Sex After Surgery: What can I expect?

@turtbean I congratulate you on your ability to see this from a different perspective. I on the other hand lament the loss of my nerves that allowed erections. In the past, when I heard women discuss their emotional state after a double mastectomy, I was confused. I thought ridding the body of the cancer was far more important than maintaining the breasts. Now I understand. Yes, I am happy to be cancer free, and yes, I would very possibly do it all over again. But that doesn't change my memories and my life experiences. I have had erections since puberty and I miss them. My VED and/or Trimix can achieve reasonable facsimiles, but learning I will never respond to stimulation again was jolting. Notice I am not mentioning intimacy with my wife. I agree with your viewpoint. I just miss my erections. Am I in a depressed state? I don't think so, but when I'm out golfing with buddies and the juvenile jokes start up again, I have to resist the urge to vent my frustrations. They don't need Debby downer in their foursome.

@topf For me, no orgasm is worse. Until Trimix, I could have an orgasm without a decent erection. There are occasions when cranking out an orgasm isn’t happening, and that is hugely frustrating!

@topf Yeah, not much, but I found that it hit me like 6 hrs later??
Levitra is not as well advertised but I read that it sometimes worked where others failed…’sometimes’ should have been ALL CAPS!!😩

@heavyphil I tried 100mg Viagra, but to no effect. Never heard of Levitra.

@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.

Two important things:
1. “…for those able to get an erection.”
And…tied to #1…
2. This Mayo blog is a subset “club” of men who are the “Unlucky Ones.”
Considering both #1 and #2 together:
All of the men who had smooth, uncomplicated outcomes to their radical prostatectomy, are NOT on this blog. They had prostate-confined cancer with no Extraprostatic Extension (“EPE”); therefore, no surgical margins and spread to seminal vesicles or lymph nodes. They had no Cribriform tissue or other pathology that was not revealed in the biopsy.
They were likely Gleason Score 6 or maybe lower/moderate risk Gleason 3+4=7, possibly 4+3=7. They didn’t have much, if any post-surgical incontinence or erectile dysfunction.
Therefore, they aren’t in this blog space.
Hopefully, you won’t be either, but… I would keep a positive attitude and a level of hope that your surgical pathology report is “clean” without any of the above, and that your urinary incontinence will be limited and resolve quickly, and your ability to get an erection will be restored quickly.
That said, the vast majority, if not literally “all” of us here, experience all of that. We are trying to manage our fear, dissatisfaction, frustration, anger, and hopelessness as we try to envision a life when someday we won’t have be wearing Shields/pads/diapers a year later; have absolutely no erectile response, and are waiting, figuratively wringing our hands wondering “when” our cancer will return within the next 5-10 years, because we know it likely will…unless we are extraordinarily “lucky.” So…
My advice is to be patient, keep realistic…not overly optimistic…hope that you’ll be one of the “Lucky Ones” whom we will never hear from again, because everything went well.
Good luck to you. Let us all know what your surgical pathology report said once you receive a copy. Blessings to you.

@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.

@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.

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

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