New York Times article "On sex After Prostate Surgery, Confusing Data"

Today's New York Times has an article in the Science Times section addressing current research on ED after prostate surgery.  The article cites a recent study by George Washington University and New York University that shows that fewer than half of men who had surgery felt their sex lives had returned to normal within a year, in comparison with the standard statistics cited by many physicians that 97 percent were able to achieve an erection adequate for intercourse.  The article notes the ambiguity of what constitutes "adequate for intercourse," and suggests that the more optimistic prognosis only creates unreasonable expectations, especially if one is lead to believe that one will be able to acheive an erection without chemical assistance.  According to Dr. Jason Engel at George Washington, the "adequate for intercourse" definition is misleading, and the better question is whether a man can have sex when he wants to, withor without drugs like Viagra.  According to Dr. Engel, only 47 percent of men who had robotic prostatectomy were able to have regular sex under that revised definition.  Not exactly an overly positive article (assuming the newer research is borne out by other studies), but I think most of us would  rather have a realistic understanding of our chances of recovery and whether we will be dependent upon ED drugs forever.

I would be only too happy to end up using Viagra, if that's how the cards are dealt. Most of us would end up using it anyway, even if we didn't have the surgery since age is never too kind to the whole process.

I was heading there anyway. Viagra was fun. Made you feel 19 again. Ask the guys who have real ED and can't get an erection no matter what. I'm sure they would be thrilled if all they had to do was take a pill.

My cup is half full in this area. I'll be grateful for whatever I get!

Based on my own experience and the comments of people on this site and others, I think the article correctly portrays the reality of sex after surgery. 

Many doctors "sugar coat" the sex issue with their patients.  I don't know if that is a service or not. The question comes down to "returned to normal".  Even younger men who have regained some sexual function admit that it is "different" than before surgery.

I blame the doctors who did not tell the truth.  My urologist kept saying "If you are motivated, we can find an answer for you".  The answer so far is NO.  It is not the same, it is not as good and in my case can only be accomplished with a shot.

The NY Times tells the truth. 

My truths and my concerns:

As one can tell from reading my history below, I too am in recovery from DaVinci Prostatectomy.  I am 64 and am approaching one year anniversary of my surgery February 5th.  My PSA's to date have all been undectable.. and I thank the Lord for that as this is my first priority.  I am about 95% cured from incontenence, what remains is uncontrolled dripping when I squat or when standing and having a couple of beers.  This is my second priority and am pretty much satisfied with incontenence issue but still doing Kegel in hopes I can strengthen my sphincter control.

Regarding sex after the surgery, there was no intercourse until my tenth month when I began using Trimix.  Up until that time it was manual stimulation only by myself and between my wife and I as I progressed through the different stages of Viagra, Levitra, Cialis, Muse and the pump. The Trimix allows me to experience intercourse with a wonderful climax but only with help from my wife supporting my penis.  My erections are not as strong and upright they use to be and not able to remain inside without her assistance..another minus.  But you do what you can...

There were no erections for ten months, some swelling but no erections.  The pump was OK but reections did not stay and the rings were not good.  For a male this not healthy nor fulfilling for any degree of satisfaction.  Climax without an erection is OK, but just an erection alone by itself without any intercourse or climax is a human need and ultimate physical completion for a male.  This is nature and the way it is.  It's like stretching your muscles for exercise, if you can't stretch completely because of physical conditions the body always lies in a state of need without resolution.

My libido cycles on an about one week basis where we use to say "horny" as kids.  This is human nature for most all males wether or not they admit it.  The call is there no matter what age and I do need intimacy with my wife even without intercourse.  So today I have the call, what do I do with it?  I have no natural erections, the only med that helps is Trimix.  And YES, I would prefer natural erections on demand and I could also settle with a pill for life.  BUt so far not the case and I am beginning to get discouraged but not hopeless.  We have to continue moving forward.  I do not plan at this time to have any implants down the road so if I do not recover I will most likely stay with Trimix as long as I can.  I'll take what I can get and live it...I can do that.

I would like to see responses from those that have had DaVinci and have recovered to natural erections and in what time frame after surgery.  Any real stats or inputs on this?

From the little I know I would believe the New York Times article.

I pray we can all recover from the cancer and have strength to deal with rest.

Marc

Puget - Thanks.  Time frame up to two years..

Very interesting data from that article... I agree, I prefer to get the most realistic understanding that I can of my future prospects. I don't feel my surgeons 'sugarcoated' the discussion in this area, but maybe glossed over it a bit.

In my case, at 10 weeks after my DaVinci, I can get some swelling without drugs but not a true erection. Obviously I'm hoping for improvement with time.

