Sex After Surgery: What can I expect?

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.

Thanks Bob! Good luck on your journey too!

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....

You are awesome. Best wishes to both of you.

(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.

Hey Steve. Congrats on picking Mayo in Phoenix. They set a standard for care that few other medical systems worldwide can match. I applaud you for your commitment to your wife. Good man!

I’m stage 3 locally metastatic with aggressive Gleason 9. They did nerve sparing on one side but I was warned that I’d be dealing with severe ED for a while or permanently. 6 months post surgery and 4 weeks post radiation that’s mostly still the case as I’m also on Orgovyx and Zyyiga which severely impacts libido and doesn’t help the situation. My oncologist and surgeon both support the idea of my seeing a urologist that specializes in the treatment of ED. I already tried a VED and did not like that at all. I see the specialist later this month and am willing to try the tri-mix shot. I know a couple guys that have used the shot with good success. If that doesn’t work, I will consider an implant. I know two men that have received them and are quite happy with the quality of their sex lives. I’m not giving up.

As for the incontinence and climaturia issue, I suggest you consider getting an appointment with a physical therapist that specializes in pelvic floor rehabilitation. https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/pelvic-floor-physical-therapy-benefits I just started treatment yesterday and while my main concern is reducing urgency I’ve been told that I’ll also benefit somewhat sexually with increased blood flow and full resolution of the occasional climaturia that I experience.

Hang in there Steve! Never give up!

Bob

Google "Penile rehabilitation after prostate cancer surgery". I did that and put together a program from all the info I found. Daily Viagra (generic, covered by my Kaiser Medicare plan), near daily use of a penis pump, and vibrator induced orgasms several times a week resulted in full return of function within 7 months. "Full" equals ability to penetrate and continue to orgasm for both my wife and I. I do use Viagra now 16 months post surgery, whereas I didn't before...I think I could do without, but haven't tried yet. BTW I'm 75 and otherwise in excellent health.

I'm 7 weeks out from my RARP at Mayo in Phoenix. Unfortunately, due to the aggressiveness and stage of my cancer, the procedure was non-nerve sparing, and the maximum tissue was removed to allow for the "best cancer surgery possible." In this case, there will be no errections without implants or shots. Additionally, the incontinence makes intimacy of any kind to messy (constant dribbling) to contemplate, so I focus on my wife's needs, not mine. I think you are making a wise decision as to surgery, but make sure you understand what the planned surgery will be (NS vs. NNS) and what the likelihood of impotence and incontinence will be after surgery. I think it is much more common than most urologists communicate to patients. Good luck on your journey!

Just bought the book! I had never previously heard of it. Thank you for the suggestion. I will probably learn something.

Make sure to learn about "penile rehabilitation." Some doctors are very good about this but I've heard others are not. It basically involves taking daily low-dose Viagra or Cialis to keep bloodflow going. If your doctor doesn't offer this, you should ask (unless, of course, these meds are contraindicated for you for some reason).

There's a good book, though keep in mind that it's a bit dated, called "Saving Your Sex Life: A Guide for Men With Prostate Cancer" by John P. Mulhall, MD. He is the director of sexual medicine at Memorial Sloan Kettering, which is a top cancer center. I had radiation and am currently on androgen deprivation therapy (ADT) so can't answer any specific questions about sex after surgery but it is covered extensively in the book.