Erectile dysfunction after operation - can get erection (but more so outside than inside the woman)

Your description is a bit on the side of TMI, but is he on any ED drugs?

John_TX said...
Your description is a bit on the side of TMI, but is he on any ED drugs?

Not sure what you mean by "TMI" - could you clarify? As far as what he has told me, he is not on any ED drugs currently.

Bobbiesan said...
Anne,

Well, now, it is a little difficult to delve into details on this type of situation. But if not here, then where? So I will make an attempt and be frank ...

Here are a few things to know:

--The whole genital area gets beaten up pretty well during surgery. And the erectile nerves may be damaged and require an indeterminate healing time -- differs with each man and can be up to years!! It took three to five years for me, and I still do not feel 100% back to normal. So, even in best circumstances, the erection hardness may be less reliable than before ....

Robert,
Many thanks for sharing your experience, this is super helpful! What I don't quite understand is why it's easier for him to orgasm through manually stimulating himself outside of me than when is he thrusting inside me. Sorry for being so direct, what are you feeling when you are thrusting inside or are penetrating a woman (your wife)? Is is that there is no physical sensation in your penis? Or do you feel completely disconnected from your penis - like it's something separate from you without tactile sensation?

You mentioned a man with ED his penis will harden and soften, and it's not in his control and this can cause a snowballing. Any particular factors that may cause it to harden or soften (apart from his anxiety over not performing)?

Do you find it easier to orgasm outside of the vagina? Or inside the vagina?

It's easier for my boyfriend to orgasm by ********** himself manually afterwards outside of me (rather than inside me). If he's able to come outside of me, the physical sensation must be there (I would think). Why would it be easier outside than in? Is is that there is not enough pressure and sensation on his penis in the vagina? Or maybe the vagina doesn't hit the most sensitive spots of his penis during penetration (which he can stimulate more precisely when he is stimulating himself)? What do you think?
Were a woman to do kegels, do you think that could make a difference in helping to make thrusting and penetration more pleasurable for a man recovering from an operation and ED?

All the best,
Anne

Anne,

anne10 said...
Is is that there is no physical sensation in your penis? Or do you feel completely disconnected from your penis - like it's something separate from you without tactile sensation?

No, some feeling is there, but it's muted. Think the best way to describe it is the difference between a male having intercourse with a condom and without. Both nice, but latter superior due to the tactile sensation of warmth and wetness that gets muted by the rubber. Indeed, I've read that condoms can cause loss of male erection sometimes. Honestly, when I did use them decades ago, I was so young that hardness was no issue, condom or not. Miss those days (sniff).
This may be subtle to understand for a woman, since both scenarios may feel about same from women's view (idk).

anne10 said...
Any particular factors that may cause it to harden or soften (apart from his anxiety over not performing)?

Besides the genital sensitivity recovering? The things I mentioned. Aging and lack of aerobic fitness. I guess a GP or uro could explain the mechanics behind this. But I believe it has to do with general blood flow to the genitals. Also, let me mention that a few years after RALP, my uro started me on testosterone injections. He and his nurse specifically warned me that it was not marketed as an ED approach, and I believe it. However, I know for sure it affects my libido somewhat, and energy level for sure. Those might also play into erection quality, but it's so complex a topic and so subtle an interaction. If for some reason his T level is down, perhaps unrelated to surgery, this might be a factor in his performance.

anne10 said...
Do you find it easier to orgasm outside of the vagina? Or inside the vagina?

about the same for me. But you may be aware that some men try to train themselves over the years to delay while inside, for the lady's pleasure, and this training may get built into the brain long-term (ha). So it may appear outside is easier.

anne10 said...
...hit the most sensitive spots... What do you think?

Actually, I think it is generally that each individual knows better than anyone else what will "do it" for him/her. Fact of life. I will say that for a couple years post RALP, I literally could barely feel any touch on my genitals. Minimal feeling, so minimal stimulation, and, sadly, minimal desire to try, and higher likelihood of snowballing crash. But it did get a lot better over time. I guess your Kegels might help him some, but maybe not as much right now, until he has recovered more genital sensitivity. Kegels for him might help some. I think again due to effect on circulation and muscle tone. Beware that overdoing them can cause some pain post-surgery. It did for me and some others on this board. So please follow doctor's advice/consult as needed.

Robert

Anne,

You may have noticed that the answers you are getting here are a bit all over the map. That's because the topic is complicated and we could write you a book. The reason guys are all giving different answers is because we all have favorite chapters in that imaginary book.

You asked about the concept of "too much information". We talk about sex quite a bit here on this forum but we tend to shy away from making it sound like fun. We tend to steer away from terms like "thrusting" or "explosive pleasure" and talk about "penetration" and "climax" instead. FrankTalk.org does a good job of handling the sounds-like-fun discussion (which you do, by the way... sound like fun, that is) and here on HealingWell we make men's problems with their sex lives sound like repairing a washing machine when the agitator is broke.

