Men worry about erectile dysfunction after radical prostatectomy, the operation that involves removing the prostate gland as a way to treat prostate cancer. Men, their spouses and partners, and their surgeons should talk about erectile dysfunction before and after the surgery. But orgasm after radical prostatectomy? Ravi Kacker thinks that should change. And, says Dr.
Proshatectomy Urol Reports ;9: Click here for an interactive image. A surgeon can perform a radical prostatectomy using different techniques, including:. BJU Int ; 4 Erectile function Sex before prostatectomy rates for selected groups of patients are high. Follow the guidelines below. Masturbate: This helps you learn how your body will respond Sex before prostatectomy stimulation after surgery and builds your sexual confidence. The blood supply to the penis is still good.
Naruto rise of ninjas new video. The Prostate Cancer Foundation is a 501(c)(3) charitable organization.
Another hormone that plays a role in orgasm is oxytocin. Sex before prostatectomy symptoms are normal for a few days to a few weeks after recovery. Radiation therapy also damages blood vessels and the nerves that control erection. Explore all that AARP has to offer. The first two parts of orgasm are affected by radical prostatectomy, explains Dr. When I had my surgery I would have appreciated any attempt at rating, period. Michael Castlemanpublisher of the website GreatSexAfter What Sex before prostatectomy eat may affect your outlook for prostate cancer. When can I eat spicy foods again? After surgery, orgasms will also feel different.
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- For men with a high level of sexual desire and a very active sex life at whatever age , the loss of sexual function consequent to treatment for prostate cancer may be emotionally and psychologically devastating — for them and for their partners.
- David B.
- The prostate is a gland located underneath the bladder, in front of the rectum.
Whether you're single or in a relationship, and whatever your sexuality, we hope you will find this helpful. If you're a partner of a man with prostate cancer you may also find it useful. Prostate cancer can affect your sex life in three overlapping ways - your mind, body and relationships. Treatment can damage the nerves and blood supply needed for erections. Hormone therapy can affect your desire for sex. When you're sexually aroused turned on your brain sends signals to the nerves in your penis.
The nerves then cause blood flow in to your penis, making it hard. Anything that interferes with your nerves, blood supply or desire for sex libido can make it difficult to get or keep an erection. You may hear this called erectile dysfunction or impotence. Hormone therapy can also lower your desire for sex and the lack of activity means your penis will stop working so well.
Certain medicines, feeling low or anxious and lifestyle factors such as smoking, drinking too much alcohol or being overweight can also cause erection problems. A group of drugs called PDE5 inhibitors phosphodiesterase type 5 inhibitors could help you get an erection. These include:. You need to be sexually aroused for the tablets to work.
The tablets normally start to work about 30 minutes to an hour after taking them. You can take sildenafil, avanafil and vardenafil when you need to. They will keep working for four to six hours or up to eight hours for vardenafil. So if they work you should be able to get an erection if you're sexually aroused during that time. You can take tadalafil when you need to. Or your doctor may suggest you take a low-dose 5mg tadalafil tablet every day.
If you have a heart problem or take nitrates ask your doctor or specialist about other ways to treat erection problems. Erection problems can also be treated with drugs using an injection that you give yourself. Your nurse or doctor will show you how to inject the side of your penis with a very thin needle.
The erection will last for up to an hour. With the pellet, it helps if your urethra, which is the tube you urinate through, is already moist, so urinate first.
With the cream, you or your partner can rub in any cream that's left on the tip and massage your penis to help it absorb the drug. If the pellet works you should get an erection within minutes which lasts for up to an hour.
The cream may take a little longer to work. You use a pump and a plastic cylinder to create a vacuum which makes the blood flow into your penis. This can give you an erection. After using the pump to get an erection, you slip a constriction ring from the end of the cylinder around the base of your penis.
You shouldn't wear the ring for longer than 30 minutes at a time. The vacuum pump can be an effective way to get an erection hard enough for penetration. It may also help maintain the length and thickness of the penis if used regularly and soon after surgery.
This involves having an operation to put an implant inside your penis. Although it sounds quite off putting, it can be a good option if other treatments haven't worked.
There are two main types:. Because getting an erection also relies on your thoughts and feelings, tackling any worries or relationship issues as well as having medical treatment for erection problems, often works well. Keeping a healthy weight , stopping smoking and doing pelvic floor exercises may help improve your erections.
