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what can i expect sexually after prostrate removal

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Posted 1/18/2011 8:31 PM (GMT 0)
hi im getting my prostrate removed in feb 2011 scared crapless going with da vinci cancer doesnt scare me but ed is my monster
Posted 1/18/2011 8:39 PM (GMT 0)
Dear Ron:

Welcome to HW...sorry you have to be here but I think you will find this is a forum with a lot of caring AND informative people. 

While you may get some feedback to your question, I think you improve the chances of getting good answers if you will provide some more information about your case, e.g. age, PSA, biopsy results, what your physican has told you about nerve sparing vs. non-nerve sparing, the experience of your chosen physician, etc.

Also, since ED is a big deal to you, you should be aware that there are alternatives to surgery that MAY provide you with a better chance of preserving your sexual functionality.  I have no idea if you are a candidate for those other options but if you provide us with some more info I'm sure some of our members will weigh in on this.

Good luck!

Tudpock (Jim)

Posted 1/18/2011 9:00 PM (GMT 0)
I guess everyone is different, but in all honesty it would seem that curing the cancer should be #1.

Frankly, for me #2 was the fear of incontinence.

ED was a very distant 3rd for me.

Unfortunately for me #1 has not been accomplished. #3 has not been accomplished either.

At least #2 has been a total success.

Mel

Posted 1/18/2011 9:07 PM (GMT 0)

I agree with Mel.  Incontinence was my biggest worry, but it hasn't turned out to be an issue.   In fact, I'm much better than before surgery in that regard.

I wasn't all that concerned about ED, partly because I didn't think anything could take away my sexual potency, and partly because I knew it was worth losing it to get rid of the cancer.

Well, I haven't seen even a hint of an erection since  mid August, and I'm beginning to wonder if I ever will.

But, answers to your question will run the gamut.  Some guys quickly recover, some take a while, some take a very long time, and some never do.  As my uro said, we have ways of dealing with that (Levitra, Viagra, Cialis, or injections, or an implant).

I had the DaVinci procedure.  Guys who have brachytherapy or external beam radiation seem to do better, at least initially.  Be up front with your doctor about your concerns.  He can't read your mind.


Posted 1/18/2011 10:48 PM (GMT 0)
The best answer is "it depends." That i,s some guys are ready to go a month or two after surgery while others never make the come back. If you want the odds, you should plan that after surgery you will always need help either as pills or injections or in the hardest case, implants.

You should also realize that climaxes will be dry (making liquid is the job of the prostate.) Definitely a different experience but guys differ on whether it is better or worse. (I'd just vote for different)

The idea of injections or implants may seem extreme at your stage, but lots of guys do well with them.

As others have said. Getting the cancer is job number one.
Posted 1/18/2011 10:53 PM (GMT 0)
ED is a very real side effect of surgery.  Some guys bounce right back, some can function with pills, some use injections and some end up getting implants.  So much depends upon the quality of the surgeon and the extent of the cancer.

It took me a good year to become functional and things aren't what they use to be.  But I'm not complaining.

Your libido should remain intact.  And you can have an orgasam without an erection, although for me that wasn't all that great.

And, as is probably true with a lot of things, while you may well have ED, you may find you also gain something as a result.  Where there's a will there's a way, and if you have a supportive partner (and patience), it's not as bad as you might think it would be.

Posted 1/19/2011 1:00 AM (GMT 0)
I took me about 3 months before I even thought about sex. I would say its different, but still good. Here are the real priority's #1 incontinence. It's hard to have sex if your leaking all over your partner . Getting that PSA down to ZERO is #2
Posted 1/19/2011 1:09 AM (GMT 0)
Ron, welcome to our world.

My priorities were old school too, like Mel's post above.

Cancer was #1 - still not accomplished despite surgery and radiation, jury still out.

Incontinence #2 - due to complications, I ended up for nearly 2 years on 21 diff. catheters, long story, and now my bladder has been disconnected and I pee through a stoma.