John

Gene,

May I ask why the ED specialist switched you from trimix to quadmix?

Marc

Geon, You first, then StrictlyInc...

I did not ask the doc why he switched and he didn't really say.  But here's what I think:  I told him about my difficulties in really getting hard enough to easily penetrate.  So he injected me and came back in about 15 minutes.  He used whatever medication he kept in his office.  It probably was not quad-mix. 

It got up to I suppose about 80% (It didn't "stand up", mind you) and I think by the time he came in it had gone down just a little.  He felt around on it (very professionally) and indicated I should be pleased with it, but that he thought he could help me do better.  One thing I have not mentioned here is that I do have diabetes.  It did not hinder me prior to surgery and my sugar numbers have never been real high.  When I mentioned that to him, he felt again, especially around the base and said that he could feel some ________ (I can't remember the word he used, but it was in reference to the sugar problem).  He said (which I did not know) that it did not matter the stage of diabetes.  All diabetes causes erection problems.  He then said, "I really think you were headed for problems with erection whether or not you had surgery."  That was a shocker.  So maybe the quad prescription instead of the tri was related to that. 

StrictlyInc,

Thanks for the link again.  I really want my wife the read the article.

Well, yes, I am thankful I didn't lose any size.  Or at least I don't think I did.  I don't exactly understand why one would lose size with the surgery, but I guess it has something to do with shortening the uretha.  I had never heard the ligament thing either and can't help but wonder if he was just redirecting my focus for the "lift" or if it is a fact.  Has anyone else ever heard that before?  I suppose it does not matter, except I've read several here mentioning theirs did not stand up like old times either.

Gene

I've never heard of a ligament removal as part of the procedure or as the cause of a less than upright erection. I just thought it was because the blood leaks out, a temporary condition that can improve over time. If it's due to removal of part of the structural components, I wonder if other ligaments or muscles can compensate?

Thanks for bumping this -- appropriate in view of the other impotence statistics thread we have going. There are many interesting comments on the NY Times article here: http://well.blogs.nytimes.com/2008/01/14/sex-after-prostate-surgery/

Like you, I have never heard of the ligament thing. But after some reading, I think they would be the ligaments that ....

[Remainder deleted to comply with forum rules]

Cindy,

Many here use alldaychemist.com for Viagra and similar meds......MUCH cheaper than in USA.

It is your business, of course, but I would suggest that your husband consider a medically approved pump and injections fairly soon if Viagra is not doing the trick alone.

Best wishes to both of you.

DanMan

Cindy,

I am not yet having unassisted erections, but studies have indicated that using the pump and/or injections leads to a higher eventual success rate for return of so-called natural erections (frankly, just using Viagra would be considered quite "natural" enough for me.  Would love to get to that point.)

When I began using the pump, my penis had been inactive for about 3 months.  It did not even look like its old self while in a flaccid state.  After using the pump for a while, it looks more like the old, pre-surgery penis.  More important, it is getting better blood flow from the pumping, which helps protect the internal tissues.  I try to pump daily.  Some here such as JamesC and Piano pump a couple of times a day, I believe.  Pumping is a chore...not painful but not erotic either....but I feel it is someting I need to do consistently.

Most urologists and studies seem to believe that injections are even more helpful as therapy than the pump.  In addition, injections cause erections, usually within 10-15 minutes of injection....and yes, one injection = one erection.  I am still experimenting to find the best formula for me, but have had some 80% erections with low doses when I hit the target area correctly.  Doctor gave me a tip Friday on using a more reliable injection technique, so I expect to find the right dose/formula for me soon, once I get a better aim...

The injections sting a little bit, but when using small insulin needles, it is not really bad.....just the thought of injecting one's self there is a bit troubling...lol.

My urologist believes strongly in using Viagra (or Cialis, Levitra), a medically approved pump (my insurance paid for most of the cost of mine) and injections......not one vs. another.......so I am using them all.  He is of the "use it or lose it" school of thought.

Hope this helps a little bit.

My surgeon was up-front (pun intended !!) about the risk of impotence following surgery and advised me that it can take up to 2 yrs, but then he presented me with statistics from their practice that looked at my age group being in the 80th percentile and higher at the end of the first year. This may well be the case, however, at almost 9 mos out it will do good to cross the finish line at the 12 month mark given the current rate of progress, slow but steady. The surgeons are proud of their great statistics but some revert into pitching the "numbers game" to the prospective patients. I have no complaints with my guy at all, I am continent, which is a blessing, and showing steady progress with the ED. The office is very supportive and encourages aggressive tx to fill in until the return of natural activity.