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  Sex after an RRP:
My Experience as a 57-year-old male

by "Richard"

[Written to advise one man and offered to help other men. "Richard" is a pseudonym.]

Each male who has undergone RP will tell you that sex after RP is not the same. Period.

However, when examining specific details, each person's experience is different. One man on a PCa mailing list indicated he had sex with his wife couple walking on beach while embracing less than 5 weeks after surgery; another man continues to indicate he was not had an erection or an orgasm in more than 4 years. That is some difference!
There are apparently three general factors involved here:

(1) AGE (the younger you are when you have the surgery, the more likely you will regain potency; if you were potent before surgery, the chances of potency after surgery are much better than if you were impotent before);

(2) ARTISTRY (the skill of your surgeon in sparing the nerves during the surgery); and

(3) The individual's own unique physiological and psychological make-up, for example, the physical placement of the nerves around the prostate might make "nerve-sparing surgery" difficult; your psychological make-up might make it more difficult for you to "bounce back" from the trauma of diagnosis and treatment of prostate cancer.

I was 57 when I was diagnosed with prostate cancer. I was devastated. After much research and consultation, I decided to have a radical prostatectomy -- and "get the cancer OUT."

MY CONCERNS

Immediately following RP, my concerns were fourfold:

(1) the pathology report
(2) the catheter and, once that was removed,
(3) incontinence, and
(4) the apparent shrinkage in the size of my penis. (See Robert Young's http://www.Phoenix5.org Website for a discussion of penile shrinkage following RP.)

My pathology report, fortunately, was excellent. That news was a great relief.

I was able to endure the catheter with very minor problems; when it was removed (exactly two weeks -- to the hour -- after surgery), I was 90% continent. I did my Kegel exercises and within 4-5 weeks I was 99.9% continent. More on 0.1% incontinence later.

Five days after the catheter was removed, I decide to have (or at least try) sex. I was eager to see what would happen. Yes, I was a bit concerned that I was attempting "it" too soon after surgery. Was, in fact, the plumbing -- with all the stitches -- ready for that kind of activity? But the excellent pathology report had made me confident and "frisky."

THE RESULTS

Even with physical and visual stimulation (I have a beautiful partner), I was unable to have an erection. Some younger men (50 and younger) report the ability to have an erection within a month or so of their RP - one man wrote about having a nocturnal erection when the catheter was still in place; others have had to wait one or two years for erections.

For some, erections never return. Most men have to have some kind of aid -- a pump (VED), Viagra (pill), Muse (a suppository inserted into the penis), and/or injections into the side of the penis -- in order to get hard. (Robert Young's Website has detailed information about each of these aids. See http://www.Phoenix5.org)

Despite the fact I did not have an erection that first time (less than three weeks after surgery) I was able to have an orgasm. The orgasm was more intense -- not longer -- than pre-surgery. It was so intense I thought perhaps I had hurt myself -- and that I would have blood in my urine or have a sore pelvic area the next day. Neither happened.

CONTINENCE ISSUES

There was no ejaculate, of course, but I did leak a fair amount of urine. This surprised me, since I had been told my orgasms would be dry. I think the urine leakage disturbed me more than it did my partner; or maybe she just hid her true reaction.

By the way, urine is harmless (unless there is a bladder infection). Some people drink their own urine; other have it injected into their body via needles. I don't like to think about such practices, but I point them out as a sign that you won't drop dead if you happen to get some urine on you.

Some doctors recommend getting a VED (pump) soon after the operation and use it to "pump yourself up," so to speak, in order to exercise the tissues inside the penis and the blood vessels leading into the penis. Such exercises also help to counteract the penile shrinkage that occurred as a result of surgery. Remember the old adage: use it or lose it.

Earlier, I stated I am 99.9% continent. Let me tell you about the 0.1% incontinence. I experience very slight linkage if I lift something heavy (like lifting a heavy box of books from my desk to the floor). The other times I leak are SOMETIMES when I have an erotic thought (very slight leak), SOMETIMES during foreplay (very slight leak), and SOMETIMES (about half the time) when I reach orgasm (more than slight - I have learned to empty my bladder completely before beginning sex). And my partner and I have a towel nearby in case we need it. For a while, we placed the towel underneath us.

By the way: I stated that I have slight leakage when I have an erotic thought or during foreplay. One woman on the PHML stated that she didn't mind her husband leaking urine -- because to her it was a sign she was turning him on! My leakage at orgasm has decreased significantly. In fact, now sometimes my orgasms are dry. I have talked to other men who say urine leakage at orgasm decreases over time -- and, for most, eventually there is no leakage at all.

NINE MONTHS LATER

It is now 9 months since my surgery; I have had a few nocturnal erections. Whenever I have unassisted erections, they are not "stuffable" (yet). My best erections occur when I use Viagra along with the pump. I have been taking 25 mg of Viagra every other night or so, to encourage nocturnal erections -- with limited success. I have not yet tried Muse or injections.

Based on my experience, there are several things I want to say about intimacy after RP.

1. First and foremost, as I stated earlier, sex will never be the same. You have to accept that and move on.

2. I miss the ejaculate and the feeling that went along with it. But I realize that with my prostate gone, the ejaculate will never come back. Those days are over.

3. I miss natural (i.e., unassisted) erections -- i.e., erections that occur not because of Viagra or the pump but because my partner is beside me and I am "turned on." I hope those natural erections return -- and soon! I don't like the idea of having to "plan" and "prepare for" sex. That certainly spoils the spontaneity of sex.

4. My orgasms are more intense ("sharper," if you will), but I would rather have my prostate back (as long as it would be non-cancerous). Other men also report their experience of orgasm changed as a result of surgery. Some report their orgasms are BETTER; others report they are not as good as before.

5. I also have learned that intimacy and pleasure do not require penetration. Kissing, caressing, and holding can be sensuous and enjoyable.

6. Within three or four weeks of surgery, my libido -- "the urge to merge" -- was back to normal. I have had no decrease whatsoever in my desire to have sex. After RP, I have undergone no further treatment -- no radiation, no hormonal treatment, no chemotherapy.

7. Don't be afraid to try the pump, Viagra, Muse, and injections. See what works best for you. I have yet to try the latter two, but I haven't ruled them out.

I want to remind you that each person's experience is different. I have shared my experience, but I don't know what yours will be.

With time, patience, and understanding, sex after RP can be very satisfying.

"Richard"

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This information is provided for educational purposes only and does not replace or amend professional medical advice. Unless otherwise stated and credited, the content of Phoenix5 (P5) is by and the opinion of and copyright © 2000 Robert Vaughn Young. All Rights Reserved. P5 is at <http://www.phoenix5.org>. P5's policy regarding privacy and right to reprint are at <www.phoenix5.org/infopolicy>.