First Orgasm following prostate removal

I had Di Vinci surgery thirteen days ago. All seems to be healing to plan and I had my catheter removed last Friday, a week after surgery.

When did you have your first post surgical orgasm? I have read a lot here about issues and what to expect, except there's not a lot of discussion on when. I am very sensitive to touch after the surgery, just not 'hard', and seem to get close.

Is two weeks to soon to try for an orgasm?

Dr. Mulhall advocates penile stimulation starting the day the catheter is removed. The longer one waits, the more the chance the damage becomes permanent.

It was about four to five weeks for me. To be honest, with all I had been through nothing like that was on my mind. A little concerned about the stitches too, so I just waited. But when it happened....it was a mix of surprise and joy. Surprise that I could have an orgasm and joy at how good it felt. Have to say it seems the orgasm, even though dry which is strange, is more intense.

Hi have my first orgarsm almost 8 weeks after my surgery and I still got pain from the base of my penis, so my doctor said it is still healling the stitch at the bladder and the utheral joint. So you have to be careful with it. Stop if you feel pain. I now still feel some pulling pain when I full a little bit harder or sometime the erection comes up to 70% I could still feel something there too.
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41 yrs old, robotic davinci on Dec 21, 2012
Gleason score rised from 4+3 to 4+5. T3b.
Right seminal vesicle got involve too. Waiting for the radiation and hormone treatment now.

there are two issues, when to start pills to promote blood flow and when to start playing with yourself/having sex.

Many people start the first even before surgery and only pause while the cath is in. But I think the issue here is trying to get an erection which I was warned against for the first 4 weeks.

Tex - when a guy with the handle Peter disabled tells you to have an ice bucket ready in case if falls off, pay heed.

Don't let things/thingy get out of hand though.

What do I know. I have not had surgery yet, but can attest that Lupron ADT has its impact.

Great writing as usual Peter. Hoping to meet you in person in Rochester at end of September GFMPH.

I agree with Peter that your body is the best judge. It's what my urologist told me too. He told me that with all therapies, XRT, BT, or RP, engage freely in sex afterwards, but if there is discomfort, stop what you're doing. He agrees with Mulhall that the evidence indicates that penile atrophy starts almost immediately after RP, and good oxygenation is vital to retaining size and function.

me neither, davidg. sounds like bad advice and possibly dangerous advice, and as far as people experimenting on their own, why not simply have their doctor/surgeon advise, the surgeon knows what he did inside, and if there are any touchy areas in particular that could be potentially damaged.

Stopping before you hurt yourself works as well as pulling out in time before you lose it, lol. A still weinie has no conscious.

I worry sometimes that newcomers will interpret some advice here as being equal to sound medical advice, its a slippery slope.

david in sc

Myself, I like evidence-based medicine and patient empowerment. Too many doctors are woefully ill-informed about penile rehab. I've met urologists for whom quality of life is an afterthought. Ideally, there would be a Doctor of Sexual Medicine on everyone's treatment team. Dr. Mulhall is a Doctor of Sexual Medicine at Memorial Sloan Kettering and has studied this extensively. You can hear for yourself what he has to say about this by listening to the following presentation made to other doctors.

Mulhall presentation on penile rehab

right, but in the link I provided he mentions taking pills pre surgery and then waiting up to 4 weeks post surgery, right?

"In a recently published study, Mulhall and coworkers18 followed 132 patients through an 18-month period after they were placed in “rehabilitation” or “no rehabilitation” groups after radical prostatectomy. Patients undergoing rehabilitation agreed to take sildenafil or intracavernosal alprostadil to induce erection 3 times weekly starting within the first 4 weeks after surgery"

"In a study by Padma-Nathan and colleagues,27 patients were randomized to either nightly sildenafil treatment or placebo for 36 weeks, starting 4 weeks after nerve-sparing radical prostatectomy."

"Recently, Raina and coworkers20 have evaluated the daily use of a vacuum constriction device (VCD) beginning within 2 months after surgery in patients undergoing nerve-sparing radical prostatectomy or non-nerve-sparing radical prostatectomy"

"Zagaja and colleagues21 found that men taking oral sildenafil within the first 9 months of a nerve-sparing procedure might not have any erectogenic response, thus calling into question their use in early penile rehabilitation."



www.ncbi.nlm.nih.gov/pmc/articles/PMC1751036/

For those who didn't want to go through Dr. Mulhall's whole, somewhat technical presentation and hear it in his own words, I captured what he said on his Slide #23:

"The nurse practitioner gives them an Rx for a PDE5 inhibitor at the time of the catheter removal, and they’re told the following: we want you taking, over the next four weeks, 6 nights a week, a ¼ pill of viagra, 1 night a full pill, and we want you stimulating and seeing what erection you generate."

The full presentation is worth listening to. He makes the point that based on current research, the process of penile tissue degeneration begins immediately after surgery and may, in some cases, be preventable. The longer one waits, the higher the probability that the damage will be irrecoverable.

bluebird123 said...
Since my husband is Dr. Mulhall's patient I can tell you what my husband's instructions were. He was started on Viagra 2 weeks before surgery, at 25mg. a day. He stopped at the point of surgery. After surgery he was told to resume Viagra at 25mg. a day once the catheter was removed. He took Viagra at that dosage until 4 weeks after surgery. At that point he was to take Viagra 25mg. a day for 6 days a week and 100mg. a day for one day a week. On the day he took Viagra 100mg. he was to try to get an erection.

He followed this protocol for four weeks. Dr. Mulhall's instructions were that if at two months after surgery he was unable to obtain an erection (he wasn't) he was started on injections.

My husband's surgeon, Dr. Tewari who knows and works with Dr. Mulhall told my husband to wait about 3 to 4 weeks before attempting any sexual activity, but indicated that he favored 4 weeks. My husband waited 4 weeks.

how are the injections working out?

bluebird123 said...
Thanks for asking David. He's doing the shots therapeutically and hoping to get better in the future.

he's only 6 months out, still a ton of time to regain it. What does Mulhall say?