Sex After Surgery: What can I expect?

Hi,
Unfortunately there is no one answer fits all. Anywhere from dead to no problem. Give yourself the best chance by getting blood into your member by what ever means. Stimulation, pumps,viagra, creams, ect. Get your significant other involved, make it fun. There is an over the counter cream you can by at your local supermarket Eroxon. Might be worth a try.

Dave 3+4

I think I grossly underestimated the impact of no ejaculation. RARP Oct 25. Initially, erections were normal, but no orgasm. Urologist recommended low dose daily cialis. No change. Urologist added viagra as needed. No change. Cialis gave me heartburn and viagra turned my face beet red. Urologist suggested cabergoline. Too early to tell of any impact. It is discouraging/depressing, so psychologically I am suffering, which is affecting arousal. I get hard enough for penetration, but with no sensation, I soon start to shrivel. Since menopause, sex has become somewhat perfunctory for wifey; and that certainly doesn't help things. But I have resumed a full and active life, so I try not to dwell on it. I think I'm going to experiment with higher dose of cialis before anticipated activity. I do keep telling myself practice makes perfect!

@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.

Question for those who’ve been at this longer than I have (I’m four months out from RP):

My main goal right now with penile rehab is keeping the tissue healthy, with a long-term goal of penetrative sex at some point.

After my surgery, I met with the ED clinician, who went over all the meds, pumps, shots, and implants, but the focus was very heavy on returning sexual function as quickly as possible - understandable, considering how important sex is to many folks, but my wife and I are more long-term thinkers, so I’ve been in no hurry to slap on a tension ring or double my maintenance dose of Viagra.

The instructions they gave me said to use the pump and Viagra daily for therapeutic reasons “for 1 year” - what happens after that year is up? Do I continue daily pumping and daily low-dosing, just to keep the blood flowing, or is it one of those things where after a year, what I’ve got regarding erections is what I’m going to ever have at that point, so the daily therapeutic regimen no longer applies?

Yes, I do intend on checking in with the ED clinic when it gets closer to a year past, but I thought I’d ask here as well.

That depends....

If your surgery is nerve sparing, then erectile function may "return" in 12-18 months, albeit gradually.

If so, what may be different?

Generally, the SV are taken out so no ejaculation.

Erections may require greater physical and mental stimulation, aka, foreplay.

Early on you may experience urine leakage when orgasming, use the restroom just before and consider a condom.

Penile Rehab Therapy is the term you are looking for. In my experience our medical teams generally do not discuss that with you. They may prescribe a daily Cialis to assist in keeping blood flow...no, you're not going to experience a nocturnal wet dream,...! At age 57, the time I was diagnosed, those were distant memories anyway.

The foundation behind PRT is use it or lose it. So, Cialis is a start. It's graduated step program, if this, then that. Some get frustrated, rightfully so with pumps, shots...

So, you'll have to find what works for you and what you are comfortable with.

My experience...

Nerve sparing
Daily 5 mg Cialis
Self stimulation, masturbation.

I can achieve very good erections, though as I said, not by just looking, requires greater physical and mental stimulation.

Orgasms are just as intense, albeit dry.

I did have urine leakage early on, went away.

There is some pre-cum when I achieve erections.

UCSF provides comprehensive penile rehabilitation and sexual medicine services, focusing on regaining erectile function, increasing blood flow, and preventing tissue fibrosis, particularly after prostate cancer treatment or for Peyronie's disease.

Programs involve individualized care, including oral medications, vacuum erection devices (penile pumps), and intracavernosal injections, often utilizing a stepwise approach to recovery.

Key Components of UCSF Penile Rehab &
Sexual Health

Services:

Erectile Dysfunction (ED)

Care: Tailored treatment plans for ED, offering non-invasive, medical, and surgical options to re-establish intimacy.

Penile Rehabilitation Protocol: Specialized strategies to assist in regaining spontaneous erections and reducing penile shortening, often following prostatectomy.

Intracavernosal Injections:

Teaching patients to use vasodilator medications to increase penile blood flow, useful for patients with nerve damage.

Vacuum Erection Devices: Use of penile pumps to assist with erections.

Peyronie’s Disease Treatment: Management including pharmacological agents like Pentoxifylline and specialized surgical techniques like the 16-Dot Penile Plication.

Reconstructive Surgery: Expertise in genital reconstruction for Peyronie’s, trauma, or penile preservation through the Center for Reconstructive Urology.

Inflatable Penile Prosthesis: Surgical options for severe ED.

UCSF also focuses on specialized care through the Lifetime Congenital Urology Program and conducts extensive research on sexual wellness.

For personalized care, patients are encouraged to discuss priorities with UCSF providers to determine the best treatment pathway.

Now, if only my wife...

Kevin

@topf Yup, bouncing right back to boner-ville turns out not to be the norm.
You can spare the nerves but the trauma they endure may or may not be reversible.
If you have not already done so, try 100 mgs Viagra or Levitra; both worked a bit (but not enough) for me but Cialis was useless. Keep at it!
Phil

@topf - no, I just went with what the ED clinic prescribed. I take a 50mg dose right before bed each night, just for the blood flow.

Dr. Google says that some doctors favor the shorter duration of Viagra for penile rehab.

@turtbean Have you talked about taking Cialis? It has a longer half life in the body and provides more consistent bloid flow.

@michaelhh Happy for you. I think outcomes are pretty random.

I had nerve-sparing RP in January of this year. Before surgery, I had the very beginnings of ED - I could achieve an erection, I even had frequent spontaneous erections, but unless my penis was actively being stimulated one way or another, I had difficulty maintaining an erection.

After surgery…pretty much gone entirely, though I do feel rumblings down there occasionally, and I did manage about a 1/4 erection on its own, so hopefully, things improve a bit down the road.

In the meantime, I’m doing penile rehab via a pump and low-dose nightly Viagra.