Your GP, hospital doctor or nurse can prescribe treatment for erection problems for free on the NHS, whether it's for sex or masturbation. There may be a limit on how much treatment they can prescribe, but there is no age limit. It can be difficult talking about sex, but talking to your doctor, nurse or other health professional will mean you can get treatment and support. Talking about it before your treatment will mean you know what to expect and can help you to prepare to start treatments for sexual problems soon afterwards.
Your team should ask you about your erections and sex life during your treatment for prostate cancer. But if they don't then you may need to bring it up yourself.
Not everyone is used to talking about sex. You can also ask to be referred to an expert in sexual problems or an ED clinic - they will be used to talking about sexual problems.
This is because some types of hormone therapy lower your testosterone levels, which is what gives you your sex drive. If you're on long-term hormone therapy, ask your doctor or nurse about intermittent hormone therapy. This is where you stop hormone therapy when your PSA level is low and steady, and start it again if it starts to rise.
Your desire for sex may improve after hormone therapy is stopped, but this can take several months. You might want to try treatments for erection problems, even if your sex drive is low. Some of the treatments for erection problems may still work for you. Your thoughts and feelings If you are feeling stressed or down then you may have less interest in sex. Tiredness All treatments for prostate cancer can cause tiredness fatigue.
This can be during and after treatment. If you're feeling very tired - you may lose interest in sex or not have enough energy for it. Other side effects Other side effects of prostate cancer treatments such as urinary and bowel problems can affect your sex life. Physical changes caused by hormone therapy, such as weight gain or breast swelling, may make you feel embarrassed and less interested in sex.
Some men notice that their penis is shorter after surgery radical prostatectomy. Some men notice other changes such as a curve in their penis or a narrower area.
We don't know for certain why these changes happen, but it could be because of low oxygen levels in the penis, caused by not having erections. Other treatments such as hormone therapy with radiotherapy may also cause changes to the size of your penis. Encouraging blood flow to the penis after surgery may help prevent this. In particular, using a vacuum pump, either on its own or with PDE5 inhibitor tablets could help maintain your penis size and improve erections.
Although you may not be ready or recovered enough for sex, you can still start treatment for erection problems in the weeks immediately after surgery.
It could be taking a low-dose PDE5 tablet once a day or using a vacuum pump, or sometimes both together. The treatment along with masturbation encourages blood flow to the penis. This can help keep your penis healthy. You may hear this called penile rehabilitation. Think of it in the same way as having physiotherapy if you had injured your arm or leg.
Starting treatment soon after surgery may help improve your chance of getting and keeping an erection. But it may not work for every man. After prostate cancer treatment you will still have feeling in your penis and you should still be able to have an orgasm, but this may feel different from before.
Some men lose the ability to orgasm, especially if they're on hormone therapy. If you've had radical prostatectomy , you will no longer ejaculate when you orgasm. This is because the prostate and seminal vesicles, which make some of the fluid in semen, are both removed during the operation.
Instead you may have a dry orgasm - where you feel the sensation of orgasm but don't ejaculate. Occasionally, you might release a small amount of liquid from the tip of your penis during orgasm, which may be fluid from glands lining the urethra. With radiotherapy, brachytherapy and HIFU you may also notice a small amount of blood in the semen.
This usually isn't a problem but tell your doctor or nurse if this happens. Some men on hormone therapy say their orgasms feel less intense.
This is where the semen travels backwards into the bladder when you orgasm, rather than out through your penis. The semen is then passed out of the body when you next urinate.
It isn't harmful and shouldn't affect your enjoyment of sex but it may feel quite different to the orgasms you're used to. Some men leak urine when they orgasm, or feel pain.
Others find they don't last as long during sex and reach orgasm quite quickly. After prostate cancer treatment you might not be able to have children naturally. With radiotherapy or brachytherapy you may produce less fluid when you ejaculate but you may still be fertile. You may want to think about storing your sperm before treatment, so that you can use it for fertility treatment later.
Ask your doctor or nurse whether sperm storage is available locally. You can usually store your sperm for up to 10 years and sometimes longer. Changes to your sperm during radiotherapy, brachytherapy and chemotherapy could affect any children you may conceive during or after treatment but the risk of this happening is very low and it hasn't been proven.
You may wish to avoid fathering a child during treatment, and for up to two and a half years afterwards. Changes to your body and your sex life can have a big impact on you.
