Orgasms After Prostatectomy

I'm just past the 3-year post-op point in time.  I can get an erection and I ejaculate, but when I ejaculate it's urine and that complicates the situation.  I don't think the sensation during ejaculation is stronger now than pre-op.  It's different, though.

You may need to wear a condom

 

I have almost exactly the same surgery background and subsequent orgasm disfunction issue as Becky. I reached potency only ten days after surgery which was elating but I soon learned that I could no longer achieve anything close to an orgasm. I am otherwise able to have initial arousal but that is short lived where it "evaporates" before getting anywhere. It has left me frustrated without a "reward system" which has steadily diminished my otherwise healthy desire for sex. I was tested to find that I had sustained some penile nerve damage which had caused the anorgasmia. The doctors I have seen have all stated no connection to my radical prostetectomy but it is too much a coincidence for this to have begun in the wake of my surgery. Now I am discovering instances where others having surgery suffered the same fate. Does anyone know of a physician specializing in this condition with a successful track record??

Have to resurrect this to get/offer some input.

I get that "stinging/burning" pain after the initial orgasm as well. It starts at the left side of the tip and spreads through the base where my prostate used to be and into my perineum and inside my left thigh. It subsides without incident, but it's new and I initially attributed it to nerve healing. It's not unbearable or wholly unpleasant, but it's there.

I came across an article in "Reviews in Urology" that discusses this issue. It seems that a patient was experiencing intense burning/searing pain in his perineum and deep pelvis post orgasm, which started about 6 months post op. Subsequent MRI discovered seminal vesicle remnants as result of nerve sparing.

www.ncbi.nlm.nih.gov/pmc/articles/PMC1477581/


It also appears that tamsulosin may be of some value, as it is felt that bladder neck contraction during orgasms can be a factor:

www.researchgate.net/publication/235668356_Radical_Prostatectomy_Sparing_of_the_Seminal_Vesicles_and_Painful_Orgasm

I've had exactly one in 2 1/2 years, but it was a dry dream. Felt good though, I'd say as intense as before.

Mine is probably better than ever!

Miroslaw said...
AlwaysLate and Dismayed, I could not find a way of contacting you on priv as i would like to know if you found any solution for the "no - orgasms" problem.

I seem to be in the same boat of men who lost the orgasm sensation after the Radical Prostatectomy.
I had my da Vinci 1 and 1/4 nerve sparing op in 2014 and since then I lost the orgasm sensation.

I have done some research on internet and tried couple of things:
1. nose spray Oxytocin - allegedly helping some men with anorgasmia.. But no improvement with me.
2. Cabergoline (dostinex) - also helped men with anorgasmia in some trial in US. The effects were reported after 9 months of tablets. I am half way through now but so far no improvement either.

Has anyone on this forum regained orgasms after losing them due to the Prostatectomy ?
And I am not talking 2-3 weeks past the op but like 2-3 years post op.

And last question: someone on this forum is suggesting Nevres Testing ? What nerves is he referring to and how to test them please ?

My Urologist / Andrologist not one but all of them are not concerned with my lack of orgasm, looks like they are assuming that 80% of men will lose the feeling after the RP.

Well, I can see why they might not be concerned, as they still have their orgasms and your money. Sorry, I guess that is super cynical. But, I am still no fan of surgery, not if there is any other choice that is not clearly suicide.

51 y/o at time of RALP on November 2, 2016. 4 months post RP and I was not able to experience orgasam. I am totaly numb down there, no feeling to touch, pinching or any painful stimuli.
RP ruined my life. I started 10 mg Cialis at 10 weeks post op with once a week full doseof 20 mg. Even with full dose, no signs of life in my penis.
Returning of erections after RP is equal to man declared with brain death. Both are artificially kept alive and might come back only by miracle.
Never had problem with erections before RP and was never taking any ED drugs before. I am in very good physical shape, very active, not overweight.
I regretted prostatectomy. Surgery is worst option especially for young guys.
The younger we are, the longer we'll be suffering.
MY RP WAS BIGGEST MISTAKE.
MK

MK,

Yep, that sucks. Sorry to hear it.

On the other hand, it's not particularly unusual for a man to have nothing whatsoever going on at four months -- even among the guys who do eventually recover. Erectile function generally tends to gradually get worse for several months after surgery, bottoming out at three to six months, and then improving slowly for several years.

You are now passing through the period of maximum crankiness. At around four months out a man gets tired of keeping a stiff upper lip. He wants something else to be stiff for a change and nothing is working yet. His incisions are healing up on his outside but the inside parts seem stuck in the off position. He regrets his decision, is mad at his surgeon, and is frustrated and depressed.

But it passes... slowly... too danm slowly.

Speaking of depression, there are a number of medications that can cause problems something like what you describe. SSRI antidepressants are among the worst offenders. The sexual side effects of Prozac are horrible and there are other common drugs almost as bad. You might talk to your doctor about whether any meds you are taking might be making the problem worse.

