Regular sex after radical prostatectomy - when?
Posted , 8 users are following.
I had RP on March 24th, 2017.
Had lymphocele, followed by serious infection 4 weeks later, dealt with however painful, and seeing doctor today for control and hopefully clearance.
Due to this complication, and even though my doctor believes I should be able to have normal sex (maybe with viagra only at the very beginning), because nerves and muscles were spared, I haven't had the guys to try since I read it is not advised to try it until the complication is resolved.
My questions are
- What are your experiences in resuming nomral sex after PR?
- Do you experience urine leaks during sex?
- Is it painful at the beginning?
- Did you experience any (slight) deformations of penis or testicles?
Thanks and sorry for the many questions.
0 likes, 7 replies
RichardKen ayman78787
Posted
Cheers Richard
richard98806 ayman78787
Edited
My rp was 3/24
MK51151 ayman78787
Posted
ayman,
here is my experience after RP. I had RARP on November 2, 2016. Stayed 2 nights in the hospital. Catheter removed on November 10 and had very bad leakage for first 10 weeks. By the end of 3 months, I was dry 98-99% and was using only one pad per day. Now at 6 1/2 months I still have stress incontinece while sneezing, coughing, lifting, strenuous movements, at the start of run, while blowing my nose etc.
I can live with that but sometimes bothers me especially if I am out, not having pad or not able to change my underwear.
in regards to ED and sex, I did not have much success with that. At 10 weeks started Cialis 10 mg daily with once a week full dose with no success and not even slightest sign of life in my penis. At 4 months started using VED with no success. After taking penis out of VED tube, it was going to soft faster than BMW from 0-60 mph. Using penis rings was so uncomfortable and painful and my penis would turn to blue very soon being very cold.
At 5 1/2 months started TRIMIX self injecting into my penis. At the first, I thought I won't be able to do it but after 3rd injection I was confident in my work. TRIMIX gave me very good erection every time I use it.
Month after starting TRIMIX, I had my first successful sex that was very enjoyable for both; my wife and myself. As of orgasam, my experience is not so good. It takes for ever to reach it and at some point is like someone is turning switch off so without ejaculation I am not even sure I experienced an orgasam. While doing manual stimulation, I am having some urin coming out, not much but bothersome. Hopefully, will stop in the future. I experienced my first dry orgasam at almost 6 months post RP. Before that I was not able to experience anything down there. I did not have feelings in my penis for months after surgery.
Now I am on TRIMIX 2-3x / week and in between using Cialis. With Cialis, I still do not have any erections not even partial. It gives me only very minimal fullness.
Trimix is very good and works for most people but you have to be willing to try it. I, as almost everybody, did not have gut to start it earlier but from my own experience, it was not to bad as I thought to stick your own penis with the needle. First few times my erections were painful because my penis did not stretch to his full length for many months and especially stayed stretched for 90-120 minutes.
I hope this will change and I will start experiencing something spontaneous so could stop TRIMIX. But in meantime, I am feeling great seeing my penis stretching to full length. When penis is soft, it is 2 inches shorter compared prior to surgery and is retracted all the time so it looks like uncircumcised.
i was very depressed with all changes after surgery and seeing my penis in its new state (shortened and retracted) but TRIMIX improved my overall feeling.
would like to ask: did you regain continence and how bad it was after catheter removal? Are you on any meds for penile rehabilitation?
As of sex, the only restriction is not having erections. You are at almost 2 months mark so you can have sex if possible and manual massage to the point of orgasm if you are in mood for that. If you have spouse or partner it makes it easier to go thru this proces of penile rehabilitation.
If you have any other questions regarding recovery and rehabilitation, I will be glad to answer it.
Btw, I was 51 at time of dx and surgery. Gleson 4+3 by biopsy, post op downgraded to 3+4.
MK
romneyj MK51151
Posted
Hi MK,
Your comments/report has been very helpful to me but have only just started trying Caverject while in Taiwan (it seems that you have to make your own Trimix or Quad-Mix or get it compounded? Are you in the USA?) - extremely effective and gratifyingly so, with erections the same as before and lasting for 2 hrs + however fairly painful (but tolerable) for the duration. I gather that Trimix/Quad-Mix deals with the pain).