ED was #3, and I am in the "Fortunate Few" club, where I have not had a single day of ED during this whole fiasco, so that' shows you that it is possible. There are a few other men here without any ED issues, and some where ED was a short time problem. For others, despite even nerve sparing ops, ED is an ongoing problem. No one easy answer there.

But please let the erradication of the cancer be your main concern.


David in SC
Posted 1/19/2011 3:35 AM (GMT 0)
I don't think there is any way around it, the RP will almost always make ED worse if you have it before the operation. The only way to find out how you will be afterwards is to have the surgery and see. If you do any reading of back posts here or other sites, you will see that ED is very often an issue and is a known side effect. You can look at the stastistics and they are not too grim but if you are on ED meds already or are using an errection aid devise, you can safely assume ED might become a major issue after the RP. Based on the prostate bioposy and his examination, your doctor should be able to give you an idea if you are a likely canidate for major ED issues and he would be the best person to talk to right now. He might be able to tell you if your cancer will safely allow the "nerve sparing" proceedure that is more often than done as part of prostate removal.
The truth is you should be worried and believe me all of here worried a lot an still do. I hope you find some reief by participating in the discussions here and finding out more about your disease so you will know better what to expect. Just remember, ED can be fixed.
Ron

Post Edited (knotreel) : 1/19/2011 4:17:54 AM (GMT-7)

Posted 1/19/2011 4:40 AM (GMT 0)
My husband had surgery and did not have much of an ED problem. Didn't really need any ED meds. I can't recall how soon post op everything worked, but I can't stress enough how important communication and patience is between you and your partner.

Good luck!
Posted 1/19/2011 5:11 AM (GMT 0)

Ronscrawn, I'm 58 had a PSA of 4.45 in 4/10, biopsy 9/10, Gleason 3 + 3 = 6, 3 of 9 cores ca, stage pT2c, Davinci prostatectomy at Mayo on 12/16/10.  Ca contained in prostate, margins negative, lymph nodes negative.  For me the #1 goal was getting the cancer removed.  Goal #2 was continence.  I'm using minipads during the day and night.  Hopefully full continence will be attained in the next month or so.  Goal #3 was not to have ED.  I'm taking Cialis and one month after surgery this goal was attained.  It was dry but still very good!  I'm well satisfied with the surgery and its results.  A positive attitude before and after the surgery helps a bunch as well as a lot of prayer! Hope all goes well for you!  Take care! 

Posted 1/19/2011 5:51 AM (GMT 0)
Mrs GFM,

open communications and sincere patience is what it is all about.
Posted 1/19/2011 1:02 PM (GMT 0)
No question about it, sex will be different. Here's what I learned.

You can orgasm without having an erection.
You can pee with an erection.
The worry of incontinence will affect your desire.
There are pills, pumps and injections that can give you an erection when you need it. (One guy here told me his girlfriend still does not know he pops himself with Trimix while he's brushing his teeth and them goes back to bed so they can enjoy 1.5 hours of wood harder than it ever was.)
Work on rehab and therapy early.
While you still have it, empty your prostate as often as you can. You're going to miss the little guy.

Jeff

Post Edited (Worried Guy) : 1/19/2011 7:02:42 AM (GMT-7)

Posted 1/19/2011 4:07 PM (GMT 0)
Pergatory's first post to this thread (combined with the others) motivates this little observantion.  Most here know that I have both the artificial urinary sphincter (never regained control) and the inflatable penile prosthesis (impant).  I know that for many of us pc guys, the orgasms are not really dry, even with my AUS.  I ejaculate urine,  even when I empy out before sex.  That was a great big shocker for me.  I never thought in a million years that my wife would want me knowing what was coming.  She did, still, but I did not want to pee in her. 