If PDE5i drugs (such as Cialis, Viagra, Levitra, etc.) aren't working for you you really ought to talk to your doctor about other possible treatment options. It is called "penile rehabilitation" and your surgeon should have a plan for it if you ask. Without occasional 'exercise' the erectile tissues tend to atrophy which can cause lasting problems even after the erectile nerves recover. Vacuum erection devices (VEDs) can help keep the stretchy bits stretched and they help somewhat with keeping the tissues oxygenated, but they don't work as well as injections.

Your insurance will pay for a VED ... probably. If it doesn't then there are non-prescription devices that cost less but work just as well. We can make some recommendations. Your insurance may or may not pay for injections (probably won't) but if you get your doctor to write the scrip for "trimix" the per-use cost is actually quite affordable. (Much, much cheaper than your Cialis.) Some guys are a bit put off by the idea of sticking needles in their penis but since you are complaining about a loss of sensation then either the shot won't hurt (which is good) or it will hurt which will reassure you about the loss of sensation thing (also good.) It's a win-win situation.

I know that you came here to vent and I've given you all this advice that you didn't ask for and don't want. Sorry about that. But, once you've gotten things off you chest you might as well see what you can do to get where you need to be.

MK- Sorry you are experiencing numbness in your penis. Don't forget it has been only 4 months since your surgery.

I had my surgery about a month earlier than you. Afterwards, while my penis wasn't numb, it was very sensitive to the touch. In general, my groin area and testicles were swollen and stayed that way until 2 months had passed. Even then, when I touched that area, it felt like a batted ball had taken a bad hop and nailed me in the nuts, like when I was a young ball player.

Now there is no discomfort, but ED is present. I haven't been following the penile rehab schedule. The more you read about it, experts vary on their recommendations. My surgeon's NP told me to proceed at my own schedule. I have experimented with Viagra a half dozen times, and obtained good blood flow and a moderate erection. I think I even had a dry orgasm. One night with my wife, I had some "sign of life" without Viagra.

Anyway, everything I've read is that it can take 6 months to 2 years before most patients will recover normal function. I also know that nerves take a long time to heal, so one has to be patient.

Statistics say you should get better. Hang in there and keep at your therapy.

I know this thread is quite old now but I have been searching all over for some information on this subject so I hope someone can empathise with me and give me any information about my problem. I had a TURP one month ago, it went well, i had a catheter in for 5 days then after that although painful I could pee again without restriction, i still get the off twinge of pain, normally after peeing but it soon goes away. Lats week I woke up with quite an impressive erection but it felt weird, as though something was pulling inside my penis. Since then I have had a few spontaneous erections but not quite as intense, they come with sexual urges so i tried masterbating. I had an orgasm with no ejaculation but OMG it was painful and once I was there I wasn't able to stop and had to endure the pain until I finished. The pain was in my penis, a stabbing type of pain. Now I daren't masterbate and don't yet want to have sex because of the possible painful result, however I still get the erections and it makes me frustrated, is pain normal at this stage? am I trying too soon.

PeterDisAbelard. said...
Hello JP,

Welcome to the forum. Sorry you have troubles. Hope we can help.

I'm not a particular expert on TURP (never had one) but a lot of the usual information about other prostate surgery probably applies.

A few particulars:

After one month you are still healing and your sensations now will be different (probably much better) a month from now. We've had quite a few guys here who have had TURPs (often they were diagnosed with PCa during the procedure) and they don't generally mention that it makes sex agonizingly painful.

The "no ejaculation" thing is probably a permanent feature, though. Men who have had TURPs ejaculate backwards into their bladders.

The sensory nerve that enervates your penis runs along close to the neck of your bladder (where your TURP is still healing) and irritation along that nerve is felt as a pain in the tip of the penis. Chances are once you have healed up completely (say, six months after the TURP) the pain and the tugging sensation will be gone.

This is a valid thing to talk to your urologist about.

Thanks for your prompt reply, I am probably a bit impatient, lost of things I was never told about, the general info I was given said 3-4 weeks and I would be ok. But I suppose its different for different people. Anyway thanks for the re-assuring info.

JPYorks said...
lost of things I was never told about, the general info I was given said 3-4 weeks and I would be ok.

This is perhaps a bit off topic but... quite a few years ago I decided I had enough children and I decided to have a vasectomy. The procedure went fine and I went home to rest up. My post op instructions said I could have sex as soon as 48 hours after the procedure but should wear a condom for the first two weeks to avoid any last-minute conceptions. When the 48 hour mark rolled around my scrotum was quite sore and had swollen to four times its normal size and turned rather purple. It was a bit like a scrotal transplant from a moose. I thought about calling the doctor to complain that he'd told me that I could have sex after 48 hours. But I knew what he'd say:

"It's fine with me."