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Sexual Function After Prostate Cancer Surgery: What You Should Know

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Even an expertly performed nerve-sparing radical prostatectomy causes some degree of trauma to nerve bundles. Below are some important facts about sexual function and what to expect after robotic-assisted or traditional open radical prostatectomy:

  • You can no longer produce ejaculate after radical prostatectomy. However, you can still have a normal sensation and sex drive. This change, which is permanent, occurs because ejaculatory fluid is produced in the prostate and the seminal vesicles—glands next to the bladder— which are removed during surgery. This also results in a loss of fertility. Almost half of all patients in the survey were unaware that they would no longer be able to ejaculate.
  • You can still achieve pleasurable, though dry, orgasm. However, the surgery puts you at risk for leakage of urine during orgasm (called climacturia). Most men that achieve urinary control do not have climacturia long term.
  • While the ability to have an erection sufficient for intercourse is common in the immediate period after surgery, it can be enhanced with oral or injectable ED drugs or a vacuum pump.
  • On average, as many as 40 percent of patients who have a nerve-sparing radical prostatectomy will typically recover erectile function within six months—if function was good before surgery and sexual activity was an important part of life.
  • The surgery shortens penile length by up to 1 to 2 centimeters (2.5 centimeters is approximately one inch). However, if you undergo a nerve-sparing operation, the reduction in length is often temporary.
  • The surgery puts you at risk for a condition called Peyronie’s disease, which can cause penile curvature upon erection and difficulties achieving an erection. Though it improves on its own in 50 percent of men, Peyronie’s disease can require treatment with surgery or medication if it’s long lasting or interferes with penetration.

The good news is that if a surgeon skilled in nerve-sparing prostatectomy performs the operation, most men will eventually recover satisfactory erectile function—often with an oral ED drug or some other therapy. 

 

Posted in Prostate Disorders on May 2, 2016


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Health After 50 Alerts registered users may post comments and share experiences here at their own discretion. We regret that questions on individual health concerns to the editors cannot be answered in this space.

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While this is generally a good article - from my observations as a 5+ year survivor of PCa and an active participate on a PCa Forum - I would like to clarify a few issues which were understated in the article: It is important for all men to know the true situation regarding prostate cancer and the effects of surgical treatments.

First: "40% with nerve sparing will typically recover erectile function within 6 months." While the usually time given by urologists is at least 4 years, and even that is doubtful, many never recover at all. The benefit of "nerve sparing" seems to be a hoax perpetuated by surgeons.

Second: "... the ability to have an erection sufficient for intercourse is common in the immediate period after surgery..." This is both inconsistent with the claim above, and not according to most men's reports. If only it were true.

Third: anorgasmia is widespread, extreme and apparently non-remedial. Many men after radical prostatectomy lose the ability to orgasm, or have anything more than a mild sensation of orgasm (in conjunction with the absent ejaculation). This side effect is rarely-to-never mentioned, to the best of my knowledge, as a side effect.

Lastly, Peyronie's disease is also never mentioned pre-op, and post -op, is apparently more of a concern by those using oral meds or penile injections, rather than as an active condition, and the consensus is that erections which might go on longer than the typical four hour warning, just don't produce that condition.

On a positive note, it is true though, that with oral or injectable meds, or surgical implants, most men can go on to have a reasonably active and satisfactory sexual life. In fact if one considers that men usually LOSE function naturally with age, the enhancements possible leave men in better shape that they would be had they not suffered the loss of their prostate.

Posted by: Dr D | May 3, 2016 1:25 PM

I agree with the poster above, surgeons should be a little more realistic and give the likelihood of things may not ever return to normal and all the likely side effects that may happen. I had the robotic radical prostatectomy surgery November 30, 2015. I am clean of any remaining prostate cancer and can urinate like a fire hose, I still some stress incontinence but it is getting better. I have not yet been able to have an erection it's been over 6 months now, I still have hope and I have not used any oral meds for an erection as my insurance does not cover them.

Surprisingly I have had a few slight orgasms, nothing like it was before surgery, I am also hoping with a full erection will result in a better orgasm. The first time I thought I had some sort of ejaculation. I was told that would never happen, it got me worried and happy at the same time. I thought maybe something different was going on as a good thing. I found out later as the article above mentioned it was the slight passing of urine which didn't feel nor like it. I was told to empty the bladder really well to prevent it from happening. This was not told to me before surgery not did I read it any where.

I think the idea of shrinkage should definitely be mentioned pre-surgery, had read it but forgot until after surgery and saw the results. I also think the surgeons need to be a little more upfront about the erection situation too.

This has been a definite learning experience that I wish could have been forewarned. I did a lot of research much was not easy to find nor was any of it mentioned to me by my surgeon or urologist. I feel the surgery was done well and I am happy I got it done but wish I was better prepared. Good luck to all that have already had the surgery and for those that will be getting it in the future!

Posted by: [email protected] | May 19, 2016 11:44 PM

I agree with the poster above, surgeons should be a little more realistic and give the likelihood of things may not ever return to normal and all the likely side effects that may happen. I had the robotic radical prostatectomy surgery November 30, 2015. I am clean of any remaining prostate cancer and can urinate like a fire hose, I still some stress incontinence but it is getting better. I have not yet been able to have an erection it's been over 6 months now, I still have hope and I have not used any oral meds for an erection as my insurance does not cover them.

Surprisingly I have had a few slight orgasms, nothing like it was before surgery, I am also hoping with a full erection will result in a better orgasm. The first time I thought I had some sort of ejaculation. I was told that would never happen, it got me worried and happy at the same time. I thought maybe something different was going on as a good thing. I found out later as the article above mentioned it was the slight passing of urine which didn't feel nor like it. I was told to empty the bladder really well to prevent it from happening. This was not told to me before surgery not did I read it any where.

I think the idea of shrinkage should definitely be mentioned pre-surgery, had read it but forgot until after surgery and saw the results. I also think the surgeons need to be a little more upfront about the erection situation too.

This has been a definite learning experience that I wish could have been forewarned. I did a lot of research much was not easy to find nor was any of it mentioned to me by my surgeon or urologist. I feel the surgery was done well and I am happy I got it done but wish I was better prepared. Good luck to all that have already had the surgery and for those that will be getting it in the future!

Posted by: [email protected] | May 19, 2016 11:44 PM

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