Finally, a very simple solution:  Remember condoms?  I always thot they interfered with pleasure, and they may a bit.  However, it seem today's condoms, with all the lubricant, do much better than when I was young.  But that's what I now use 100 % of the time in my sexual relations with my wife (don't have any with anyone else).  Also... & here's a rather pleasant surprise... the urine ejaculate, for me at least, produces that extra pleasure which semen used to produce as it pulsated through the urethra.  For me, the urine feels the same a semen. Hope this was not too off the subect or too graphic.  Gene214   

Posted 1/19/2011 4:16 PM (GMT 0)
Gene, never had the urine issue with post surgery ejaculation, but I can see where that could be a challenge. The use of condoms sounds like a good compromise, especially the type that have a resivoir on the tip, think Trojan use to make those.

I have a very active cowpens gland, surprisingly. It's main purpose is to pre-lube and cleanse the urethra prior to a normal ejaculation. For many with surgery, it is either removed, or becomes non functional.

With me, when the big "O" occurs, enough fluid from that glad arrives at the same time, and in a lesser way, it emmulates what I use to have. Not quite the same force, and hardly the same volume, but still, it makes you think you are doing something special.

The first 6 months after SRT, the gland stopped working, and I figured it was just another casualty of radiation. But as the months have gone by, the little gland has come to life again in a big way.

We never know what we are going to get in the game called PC.
Posted 1/19/2011 8:17 PM (GMT 0)
ED depends on a lot of defferent factors. the skill of the surgeon in seperating the nerves from the prostate, your age, if you had ED issues prior to surgery, your overall health, and probably much more.  My personal opinion , I think one of the biggest factors is the skill of the surgeon.

I was very lucky and I have had no major ED issues. I was getting rock solid erections the day my catheter was removed and without drugs.  The one thing that was very different after my surgery to prior to my surgery was the fact that prior to my surgery, just a simple mental visualization of sex or looking at an attractive woman was enough to give me an erection.  Now, after surgery, I can think about sex and look at naked women 24/7 and I feel nothing down there, not even a tingle.  The only way I can now get and maintain an erection is with constant manual stimulation.  As long as there is stimulation I can maintain an erection for hours if need be, but the second that stimulation stops, so does the erection.

The other thing that is very hard for me to get use to is orgasms.  I happen to be one of the unlucky guys that ejeculate urine.  I am normally 100% dry, but the second I start getting sexually aroused, I can start to feel my splinkter muscel relax and I will start dripping like a faucet. Even if I empty my bladder before sex, I will still drip a little.  What is worse is that I ejeculate urine with such force, I can hit the ceiling.   I ejeculate urine with more force now without my prostate then I ejeculated seman when I had my prostate. 

My uro told me there is nothing you can do about it and I just have to learn to live with it.  He also said that urine is steril so if you ejeculate some in your partner, not to worry because it will not harm her. Just try telling that to a woman!  I asked the surgeon,  if I am going to ejeculate urine, at least is there a pill I can take to color it white?  No such luck.  He did tell me to drink a lot of water prior to sex because that will at least dilute the urine and reduce odors. I guess every little suggestion helps.  Some people here suggested using a condom, but with I condom, I loose my feeling of stimulation and I loose my erection.

Overall, I will take these small problems any day to the alternative of having cancer. 

Posted 1/19/2011 8:33 PM (GMT 0)
NY - perhaps you could scatter some "Liquid Paper" about and fake out that its ejaculate. Just kidding, was thinking of other white liquids.
Posted 1/19/2011 10:06 PM (GMT 0)
NY-Sooner. 

I cannot imagine the gift of a hard erection after removal of prostate.  I'm glad you (and evidently others) do have that capability.  The following personal experience info is R-rated, offered only as a help and not in any way intended to be ****ographic. 

During foreplay/stimulation, stay on your back.  There SHOULD be no reason to leak because gravity SHOULD keep it from leaking.  When ready, apply a condom while on your back.  The condom WILL contain the leaking & the subsequent ejaculate... works for me.  I hope this helps.  

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