Sex After Surgery: What can I expect?

@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.

First of all welcome to the forum and the club no one wants to join. You’re going to be alright and we’re here for you.

I had surgery mid January 2024. Sex is a work in progress for me but I’ll share a few comments based on my experience. Get busy as soon as you feel well enough. Be patient and kind to yourself if things take a while. It probably will but the destination is worth the journey.

Climax feels different and without seminal vesicles you will no longer ejaculate so there is no “build up” and “release” and some describe it as a “dry”:orgasm. On the positive side it’s less messy and I’ll leave figuring out the advantages of that to you. Some men say it’s less intense. Some say it’s more intense. Your mileage may vary.

What’s your Gleason score?

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

@retireditguy How did it come back? Was it gradual and steady or was there a sudden improvement?

When I had the ability to get an erection near-instantly all my life - for 70 years - I never had a twinge of a thought that "someday I may not be able to have sex." As a result, I never realized how tightly-bound my ability to have sex was with "being in a relationship." To clarify: Yes...I was married for 38 years before my divorce one month before my radical prostatectomy (RP), but...with the near-simultaneous divorce and RP which destroyed my ability to get an erection, I have been reeling in a frustrated depression about likely being alone the rest of my life, because if I have a relationship - even another marriage - I expect myself to be able to perform...to me it is the essential, necessary part of a man in a relationship: express my love and sexual desire with my girlfriend/wife. It came naturally...of its own volition...about six months ago, that "if I can't have sex and please my partner, then I am not going to "look", "date", or get serious about anyone." To me, it is the ultimate humiliation not to be able to perform. Forget "me" having the pleasure that I know I'd have...it is about my inability to please my future girlfriend or wife, that is the issue. I have been taking Cialis (Tadalifil) every other evening for nearly a year, with absolutely no result. I have heard and read about Trimix here, and my physician said that "when you're ready for it" he'll teach me how to inject it properly, but the word "inject" is a complete turn-off. I was around needles my entire professional life being the Director of Clinical and Anatomical Lab services in hospitals. I've stuck needles in literally thousands and thousands of people, but sticking one in my own penis is a "no go." So maybe the question to all of you guys is: How long did it take you to get an erection while taking Cialis? Next day, a week later, a month later, 6 months??? Knowing that will give me a chance to decide to stop taking Cialis, or to keep taking it because it might take two years. Thanks

@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.