What is a radical prostatectomy for prostate cancer? During recovery, medications like Viagra and Cialis will help. Learn about risk factors, symptoms, treatments, and outlook. The same goes for men with the cancer — that is, as your age at treatment increases, so does your risk of ED. You can do a lot of prep work to make the perfect sleep environment.
Sex before prostatectomy. Limit prostate cancer to just another part of your evolving sex life
There are certainly ways to treat this effectively. I strongly agree with your suggestion of how to rate surgeons. When I had my surgery I would have appreciated any attempt at rating, period. In hindsight, although I became very incontinent and impotent, I believe that my surgeon was experienced and competent.
I know he felt bad about it; he said he was sorry. My understanding is that it is very difficult to spare nerves. He did his best. Sitemaster, I agree with your comment. Every prostate cancer patient should be reading your missives. A close friend had prostate cancer and went to his urologist, who suggested that he choose radical prostatectomy.
And that is the problem facing prostate cancer patients right now … and is the exact reason I chose HIFU. Six months out I am fine. It is difficult to discern which physicians are competent in sparing the nerve bundles with RP and which ones are not. Let me be very clear … The number of urologists who do less than one radical prostatectomy a week who are actually sufficiently skilled to do this operation in any circumstances other than an emergency is probably extremely close to zero.
There may be a few exceptions to this general rule … but it would be very few. There is extensive data to support this assertion. Indeed, there are good data to support the idea that it takes about radical prostatectomies to learn to do this operation well, which means three operations a week for nearly 2 years.
Wonder what it is? The number of RPs carried out by urologists each year certainly exists in the certification and re-certification records of board-certified urologists. However, I have never seen the numbers you are interested in. If you look at the recent paper by Lowrance et al.
Lowrance et al. However, the data used by Lowrance et al. I understand that the cancer follows the nerves like tree roots follow a leaking sewer pipe underground and a surgeon will of course sacrifice the erectile nerves to remove all of the cancer.
It is much simpler than that. The nerves that control erectile function literally run across and just outside the capsule of the prostate. Did you start out with AS? Another outstanding post, Site. One only has to go to some of the prostate cancer site forums to see prostate cancer patients who have regret.
With a PSA of 5. Stephen Scionti April. I would still argue that there are outstanding surgeons who have high rates of recovery of full continence and good rates of recovery of sexual function.
Are they perfect? At least that way patients may better understand why active surveillance may be the way to go before they jump in. It takes time for the radiation to kill the nerve cells if the nerves that control erectile function have to be included in the radiation field.
Many are confused about what is actually happening and have the impression that the radiation only kills cancer cells as opposed to normal prostate cells too. Targeting to the prostate is not the same as limiting the field effects. And for me, none of the choices the FDA approved were reasonable. As far as I am aware, the FDA has never approved any form of surgical technique or equipment for the treatment of prostate cancer. Metastron and Quadramet are actually classified as drug therapies.
The FDA has approved various type of radiation device for delivery of differing types of radiation … but not specifically for prostate cancer. Historically, the FDA also has very little authority over how physicians actually use approved products. They have no authority in this area. Several studies show that erection drugs help restore erectile function, but usually only after nerve-sparing prostatectomy.
Here's why:. If a man doesn't have enough nerve function to enable erection, the amount of blood in the penis won't matter; no nerve function means no erection. Nerve-sparing surgery, by contrast, allows a man to retain nerve function, so erection drugs can help. Italian researchers analyzed 11 studies of men who took erection drugs after prostatectomy. After conventional surgery, erection medication helped 15 percent of them.
That's because conventional surgery sometimes preserves the nerves. After nerve-sparing surgery, however, the drugs helped about 50 percent of the men.
Bottom line: For the best chance of preserving sexual function, opt for nerve-sparing surgery, then use erection medication. Different nerves control erection and orgasm. So even when prostate-cancer treatment damages or destroys the erection nerves, those that govern orgasm usually remain intact. Yes, it's an adjustment to have a flaccid penis stimulated to orgasm. But in an erotic context with sufficient stimulation by hand, mouth or vibrator, it's entirely possible.
A recent Canadian study shows that sex therapy helps couples resume sex after prostate-cancer treatment. The 77 couples who participated in the study enjoyed "significant gains in sexual function. Michael Castleman , publisher of the website GreatSexAfter You are leaving AARP. Please return to AARP. Manage your email preferences and tell us which topics interest you so that we can prioritize the information you receive.
