@jim1961 - This hit the nail on the head for me. I am 56 years old (diagnosed at 54) and now 14 months post RARP. My surgery was partially nerve-sparing. ED has been a huge factor, both psychologically and emotionally since the surgery. I immediately started on 5mg of Cialis after the surgery and continue it daily. I was recently prescribed an additional 20mg as needed for sex, but it has only had minimal results. The pump really did nothing for me. With the 20mg of Cialis I can get an erection about 90% of pre-surgery. I have climacturia every now and again with masturbation, but not every time. During masturbation, I can get an orgasm but it takes a lot of extra effort. The lack of ejaculation has had a bigger negative emotional effect on both me and my wife to the point I often wish I never had the RAPR. Other than the ED, I maintain a very healthy and normal life again, but sex is no longer a priority in my life.