out from RP):

My main goal right now with penile rehab is keeping the tissue healthy, with a long-term goal of penetrative sex at some point.

After my surgery, I met with the ED clinician, who went over all the meds, pumps, shots, and implants, but the focus was very heavy on returning sexual function as quickly as possible - understandable, considering how important sex is to many folks, but my wife and I are more long-term thinkers, so I’ve been in no hurry to slap on a tension ring or double my maintenance dose of Viagra.

The instructions they gave me said to use the pump and Viagra daily for therapeutic reasons “for 1 year” - what happens after that year is up? Do I continue daily pumping and daily low-dosing, just to keep the blood flowing, or is it one of those things where after a year, what I’ve got regarding erections is what I’m going to ever have at that point, so the daily therapeutic regimen no longer applies?

Yes, I do intend on checking in with the ED clinic when it gets closer to a year past, but I thought I’d ask here as well.

@turtbean -- I had NS RARP on 06/2024 at age 70. I'm not a medical professional, so take my comments with a grain of salt. I had ED after surgery and that recovery took about 15 months to get back to normal, even though I was doing penile rehab (vacuum pump, low dose daily Cialis, on demand 100mg Viagra). Writing it now, 15 months sounds great. But during that 15 months, recovery felt soooo slow and it felt like it took forever to recover. The pump never helped me for sex, and I only used it at first for a few months for blood flow. I also tried to eat well, took vitamins, magnesium, L-Citrulline, exercise regularly, etc, to facilitate my recovery. I also started Kegels before surgery and continue the Kegels to this day to maintain pelvic floor conditioning. At this time I'm very happy with my ED recovery, but I still am on the daily 5mg Cialis (generic) and on demand 100mg Viagra (generic). I also still exercise, take a multi-vitamin, magnesium, and L-Citrulline. The pills don't bother me at all and since I had some ED and needed Viagra before surgery, I plan to continue to use them indefinitely. I don't really know if the vitamins, magnesium and L-Citrulline really help or not, but I think they do and so I hesitate to mess with success. 🙂 BTW, I believe part of my ED was that my penis just wasn't as sensitive as before until the nerves eventually woke up. For me, during my recovery I found I couldn't just "let the physical side" do the work. Rather, I needed to get "my head in the game" with more cuddling, romance, and foreplay. That realization helped me a lot, including reaching a point now where I normally am able to climax almost all the time we have sex. But I don't think I'd be doing as well if I hadn't made that adjustment (which I read about on this blog). Also, I had a verrrrrry patient and supportive wife. I've heard a sexual health doctor say anxiety is an "anti-Viagra", so it's important to have a partner who's trying hard to make it as stress free as possible. That also was a huge benefit I enjoyed as I definitely had a lot of anxiety whenever I'd make the attempt to have sex during the recovery time. During the recovery period (15 months for me) I never knew how successful any attempt to have sex would be. I found that stressful and my wife consistently did all she could to de-stress our attempts. I believe that was a crucial component of my eventual ED recovery (along with having had an outstanding surgeon). Best wishes.

I think I grossly underestimated the impact of no ejaculation. RARP Oct 25. Initially, erections were normal, but no orgasm. Urologist recommended low dose daily cialis. No change. Urologist added viagra as needed. No change. Cialis gave me heartburn and viagra turned my face beet red. Urologist suggested cabergoline. Too early to tell of any impact. It is discouraging/depressing, so psychologically I am suffering, which is affecting arousal. I get hard enough for penetration, but with no sensation, I soon start to shrivel. Since menopause, sex has become somewhat perfunctory for wifey; and that certainly doesn't help things. But I have resumed a full and active life, so I try not to dwell on it. I think I'm going to experiment with higher dose of cialis before anticipated activity. I do keep telling myself practice makes perfect!

Hi,
Unfortunately there is no one answer fits all. Anywhere from dead to no problem. Give yourself the best chance by getting blood into your member by what ever means. Stimulation, pumps,viagra, creams, ect. Get your significant other involved, make it fun. There is an over the counter cream you can by at your local supermarket Eroxon. Might be worth a try.

Dave 3+4

Reading this, I wonder what is worse, no boners or no orgasm…

I had nerve Sparing RARP at Mayo Rochester in late October 2025. I am 64 years old. Gleason (3+4) 7. Post-surgery pathology showed multifocal 2mm margins, including 4's, and the prostate biopsy showed some cribriform. For now, six months out, my PSA (previously 11) remains undetectable, so I won't worry too much about that until I hear otherwise.

