prostate removal effects on sex life

You give no details about your situation and there is nothing in your profile. If you look on my profile you'll see what my situation is and has been.

In retrospect my sex life had already been impacted by the growth of tumours in my prostate. Many months before diagnosis I had noticed a significant drop in the volume of ejaculate and also in the quality of orgasm. These two changes aren't advertised or expected to be symptoms of prostate trouble. After  reading comments by other men I now realise that these symptoms are not that unusual.

From my researches since diagnosis I now realise that the prostate is the little considered powerhouse for good sex. Again from what I have learnt from other men on the forums, those that are able to resume sexual activity do find their sexual activity to be of diminished quality. My view now is that whether untreated or treated, where there is prostate cancer the quality of sex will always be diminished. I think it is wrong that the professionals underplay this point and even ignore it all together with older men.

I would observe that prostate cancer and its course is always marked with uncertainty. Without treatment its progress is likely to be relatively rapid when compared to its progress after primary treatment. Without treatment sexual activity is likely to continue for only a short period and will be progressively impacted. I personally think that in desiring to maintain the accustomed level of sexual activity and satisfaction should we set lightly in the balance when weighed against the troubles and dangers of prostate cancer.

The diagnosis of prostate cancer separates you from the past continuum of life with its plans and hopes. It sets a new departure point for your life . it is a terrible position to find yourself in as all of us on this forum have found. You have my heartfelt sympathy if you have had a diagnosis of prostate cancer. Accepting the position and resolving to live from this new starting point is the beginning living life with prostate cancer with new plans and hopes and dreams. It is not easy nor pleasant to make this transition. You have found this forum and I hope you'll continue with us and find this forum a source of comfort, encouragement and useful, valuable information .

My husband was diagnosed last June, with early prostate cancer, he saw the consultant, he told him he would be incontinent for a short time and more than likely impotent perminently (though I have read on other sites that erections can return) When my husband heard this he decided he definitely was not going to have it removed, so went down the brachytherapy route.

However after doing a lot of research I can understand why some men chose to have it removed, this way you have got rid of the cancer quicker, though chance of return is 1 in 3 men, this is the same whatever you chose (removal, radiotherapy or brachy) But if it returns after removal then you can have radiotherapy whereas if you have already had radiotherapy or brachy you have already had the maximum dose you can have. 

So if you are ready to have prostate removal and are prepared for the side effects then maybe it is a good option (or perhaps this is your only choice as you have not said if other options are available)

I hope you get some more helpful advice.

Where can I start to answer this and maybe some people will not like to hear what has happened to me.

George is right that sex was still possible just prior to diagnosis, but not at the same level, (maybe a lot of men without PC get this and it is just a sign of ageing).

Following surgery my brilliant Consultant suggested a low dose of Viagra on a daily basis and used the phrase "use it or lose it".  I must admit my priorities were greatly changed following surgery and sex was not on my agenda.  Following surgery my PSA started to rise and I was immediately prescribed Casodex and Zoladex for two years plus radiotherapy.

Whilst on Casodex I would describe it as the mind was willing but the flesh was weak, on Zoladex (chemical castration) it never even crossed my mind.

By the way the daily Viagra after surgery did absolutely nothing and was discontinued.

I am two years post Zoladex and some feeling is returning, my PSA remains at Undetectable.

The other side is I would probably have died end of 2012 - early 2013 and I am still very much here.

I realise that age may change one's outlook I was 64 when diagnosed in Dec 2010.

Easy to say, but there really is life without the sex act.

Hope this helps

I have read with great interest all the responses here. For a more detailed perspective I would suggest contacting Prostate Cancer UK Helpline and asking for the one to one service and you will be able to speak to men of a similar age to you who have had similar treatment and they can give you a perspective.

Firstly, can I say we are all unique and what works for one may not neccessarily work for another. 

It looks like you have had surgery, but was it 'nerve sparing' and have you asked your surgeon how well he did in sparing the nerves? This is really important to know as it will give you an idea about recovery.

With surgery, outcomes are all dependant upon the skill of the surgeon. That includes removal of cancer , preventing or minimising incontinence, and helping to prevent long term ED.

If nerve sparing was not successful and both bundles were cut then natural erections will not return, however you have other options including a penile implant. A friend at a support group I go to has had one and he is really happy with it - erections on demand.

If sparing was successful then its all about the length of time it takes the nerves to recover. I do know people who have recovered natural erections in under 12 months, though most I know its more like 2 years and some 3. Again other factors influence this, including the strength of your erections prior to surgery.

What is really important post surgery is keeping the blood flowing in the penis. This isnt just about nerve recovery but it prevents atrophy / celluar degeneration , which is caused by the lack of natural erections. To assist in this , this is the reason you are prescribed 5mg daily cialis/tadalafil - not for erections ( thats just a side effect later on ), but to keep the blood flowing. In addition to the cialis you should also be using a pump or at least masturbating on a regular daily basis. Think of your penis as a muscle like in your arms and the daily routing like going to the gym.  This is really important. In keeping the muscle healthy when the nerves recover and you start getting erections these will better. Failing to do this you risk atropy and fibrosis.

