Loss of Libido Following Surgery

Following surgery I find my libido dropped to zero. Four years later it's still at zero. I suspect there are many reasons for this and these represent my thoughts about this issue. I know my own lack of interest was a result of more than one of these issues I experienced following surgery. I suspect that's true of many men post surgery. Here's the list:

1. Receiving a diagnosis of prostate cancer can generate fear and/or anxiety. Both of these emotions can reduce a man's interest in sex.

2. Depression- men often experience post-surgical depression. When men are depressed they don't typically experience depression the same way women do. Women typically become sad. Depressed men are frequently agitated, irritable, and easily angered. They could experience a loss energy and interest in previously enjoyed hobbies and activities. Depression often leads to a noticeable reduction in desire and/or interest in sex.

3. Losing urinary control- After prostate surgery the majority of men lose the ability to control urination. This lack of control may great impact a man's desire for sex.

4.Climacturia is a medical term describing orgasm-associated incontinence. Few if any men are told it's very possible they will leak and or urinate during their orgasm. For some men and/or women, urinating during an orgasm is either highly embarrassing or a complete sexual turn off, so the couple may avoid sex due to the appearance of climacturia.

5. The Loss of Ejaculation- After surgery men lose their ability to ejaculate. This can affect the pleasure men feel. Some men will avoid experiencing orgasms because of the sense of loss or sadness they feel after an ejaculation free orgasm.

6. A change in the quality or intensity or painful orgasms-For some men there is a significantly reduced intensity of their orgasms so there is a reduction in pleasure. This could serve as a turn off. Some men will experience painful orgasms after surgery, and there is a built in desire to avoid pain.

7. A reduction in penis size-Some men report a noticeable reduction in the size of their penis. This may cause some degree of shame-which will greatly impact a man's interest in sex.

8. Erectile Dysfunction-The majority of men will experience the loss of their ability to experience an erection for a minimum of 18-24 months. The inability to experience an erection can have a devastating impact on a man's libido and desire for all forms of physical contact.

9. The aging process-Many men who chose surgery are in their late 50's or 60's. Many men experience a decrease in libido as they age. This may be related to a drop in testosterone as men age. Medications to treat a variety of diseases, such as high blood pressure can adversely effect a man's libido.

I don't know why I haven't read this any where else but this seems obvious to me that prior to surgery each man had a number of triggers which could result in an erection. Some of those triggers for an erection were:
1. Sight-Men often get arouse as a result of seeing something that turns them on.
2. Sound- Certain sounds or sex talk can arouse men. There is a whole industry based on the power of sex talk to arouse men
3. Smells- Certain smells can arouse a man to experience an erection
4. Fantasy- Men have the capacity to use their imagination to think about sexual experiences that arouse them, resulting in erection.
5. Words-Some men are aroused by reading about sexual encounters.
6. Touch- Certain forms of touching can create a state of arousal.

After surgery, most men will experience a complete and total loss of sexually exciting, erection inducing triggers. For men, their erection is the signal they are sexually aroused. Unfortunately,
for a majority of men, prostate surgery results in the inability to experience an erection when exposed to previous erection inducing triggers. Men experience their flaccid penis as evidence they are no longer aroused and then go one to conclude surgery forever ended their interest in sex.

When men lose their every trigger they had which produced an erection, there a a powerful emotional reaction this this loss. Now these previously exciting triggers result in a man feeling a sense of loss, disappointment, frustration, anger and shame. Many men coping with erectile dysfunction feel that surgery robbed them of their manhood

In order to avoid feeling those powerful emotions a man will avoid everything that was previously exciting to him. Frequently, a man with erectile dysfunction will avoid all forms of physical affection. By doing this he seeks avoid feeling shame and the awful reminder that he's lost his manhood. The strategy to avoid all forms of physical affection adds a significant amount of stress and tension into the relationship.

In my opinion, the complete and total loss of sexual exciting triggers is what men experience as a loss in libido. Most men associate a flaccid penis as a lack of excitement and/or interest in sex. So it's easy for a man to conclude that as a result of surgery he's lost his interest in sex.

The couple discover much of their sexual history is lost to both of them. Behaviors that previously resulted in mutual excitement and pleasure now end with failure, disappointment and frustration.

It takes a compete re-wiring of the brain for a man to learn he can be sexually aroused with a flaccid penis. Most men have no idea it's even possible to experience an orgasm with a flaccid penis.

It's challenging (and possible) for couples to find new ways to enjoy sex post-surgery. For a couple to reclaim their enjoyment of their sexuality and sex, it means learning to become aroused while experiencing a flaccid penis.

