Sex after Robotic Prostatectomy - What to expect?

Hello Tom,

Without knowing more about your cancer we can't tell you much and even if we did know the details there are no guarantees. It all depends what the doctor finds when he gets in there. But assuming that things go well, with full bilateral nerve sparing, you should expect the surgery to cause some temporary ED problems from the trauma to the nerves. Not everyone gets ED problems -- and for some men they aren't temporary -- but the average is something like nine months of pretty bad ED (requiring pills, at least, for sex and maybe injections.) After that the nerves will recover and your ED will get better. You may also take a while to regain continence. Again, some men are continent right away and other men never get there, but the average is probably a month or two to regain full control.

Your libido (your desire for sex) will not be affected directly but the other side effects can make sex difficult and that can make you discouraged at times. But in most cases men eventually recover most of their pre-surgical status (this can take as long as two to four years.)

Good luck with your surgery.

Fairwind said...
Sexual desire CAN be destroyed by PC treatment, but that comes later, should surgery fail and hormone treatment comes into play...

I prefer the word "suppressed." Destroyed sounds so permanent. I plan to resume where I left off just as soon as my HT is over... sometime in 2015... *sigh*

Just too many variables. Varies so much from guy to guy, doctor to doctor. I have similar stats to yours, was age 56 at dx. Never had any ED issues before PC. Had surgery, no ED issues after surgery, was getting full wood while still on catheter. Later had radiation, no ED issues 3 years after radiation.

So you can see, the results can be all over the place, and there are no guarantees or things you can do to improve the outccome.

david in sc

Hi Tom,
I shared your same concerns. We are nearly the same age so I'll share my Ed issues after having RP with Dr. Patel. Before my surgery on a scale of 1-10 I was an eleven when it came sex. My wife and I share an amazing sex life. Although I am about three months post surgery my sex life has changed. First my penis is smaller when limp. They never warned me about this!! I know it sounds trivial but to me it makes a difference. When you have lived your entire life with a penis you've grown to love, it can be a shock to see it as a weakened version of itself. I feel blessed that i was able to have sex so
soon after surgery. I would however now downgrade my sexual report card to a 7 out of ten. Viagra really helps. Patel recommends you take a dose three times per week to stimulate blood flow. I'm also (occasionally) using the vacuum pump he prescribed. My wife and i discovered that using the doggie style position really helps facilitate intercourse. I feel blessed to have had my cancer diagnosed, treated and hopefully cured. I also feel blessed that my erections are gaining strength. My wife and i are approaching these first six months after surgery as a type of sexual rehabilitation. We will keep working at it until we get it right:) As far as lack of desire, for me its all in the head on my shoulders, not the head of my .....
If you have any questions about your upcoming surgery with Patel I'd be happy to give you my honest responses. Feel free to email me. Best of luck & don't rush into anything!!!

Congrats Tom on your decision. You are in good hands with Patel.

As rowlinrock indicates, Patel has a plan for ED issues that he will work out with you. They have a seminar every Monday at the hospital, be sure you go to it before going home.

I am pleased with the ED issues I have had. It is the "new norm" as we say but "Dead men don't have sex" as we say here. I used the vacuum pump and maintained an erection less than 6 weeks post-op.
Feel free to email me again if you have any questions about anything, including the hotel etc.

Bill

I am 8 months out and have very significant ED. I am young with good preop function. I am hopeful but certainly concerned about long term ED. I think that in retrospect I wish I would have considered brachytherapy as an option. I agree with the poster above that if sexual issues are your top concern then I would look at non surgical options. Some do very well with surgery but its 75% at best. And let me tell you that ongoing ED stresses your life and marriage.

Hi HVC- Don't give up to soon....you are not even 1 year out since your RP.... I am now about 19 months out and just seeing significant changes in my ED issues. Been using trimix and now going to try pills again...

Are you doing anything about ED rehab....? seems like a lot of Dr's are not educating patients to what they should be doing.

Curt

tom0613
I overlooked that you were the original poster. I don't want to discourage surgery. Most do very well. It is still what I probably would have done if I had it over again - I just would have at least listened to a brachy provider. There is a great sense of relief knowing your path which only surgery can do. I simply am posting my feelings as therapy and to be open for all about what the real outcomes of surgery can be - everyone is different. I have two friends who are perfect and one younger guy who has not had an erection in four years (all nerve sparing).

When I met with my urologist at Mayo Clinic before my DaVinci procedure, he was very blunt (very pleasant, but also very frank with me) in saying that my erections would NOT be as strong after the surgery. The trick here is that everyone is different and everyone has varying degrees of sexual ability.

In my case, my erections were being badly affected (as was my urination) by a BPH affected prostate that had grown 3-4x normal size. So, whatever my personal level of erections were, I could NOT expect to become that hard again.

This, I guess, is the general rule. Whatever your personal ability is before surgery, figure that it will not be that good afterward. For those who are hard like a rock, perhaps that means they will still be easily erect enough for intercourse -- but just not as hard as in the past.

In my case, I am just now beginning to sense a physical upswing after 14 months. With the help of Cialis (20 mg), I was able to achieve a fairly hard erection with my girlfriend a couple weeks ago. I am also encouraged at reading one of the other posters in this thread on how things are improving after 19 months. This gives me hope for the future.

Indeed, I have read that it can sometimes take 2-3 YEARS before sexual recovery is complete.

Chuck

July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate. Right
posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Catheter out in 7 days. No incontinence, occasional minor dripping.
First post-op exam 2/13/12, PSA <0.1.
Only semi-erections so far, with continued improvement.