Sex After Surgery: What can I expect?

@jim1961 Does the Trimix help with orgasm?

@kmc1372
Thanks for the reply. It does sound like a very similar experience. I got a shipment of Trimix, and the first dose resulted in a trip to the ER! I think the dosage is now worked out, but the whole episode did not help with the overall journey.

@jim1961 -

“does anyone else want to share comments about the psychological and emotional challenges of ED post RARP?”

Sure, I don’t mind, and I think it fits squarely with the topic.

I’m fine with sharing, because I think, after reading ED-related posts here and other forums for the past four months, I must be some kind of oddball or outlier, because I don’t have any psychological or emotional fallout from ED. To me, it’s simply that it’s an expected side effect of the surgery, I knew that going in, so when it happened, it didn’t bother me in my mind or in my self-perception or general outlook on life. I feel like I’m pretty much the same person I was before Mr. Happy became Mr. Floppy.

Thing is, I’ve never gotten caught up in any kind of gender norms for masculine or feminine behavior. The idea that this thing is “manly” and that thing is “girly” just doesn’t register with me, nor does it my wife. We line up really well that way.

That follows through right to our sexual relationship - we’ve always just tried to make sure each other had a pleasurable, satisfied experience and that was that - I’m not even sure how to word it, because I guess I see the mechanics of sex as one thing and the emotionality of intimacy as something else. I’ve lost the ability for penetrative P-in-V sex for simple physiological reasons - something I can’t really help - but my ability for intimacy (as well as my libido) are still quite intact, so I guess it’s a matter of choosing intimacy over a purely physical act (like in some bizzaro world where I have the ability to achieve an erection, but no libido - sure, I could have sex, but would I want to? Would my wife want to have sex with me if there were no intimacy attached?).

Someone asked me, right after my surgery (and I mean just a couple of days after) if I felt like less of a man with my prostate plucked out, and I honestly thought to myself, “What a ridiculous question, of course not! Why would I?”

I doubt if that made any sense, but maybe all I’m saying is my identity and our marriage isn’t built around sex, sex is just a single component of many.

@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.

@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.

@robertmizek Hi there I had my prostatectomy in May 2020 and learning to have sex and have an orgasm is a journey, don't give up. For me it keeps getting better, I had to lean how to have an orgasm and yes it is dry but very intense and goes on for like 30 seconds. But what brought me here was that I have "diaper rash" on my right testicle, from leaking and can't get rid of it . Been to the Doctor twice and she said use vasoline and 40% zinc oxide which is for the rash. So I'm still looking for a solution.

If it helps any, cialis never did anything for me, but i take it daily for blood flow. It is also good for your heart. Viagra or generic works great for me now 2 years past surgery. 100 mg 30-45 min before does work. I tried needles and it just did not work for me. I got the erection, but I did not really feel anything.

(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.