But, before you head off to FrankTalk.org where the fun-loving types hang out, a few words about your guy's plumbing:

You can think of a man's erectile tissues as two pieces of sausage casing stuffed with sponge. Blood from his heart comes into the sponge cylinders from arteries that run down the middle and blood drains out through veins that run along the outside (between the sponge cylinders and the sausage casing). All of the little holes inside the sponges are surrounded by muscles that keep them normally squeezed shut.

When a man becomes aroused his brain sends messages through his erectile nerves to receptors in his penis that release nitric oxide that makes those muscles relax. Since the holes in the sponge aren't squeezed shut any more they let the man's blood pressure stretch them out. The sponge gets bigger. It presses against the sausage casing that isn't particularly stretchy and gets hard. And voila! an erection.

If a man gets distracted and loses interest his brain will stop sending the signals that cause nitric oxide release and the nitric oxide that is already there will be gradually cleared away by an enzyme called phosphodiesterase-5, and the muscles in the sponge will clamp down again, and the erection goes away gradually. If, on the other hand, the man climaxes, a different nerve stimulates the release of adrenaline in the penis which causes the muscles to clamp down immediately -- regardless of nitric oxide -- and the erection goes away quickly.

One other thing to mention: remember that the veins that drain the penis run along the outside between the sponge cylinders and the sausage casing? Well those veins are designed to be squashed flat if there is increased pressure from squeezing or bending. This keeps the blood from being forced out during, um, thrusting or other vigorous activity.

There are a number of things that can go wrong. Among them,

1) The man's arteries may not supply enough blood at enough pressure to get the job done. This happens most often to men with diabetes but it also happens to men who have been treated with radiation or have some other vascular problem. This is somewhat uncommon but hard to fix.

2) A man's erectile nerves can be damaged or insufficient, causing too little nitric oxide to be released to obtain, or to maintain an erection. There are several things that help with this. Assuming the nerves work somewhat he can take medicine that blocks the enzyme that neutralizes nitric oxide. All of the ED pills -- Viagra, Levitra, Cialis, etc. -- work this way. They are all called phosphodiesterase-5 inhibitors (PDE5i drugs) and they are often needed by men who have had prostate surgery that damages the erectile nerves.

3) If the man's erectile nerves don't work at all and there is no nitric oxide released the man can inject medicine into the penis that does the same thing as the nitric oxide. This is called penile injections and it works most of the time.

4) If the man doesn't get a hard enough erection to squash the veins that drain the penis then the blood can leak out. Sometimes pills will help with this if he just needs a little bit more fullness to squeeze them shut. Other times injections may help for the same reason. But sometimes the veins have gotten stiff and they don't squash very well. This is called "venous leak" and it gives men erections that look good until they try to do anything with them.

I suspect your guy has problem 2) and maybe a little bit of 1) and 4). These are things for him to talk to his doctor about. Not that much you can do except encourage him to get help.

And then there is problem number...

5) If a man is sufficiently nervous that he will fail to perform then he will fail to perform. Remember that to maintain an erection requires constant messages from the brain to maintain the supply of nitric oxide (to add it faster than the PDE5 enzyme clears it away). As long as he is thinking "ohhh, baby baby" he's OK. But the second he thinks "Oh no! It's happening again!" the messages from the brain stop coming and he is sunk. If he is really freaked out then his body will unhelpfully dump lots of adrenaline into his blood which is guaranteed to deflate his member and he is really, really sunk.

The thing you can do to help him with this is to give him other things to think about. Tell him what sexy ears he has. Remind him of that thing he did with his elbow and the lime jello that you liked. As him algebra problems. Anything. Anyting but letting him think about Mr. Disappointing letting him down again.

BillyBob@388 said...
Anne,
I just want to say how lucky your man is that you are so concerned about this situation, and want to find some way of helping him(and yourself)!

I don't know if this was answered: Is he already taking any pills to help with erections, or is he able to function to the degree you describe without any medicinal help? If so, then looking into some Viagra or Cialis might provide a very significant boost.

In addition, some men use penile pumps and rings that allow them to function even if there is zero function. In his case, as he only needs a little bit of extra help, a little pumping and a ring that is not all that tight might again provide a very significant boost. Or even no pumping, just the ring...

/quote]

Billy Bob, he's currently not taking pills It's good to know these options thanks.
Best,
Anne

gedman said...
Here is what I learned from Dr. John Mulhall, one of the world's leading experts in ED:

When a man feels stress/anxiety, his body produces adrenaline. Adrenaline is the world's most potent ANTI-erection chemical. Therefore, if a guy is anxious about getting/keeping his erection, he is likely to lose his erection due to adrenaline. A self-fulfilling prophecy, of sorts.