Sexually, everything worked fine before surgery. I hate to be the bearer of bad news, but post-surgery has been an ongoing project in that area. I immediately started taking 5 mg Cialis daily post-surgery, and an additional 15 mg as needed, doing Kegels, and using a pump and encouraging erections (Use it or lose it). I was able to get an erection right away after catheter removed. But.... it was not what it was prior, and it has not returned to that.

My first orgasm masturbating, I was expecting the dry orgasm, but much to my surprise I shot gushing spouts of urine all over the bedroom ceiling and walls. It was shocking!! That is called climacturia. I ejaculate urine when I have an orgasm. It turns out that is common post RARP, but I hadn't read the fine print.

I otherwise regained continence after a couple of months except... in addition to climacturia, I have "arousal incontinence" If I start making out or getting aroused, I leak unexpectedly without warning.

I am now six-months post-surgery. I can get an erection sufficient for penetrative sex, but it takes some work. The problem now is that I cannot maintain it until orgasm when I am having intercourse. I can have an orgasm masturbating, but it takes longer, and I have to clamp the base of my penis to keep it hard when I get close to orgasm. I try to empty my bladder as much as possible before any sexual activity, but I still get some level of climacturia.

My partner is very patient and understanding. Fortunately, my boners do last long enough to satisfy her, so that is a relief. She says it is no problem if I pee on her or in her, so that should be reassuring. Despite that, I have had only one orgasm with her in the last six-months. I use Viagra and/or Cialis, but it is still not enough to keep me hard to orgasm. Erections overall are maybe at 75% of baseline when I start, but they fade.

People and AI recommend using a condom or cock-ring for the climacturia. Neither is very helpful. Theoretically a condom would contain the urine, but it is not an issue because I am unable to orgasm while wearing one. The cock-ring made no difference in stopping the pee.

I recently went back to Mayo Men's Health Clinic and got a prescription for Trimix. It is supposed to be like Viagra x 10. Trimix is injected into the penis with a needle. I did not like the practice run in front of the nurse very much, but C'est la vie. I am optimistically awaiting its arrival.

Mayo Men's Health said that, as a practical matter, I was at max improvement. That is despite the literature that says function can improve for 18 to 24 months before reaching the new baseline. The Mayo provider said that, while there may be further improvement (consistent with the literature) that for me it would be very incremental and insignificant from my present situation. Mayo said I was eligible for the implanted pump surgery and we discussed that option. If necessary, that sounds very viable. I will give Trimix a chance first.

It has taken a toll psychologically. I think that aspect is under appreciated by the Urology clinics. At least that is my experience with Mayo. I am practical. It is what it is. I had cancer and the ED is collateral consequence. I will deal with it. But, despite a very understanding and generous partner, it has had a significant impact on my sex life and self-confidence. Perhaps my self-identity is too intertwined with my sexuality. Not much to do about that now except to work on accepting the new reality.

I don't want to steal the thread, but does anyone else want to share comments about the psychological and emotional challenges of ED post RARP?
Jim

@jim1961 -- I won't repeat my basic info as I gave my own case overview about 4 posts before yours in this thread. During my 15 months journey getting back to normal sexually I also experienced climacturia early on. For that, I double void to totally empty my bladder. I also limit my fluids for the 2 hours before sex, Finally, I found for me that a shower right before sex helps be ensure the bladder is really empty. I continue that routine to today, and frankly I doubt I'll ever stop. Even though I consider myself fully continent (for which I'm very grateful), it's probably more realistic to describe it as a "new normal" (which I'm happy with), but it's not exactly as good as before in regards to control. I also had a lot of trouble with getting firm enough for penetration, and maintaining the firmness. That gradually improved over time, but it was really slow. Most of the first 12 months that was an issue for me. I really don't know, but I believe strengthing my pelvic floor with Kegals and general exercise helps in this regard. But for me, far and away the biggest and most effective adjustment for me (as described in my post above) was when I talked about "getting my head in the game". For me I needed to do that to facilitate getting aroused, staying aroused, and having a climax. Penis sensitivity didn't return to normal for me for 15 months, so I really needed the "mental assist" to even climax. For me, that meant spending more time cuddling, foreplay, and just generally getting my brain fully engaged. We also made some minor physical adjustments to our body positions to enable exploit other erogenous areas to help make up for the loss of sensitivity in the penis. I don't know if any of this will help you, but I just wanted to share the kind of things my wife and I had to change to get back to "normal" (ie. having a low stress enjoyable sexual experience that usually concludes with a satisfying climax). BTW, none of these ideas were provided by my (otherwise outstanding) medical care team. I don't think these are topics the typical care team member knows or would want to discuss with a patient. Best Wishes.

@jackwester -- Thanks for the offer, but this blog already has a private email capability. Just click on someones handle and you'll see an option to send them a private message in the top left of the screen by their name. Best wishes.