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In the meantime, please feel free to search for ways to make a difference in your community at www. Share with facebook. Share with twitter. Share with linkedin. Share using email. Istock Best chance of preserving sexual function: opt for nerve-sparing surgery, then use erection medication. It depends on luck, the tumor's location in the prostate, the aggressiveness of its cells and two main risk factors: Age.
Nerve-sparing surgery? Surgery plus erection drugs Several studies show that erection drugs help restore erectile function, but usually only after nerve-sparing prostatectomy. Men don't need erections to enjoy pleasurable orgasms Different nerves control erection and orgasm. Also of Interest How to handle a sexless married life Are you a Viagra wife?
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Achieving orgasm after radical prostatectomy - Harvard Health Blog - Harvard Health Publishing
David B. Certainly, a prostate cancer cure is top priority, but then what? Samadi, MD, understands that men want to know:. If you select robotic prostate surgery your chances of enjoying sex after prostate surgery are very high.
However, it is absolutely critical to choose a robotic surgeon with a high case volume and extensive prostate surgery experience. The robot does not perform the surgery and technology is no guarantee of success. Samadi is considered one of the best NY robotic surgeons because of his high surgical volume, successful track record, and background in open and laparoscopic prostate surgery. It was paramount that I find a way to remove the prostate gland without damaging functions critical to a comfortable and enjoyable life after recovery.
Knowing what to expect is a large part of optimizing your sexual recovery from prostate surgery. During recovery, medications like Viagra and Cialis will help. Orgasm after prostate surgery: You can expect to enjoy sex after prostate surgery. Many men are surprised to find that they even experience pleasurable orgasm without an erection.
Keep in mind that your sexual pleasure does not depend on penetration. David Samadi says restoring an enjoyable sex life after prostate cancer surgery is in part dependent on the prostate cancer treatment and choice.
When men and their partners know what to expect, they can accelerate recovery, experiment, and work together. Sex-related activities should be resumed as soon as you are ready but keep in mind some changes are temporary, and some might be permanent, but the bottom line is that all of the problems can be overcome. Patients that recover from robotic prostatectomy can expect one significant change regarding orgasm, the orgasm without ejaculation.
It will feel different but the pleasure part will still be there. Ejaculation will cease: Without a prostate gland or seminal vesicles you will no longer experience ejaculation. Even though your orgasm may feel different, it will still be pleasurable. Leaking urine during sex: This is possible, but does not happen to all men. Being open and honest with your partner will help. Keep in mind that your overall health, age, and present ED status are all factors in your recovery to sex after prostate surgery.
Less commonly, the prostate cancer tumor may bulge to one or both sides of the prostate gland, making nerve-sparing surgery extremely difficult or impossible. Samadi will help you understand your exact prostate cancer status and the position and size of your tumor. In some cases, a nerve graft can be performed to regenerate the penile nerves for sex after prostate surgery.
Changes in mood and libido: The psychological impact of surgery can be significant; this will leave you tired and irritable, not in the mood for sex so you will need to move towards intimacy slowly and your desire will return back to normal.
Congratulations on your robotic prostate surgery! Samadi and his knowledgeable team are available to support you and your partner as you work to resume sexual activity.
Masturbate: This helps you learn how your body will respond to stimulation after surgery and builds your sexual confidence. Kegel exercises: Try out pelvic floors exercises to improve orgasm and urinary control. Involve your partner: Work with your partner through physical and emotional intimacy; sex will follow. Samadi provides expert counsel and referral for alternative ED treatments. Penile injection therapy for sex after prostate surgery: If oral medications are not effective, penile injection therapy can be used to help the nerves regenerate or recover sufficiently.
In a recent study it was shown that it is very valuable to use injection therapy to aid erections soon after surgery to increase the chances of the return of normal function. Penile implants for sex after prostate surgery: In some cases, no erectile function will return after prostate surgery.
In such cases, you may want to explore the option of a penile implant for a permanent ED solution. A penile implant is an excellent option and is associated with a very high rate of patient and partner satisfaction. If your husband or partner is undergoing robotic surgery for prostate cancer treatment, or is in the midst of recovery, it can be difficult to know the right things to say or do. Prostate cancer can be an emotional journey for the entire family. Trust that you and your partner will soon enjoy healthy, happy sex after prostate surgery.
Make an Appointment. Men who undergo Dr. Samadi, MD, understands that men want to know: Will I have sex after prostate cancer? How will sex after prostate cancer be different? For many men, prostate cancer treatment choice determines these answers. Share on:. Book an Appointment with Dr. David Samadi:.