So, if your friend is anxious about maintaining an erection during intercourse, he is going to lose some or all of his erection during intercourse. On the flip side, if he feels confident about maintaining his erection during foreplay, then he'll stay hard during foreplay.

Bottom line: Your friend needs to overcome the psychological side, and the physical side will do just fine. Dr. Mulhall "prescribes" a few glasses of wine before sexual activity to help a guy "chill out" a bit.

Gedman

Thanks Gedman and for putting things in black and white in your bottom line, realizing how important the mind/psychological side is.
Best,
Anne

Annie, I had a great response written...and then it wouldn't let me post it

The short version is that it's probably mostly in his head (the big one between his ears). I'd suspect he's convinced that he's not as good as he used to be (or as he remembers he used to be), and you're relatively new in his life, and he's seeing how much fun you're having and is afraid he can't keep up with you. All that anxiety has the effect of shutting things down for him.

I'd suggest you remind him regularly--like every day--that he's doing a great job of taking care of you, and that you don't mind that he's different from other men. Lots of men post prostate surgery get this idea that they have lost a fundamental part of their 'maleness'--and it plays games with their heads. The fact that he's functional and is willing to do that is huge. It's different for him than it used to be--he has to hear that it's ok with you.

Some men have a real problem it seems with having dry orgasms....personally, I kind of like it.

In short, keep caring for him, keep loving him, and keep assuring him that he's doing a great job taking care of you. He'll be fine.

anne10 said...

InTheShop said...
Anne - post surgery a man's body changes a lot. There is nerve damage and other things. He might need some meds, but a conversation with his URO might help. A man's confidence is shaken and his ability to perform like he did in younger years is much different.

You might want to also checkout the websit, franktalk.org where ED is the main topic and there is lots more information on the subject...

Thanks Andrew, I will definitely take a look at frank talk.org

All the best,
Anne

As others have said he is a lucky man having you in his life. I did notice that you didn't post how this conversation goes with him, if there is one. Is he bothered by the situation? Can the two of you talk with the honesty you show here? Hopefully he realizes he is ahead of the curve, has someone special in his life, and regularly does the happy dance naked under a full moon.

Tall Allen said...
I relish the graphic detail! Too often these things are not discussed openly, and it is the men and their partners who suffer. When urologists look at such things (which is not often), they sometimes ask men to rate how often their erections have been hard enough for penetration. Even among men who are able to muster some penetration, the erections are seldom what they were before prostatectomy. And they don't last as long.

Thanks Allen. There should be techniques to strengthen erection hardness for post-operation men.
Best,
Anne

Annie,

Here's the deal for me: After my surgery in February of 2015, I had read all the stories, and I was prepared for that part of my life to be finished. For a significant percentage of men--even a fair number on this forum--a spontaneous erection is a distant memory. Pills, injections, pumps have some benefit for some men.

For me, I had a partial night time erection during the first week after the catheter was removed, about 10 days after surgery. That was a surprise. I had, with the help of my loving wife, an erection and very gentle orgasm at around week 3, and have never looked back since. I have been taking daily cialis, 2.5 milligram (the lowest dose available) for some time now--I find that it helps both the erections and my occasional urine leakage. I'd encourage your boyfriend to talk to his doctor about trying it for a few weeks.

For me, I find that, at least some of the time, the orgasms are better than I remember them before. Sometimes I feel as if I'm having something that matches the descriptions I've read by women who write about the full-body orgasm. That may be in your boyfriend's future, or it may not.

For all of us, it feels very different than it did before. Here are some differences that I've noticed:

1. Lack of ejaculation is a big thing. There is no literal marker to identify when orgasm has happened. And, for many men, that loss reminds us that we are no longer complete men. Much as, I suppose, women who have had a breast removed are reminded constantly that they are not whole women. I suspect that it's different for our partners as well. The loss of fluid means the loss of lubrication--that also follows our spouses when they are our age with menopause. Intimate lubricants are wonderful things.
2. Getting ready takes longer for me than it used to, and it takes a lot more direct stimulation. The days of sliding into bed with a naked woman and getting an instant erection are past. It takes focused attention, lots of direct contact, rubbing, stroking, etc. to get me ready. Not that is is a bad thing...it's just different.
3. Some days, it just doesn't work. No matter how hard we try, nothing happens. And that HAS to be ok.

Best of luck to you...keep at it.

Anne,

We send folks to FrankTalk for these discussions, as it is an adult-only forum, and things can be dealt with in more detail.

Here at Healing Well the forums are open to younger folks, 13 and up. We also have more family members in some forums. Thus the rules and guidelines about content.

We allow ED discussions here because they are very real in the context of PCa side effects, but we have to keep in mind that some 13 year old on another part of HW can drop in on the thread.

Hence the comment of TMI made earlier.

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