When it comes to having sex in the early days, yes to can use Caverject, Muse or the pump with rings.  Viagra really doesnt help until you start getting chubby or the nerves start to come back. 

Keep at it - things do get better. 

I facilitate a support group in the Midlands for Bi and Gay guys and I also support STR8 guys as well. I can tell you that during our meetings probably 60% or more time is spent discussing the impact of ED. We also discuss a lot the strength of erections for penetrative sex. Interestingly we have a chap who is on the daily 5mg cialis and for days when he has sex he takes 100mg viagra. His consultant has prescribed this to increase the strength. 

Little bit of advice. You may encounter problems with your GP getting Cialis and Viagra ( sildenafil )  - you need your consulant to write a letter if this happens. NICE have dictated that GPs can only prescribe 4 Sildenafil for ED per month. To be clear, this is for sexual purposes NOT for preventing atrophy, which is why you can get both the 5mg Cialis and the Sildenafil.

Hope the above helps. Dont give up.  If you can find a support group, use it or use the telephone support at Prostate Cancer UK. Its all confidential.  Physcosexual support is important when you are recovering from ED due to Prostate Cancer treatment.

Eddie

What is your status? It has been a while since the original post. I had a prostatectomy in August of 2012. Over time, there has been shrinkage especially when flacid. Orgasm without ejaculation is definitely different, but for some reason I have a mental picture of ejaculating even though I don't. There is some fluid which comes from the Cowper's gland. Sex for me is not the same but I think that is just my fault. I expect to much and therefore sex is pretty uneventful for me. Any similar experiences out there? Thanks.

I know this is months old, but I will offer my input for you, and maybe others than are searching for answers months and years after I post this.

I had nerve sparing prostatectomy with a surgeon who had thousands of previous procedures. I NEVER had a single instance of lack of erection in my life prior to the surgery. I was 63 when I had the surgery. I am 18 months out from my nerve sparing prostatectomy. I am just now getting some reasonable erections without use of drugs, but not sufficient "rigidity" for vaginal penetration beyond a few minutes without 25-50mg of Viagra. If you orgasm, they will be dry, no ejaculate, and for me and most others than offer input, they are different. Still pleasurable, but not the same. The whole process is just more complex, or at least less "naturally simple" ( I like to describe them as involving un-sexy distractions). I presume your prior experiences and level of ED may play a role in you post-op sex. For what it's worth, I never up to the day before surgery, ever experiences an issue of ED. With a well respected surgeon with a supposed excellent record, I am 18 months out with much less than ideal results, sexual experience wise.

Of course, this is only my experience. Read those of others.

I suppose the orgasms will not be as strong and erections should still continue as normal. Erections come from blood flow, and mental stimulation.

Hello, I'm 73 and had a normal sex life until surgery 2 weeks ago. I had the robotics but at this stage I'm unsure if they saved my nerves.

I'm not so worried about ED but more the lack of any sexual feeling (which has been a healthy part of my life for probably 60 years).

For example "Hmm I feel like having sex"

will this sexual feeling return,

Thank you in advance.

Fortunately, my nerves were spared and about 6 months after the surgery my erections had returned almost completely without assistance.

Since they remove the entire genital system with seminal vesicles and vas deferens during a radical prostatectomy, there is no more ejaculation. In my case, it looks very different and I miss it a lot both visually and in terms of the feeling of no longer having the gooey white liquid spurting from my penis. The feeling of orgasm is there and I have the palpitation of the penis but it expels absolutely nothing, there is much less sensation and I find it very weird

I had a radical surgery 7 years ago now and although everyone tells me that i should be grateful that i am alive and i know i should the part of my life that is missing affects me very badly.

I know there will be many men out there that feel the same. This has had a bad effect not only on me but also my wife. The difficulty that we both experience is that we can no longer have a normal sex life and although i would be prepared to do anything, try anything, my wife is a very private person. We have been through so much together over the years i wouldn't want to not be with her however i am just so desperate about our predicament I realise i need help.

I have absolutely no idea what to do.. Any advice would be gratefully received Thank you.

I am at the very beginning of this and this is one of my biggest fears. I'm almost 68 years old. After recent blood work it was discovered I had a PSA of 11. I went to a urologist( highly respected in this area) and he did a 4k test and it came out as 12. He said I should get a biopsy and ordered a MRI. The results of that were No dominant lesion.. PI-RADS v2 score 1 and Prostatomegaly. He still wants to get the biopsy and scheduled it for a few weeks from now. I kind of feel like I'm on the merry go round for this right now. I do realize I may be jumping off the deep end before I get the final results. The more research I do it seems like no matter what treatment, if any is required, I choose my sex life will effectively be over no matter how they sugar coat it. The medical community seems to treat this as not such a big deal and just one of the side effects. To me that is a pretty devastating side effect that will impact my life greatly. I'm in pretty good shape and have no difficulties in that department. Like many men I really enjoy sex and orgasms and the prospect of turning that off with a flip of a switch is terrifying.