I had been researching the whole issue of post RP ED and discovered the following which I feel would have been useful to know BEFORE surgery. As it happened I was quickly onto a VED and cialis after surgery so am ok but for those who have not read around the subject a short physiology/pathophysiology lesson might be useful:
Post RP erectile issues:
1. Treatment must be prompt to prevent fibrosis and increase oxygenation of penile tissue
2. During sexual stimulation, nitric oxide (NO) from the cavernosal nerves is released, leading to an increase in oxygenated blood flow to the penis
3. Vascular and sinusoidal forces on the endothelium lead to a sustained nitric oxide synthase (eNOS) release from endothelial cells
4. This mechanism is crucial for erection prior to intercourse as well as the long-term maintenance of corporal health.
5. A reduction in tissue oxygenation leads to a decrease in NO production, and this in turn leads to inhibition of prostaglandin release.
6. This has an important role in protecting smooth muscle through inhibition of accumulation of profibrotic substances (such as collagen I and III).
7. Prolonged hypoxia will result in connective tissue buildup, which will eventually replace more elastic trabecular smooth muscle. These fibrotic changes make it increasingly challenging for the penis to expand on stimulation through the mechanisms described above
8. Even in the hands of the most experienced surgeon, a degree of cavernosal nerve damage occurs during prostatectomy
9. The main mechanism through which this is thought to occur is neuropraxia – etiology hypotheses include:
a. direct trauma during surgery,
b. thermal damage due to electrocautery,
c. cavernous nerve ischemia due to vascular injury (such as the accessory pudendal arteries), and
d. local inflammatory effects associated with the procedure
10. Overall, EF is impacted post-RP by interference with the nerve function that facilitates cavernosal oxygenation.
11. In time, fibrosis ensues, and this is manifested by the presence of transforming growth factor ß (TGF-ß) – a marker of chronic inflammation and fibrosis.
12. Simultaneously, production of antifibrotic mediators prostaglandin E1 (PGE1) and cyclic adenosine monophosphate (cAMP) ceases, and there is no resultant inhibition of TGF-ß1-induced collagen synthesis.
13. In addition, synthesis of endothelin-1 (ET-1) (a potent constrictor of penile smooth muscle) is amplified by TGF-ß1 and prolonged hypoxia.
14. While neuropraxia is, fortunately, reversible, the product of fibrosis, cavernosal smooth muscle apoptosis, is not. This is why timely treatment of post-RP ED is vital
15. It is possible that the deposition of collagen is due to cellular apoptosis of smooth muscle (not of the endothelium), particularly in the subtunical area, causing dysfunction of the veno-occlusive mechanism of the corpus cavernosum. These mechanisms underlie the etiology of the massive corporeal venous leaks that follow. The damage manifests itself as chronic ED.
16. To counter the fibrosis, early tissue oxygenation is paramount, and this serves as the rationale behind the majority of management options.
17. Recovery of function can occur only through a rehabilitation process that prevents fibrosis and end-organ damage while the nerves and vasculature recover.
Tissue oxygenation can be achieved through daily cialis, daily avanafil (the most effective), cialis (the next most effective) or viagra. VEDs have recently been shown also to be truly effective. The more erections you have have - at least daily - the better. The nerves take several months to heal, but id the erectile tissue is damaged or if there is venous leakage you will never return to normal so maintaining the helath of the little chap is paramount!!
I hope this has not been too boring. I wish I had thought to understand this earlier.
romneyj ayman78787
Posted
Sex isn't that easy for me as I don't remain hard for more than 10 minute at most - even with cialis + viagra (I had mt left hand neurovascular bundle removed). I have started with a vacuum pump - only for two weekd so far.
I sometimes squirt urine during orgasm! But no leaks other than that.
No pain.
No deformations however slight.
Good luck mate. I'm sure you'll fly
mark_fastco ayman78787
Posted
Well sex will never feel the same as before so if this is what you mean by normal sex then chances are that it won't happen. It will be different and probably with outside help it can be very fulfilling and you will feel like you are learning all over again. For me there is no leakage during sex but there is some pain . I use injections to help me. No deformations my surgery was August 31st