To re-claim your sexuality post-surgery takes time, effort, experimentation, and new experiences to re-program your mind and body to experience arousal in completely different ways than you did prior to surgery. Men must learn how to find pleasure, enjoyment, and orgasms with a flaccid penis, This isn't a simple or easy lesson for a man to learn but it's an essential lesson to learn in order to re-claim and renew sexuality post-surgery. It doesn't take an erection to enjoy sex. That's my take, what do you think?

Thanks Gedman,

I agree low T can certainly cause a drop in sexual desire. That said after a prostatectomy testosterone levels go up. According to Johns Hopkins, the increase in testosterone is not noticeable, "but it certainly dispels the idea that a loss of male hormones contributes to a loss of sex drive:
http://urology.jhu.edu/newsletter/prostate_cancer55.php

Additionally, there's been recent FDA warnings about using testosterone:
http://www.fda.gov/drugs/drugsafety/ucm401746.htm

So I wouldn't advise men to rush out to get testosterone.

(I can't figure out how to make these links work.)

I've taken every pill there is to take and used penile injections. Neither of those options restored libido. At times, both options a allowed for usable erections. More often than not both failed. That said, how to get an erection post surgery or a discussion about a partner are discussions for a different thread. I wanted to focus on the loss of sexual desire post-surgery. Injections and pills may give you a usable erection, it doesn't give you a desire. Desire (Libido) is very different from opportunity.

I'm struck by you calling this a "list of woes" as opposed to an accurate description of the psychological/physical issues men face reclaiming their sex life once their prostates are removed.

I've had conversations with hundreds if not thousands of men following surgery. I would guess that 99.9% of those men faced one or more of the psychological and/or physical issues I listed. Therefore I'm not to concerned about changing the word "most" when you should have said "some", "at least" where the correct word is "generally", and "the majority" when you mean "many", though I thank you for a VERY through review.

I met a guy at UCSF who had his prostate removed. Since cancer was found outside his prostate he was given both radiation and hormone therapy. Throughout his hormone therapy he never lost interest in sex or his ability to have an erection. We use to joke around about taking the best our experiences and combining it to be one patient. He wanted my diagnosis (cancer confined to prostate) and I wanted his desire and erectile ability.
If you've lost your desire as a result of hormone therapy, I hope it will return to you as your testosterone levels rise.

I hope more men who read this thread will discuss what if anything the did which enabled them to recover and reclaim their SEXUAL DESIRE (not their erectile abilities) post-surgery.

I haven't found anything including a two month try with androgel that restored my libido to pre-surgery levels. I've decided that isn't going to happen.

Rick,

I've made you cross. I am sorry. Worried I might but tried not to.

Let me particularly apologize for my fourth paragraph which I assume was the part that offended you since you have quoted most of it back to me.

I'm not sure it is accurate for me to say that I have lost any libido, or desire, though I may be starting to repress it. But the desire is there if there is a need to suppress it. What is missing is an ability to act on that desire (aka torture) and a lack of desire to jump through the hoops and and suffer the anxieties(pain, PD, incontinence, expense and possible ER trips IF it actually works TOO well, etc) for so little reward. IOW, it might work enough to barely pull it off now and then(speaking only for me). But what an incredible downer to go through the risk and discomfort for nothing usable- only just almost usable- most of the time. And if it is usable ( from an injection or pump or both) it just does not feel the same, no where near so far. And the whole thing some times just seems a bit, lets say strange, nicest way I can put it.

So, a lack of desire to go through all of that for mostly disappointment so far- is for sure there. To the point that I just have not even been trying lately. And that lack of desire to jump through the hoops can probably lead me to just put the other desire out of my head, or to try. But the desire/libido is there just as much as always, though suppressed. And that desire is mostly just another negative. I would rather it just go away if I can not do something pleasurable with it.

But who knows, maybe things will improve in the future as I am only 6 months out. Not that I expect a return of function even with pills, I think my nerves are gone. But maybe I can get a more enjoyable experience from all the other craziness. Maybe I just have not got used to it all yet, and maybe someday I'll find the right dose that is plenty enough- and I can even lay down, but no ER trips! Maybe!

I appreciate those who are sharing their post surgery issues with the lack of desire or the desire but lack of ability. I suppose I could consider myself fortunate that my lack of ability coincided with the loss of desire. I'd imagine it would be very frustrating to have the desire but lack the ability. Am I the only man who didn't know it's possible to experience an orgasm with a flaccid penis?

Rick, can you please email me via the little envelope under my name on the left side of the page?

Thanks,

Jim

I share all of those observations.  Nothing since surgery.  Now that I am off of Hormones I think about sex but no erection just leakage.  Freaking depressing.