Need Advice, problem with orgasms after prostatectomy

[javon99]

I am looking for help from men who have had problems with orgasm after a prostatectomy, and specifically whether things have improved with time.

I am 71, and had a nerve-sparing DaVinci prostatectomy on 7/30/14 in Denver, CO. (Gleason 3+4, negative margins, several extraprostatic extensions, 6 week post-op PSA <0.1) I am not currently on any prescription drugs, and there is no change in my supplements since before surgery. I was sexually active before surgery, and had great orgasms without ejaculation due to a TURP way back in the 90’s. After surgery, I have experienced total ED (expected), and have started therapy (5 mg daily Cialis, a VED, and injection therapy). I was told I would still be able to experience orgasms without having an erection while waiting for recovery from ED. However, I was not prepared for what I am experiencing now. I have a profound alteration of orgasms! It is now almost impossible to achieve an orgasm, and on the rare occasions that it does happen, it is over in less than a second, with no rhythmic contractions, and is so minimal that it is hardly worth the effort! My penis has lost almost all sensitivity to manipulation. The drug Oxytocin improves the odds of reaching an orgasm from zero to just a little bit better. This change has been extremely devastating, and I can only hope it will improve with time.

My understanding of orgasms is that the nerves involved don’t pass anywhere near the prostate, and shouldn’t be affected by the surgery. However, recent research online seems to indicate that many men have changes, mostly negative, after surgery.

Here is what I would like to know:

Is it likely that my current condition (3 months out) is permanent, or is it likely that things will get better with time?

If you had a decrease in your experience with orgasms after surgery (either difficulty in getting one, or a decrease in the orgasm itself), how bad was it? How has it changed over time as your ED resolved itself?

Is it possible that improvements happen along with recovery from ED in the typical 18 to 24 months after surgery?

I would really appreciate any comments on this! If there is no hope for any improvement, my quality of life from here on seems very bleak!

[palace01]

I had the surgery in April '14, but had to have some radiation treatment Aug/Sept
ED pills do not work. ED injections only give about 75%
To be honest I did not realize that (dry) Orgasms would occur without erections so was happily surprised when one occurred 2 or 3 months after surgery. I have a patient wife who can stimulate me orally or manually to orgasm. Yes not every time and yes a bit different to pre-surgery but plenty of sensation when it happens

[javon99]

Palace01
You are lucky! I was totally not prepared for the near total inability to have an orgasm. It is even worse when I realize that there is really no treatment for this, and that I may never improve. I know it is not as important as curing the cancer, but I never had any symptoms from the cancer which seems like some phantom problem. However, the inability to orgasm is a here-and-right-now in-your-face type of problem that is hard to get out of my mind!

The ED issue is also not working as I expected. I have used injections successfully for several years before surgery, so I thought I would have a leg up on others. But I am now experiencing massive pain with my old formula with Prostaglandin and can't use it. Apparently, the surgery can make one sensitive to that drug. A new maximum strength bimix without Prostaglandin, using a full 1.0ml syringe only results in maybe a 50% result. So I'm locked out of both erections AND orgasms! Very depressing, to say the least!

[bumpintheroad]

I also had the nerve sparing robotic surgery 3 years ago. I first started using the "pump", which I still use today. and at times experience an orgasm. I tried the injections which worked great but along with it came the "Edex pain". So I no longer do the injections. I now have the Viberect which is suppose to " stimulate" the penis(nerves) and produce an erection. This does work to a certain extent. You may wonder where I am going with this. For me the "orgasm" has been elusive. It occurs now and then. I have tried looking at porn which does increase(greatly) the chances of an orgasm, especially when I am using the Viberect. This has been a long journey for me. Three months time is not that long. Your body is still adjusting to the surgery and it ( I have been told) can take a while for the nerves to wake up. Things will never be like before. I too became despondent and finally came to grips with the new "me". I can say for me that it has been a slow process and the " orgasm" is still "hit and miss". But when they do occur are pretty intense.So hang in there and "never give up".

[javon99]

BumpInTheRoad:

Were your elusive orgasms "pretty intense" a few months after surgery, or is that something that improved over time?
(I really wish mine were even noticable when they rarely happen. I try to stay optimistic that I can reach a better place.)

How does the current 3 year post-op intensity and length of time of orgasms compare with pre-surgery?

Did you find any connection with improved orgasms after the return of erections?

I have used injections for a number of years before my surgery with great success. After surgery I find I'm suddenly plagued by the Prostaglandin pain (i.e. Edex). Somehow the surgery made me very sensitive to it. Weird! Bimix w/o the Prostaglandin at maximum strength only results in a partial erection. So injections are now problematic. The pump is not working very well either, since the new me is quite soft at the base of the penis, and the pump sucks up scrotal and other tissue. Very painful, and no way to get a ring in place to keep the erection w/o the pump in place. So right now it seems that absolutely nothing works. I refuse to give up though. I just hope that when enough time passes I will recover erections and that orgasms will be easier to obtain and a little more substantial, even if they feel very different.

[javon99]

BumpInTheRoad:

Forgot to mention: I also recently purchased a Viberect to help the nerves wake up. It does not produce an erection, but when I use it along with the drug Oxytocin, it is the ONLY way I have any chance at all to get an orgasm. Otherwise, nothing else works. Pretty noisy though.

[DesertDweller]

Javon,

You are still recovering from prostate surgery. It took me a year to recover, and with each subsequent year I learned more about how to reach that now elusive orgasm. Here are my suggestions, based on what you said in previous posts:

1) First and foremost, I learned that state of mind is much more important to reaching an orgasm than it was before prostate surgery. I have to erase all worry, and just focus on pleasure and fantasy. And then, when that orgasm starts to get within reach, I really need to abandon all sense of control and civility and go for it. I give myself the freedom to quit being a neurotic human and start being a wild animal at that point.

2) It takes practice and experimentation to learn to use a pump in a way that both gets you hard and does not suck your scrotum into the suction tube. I learned that I have to use just the right angle, pressure, gradual application of vacuum, and lube viscosity to avoid that scrotum problem.

3) For me, learning to use the pump effectively also required getting used to having sex with a little more pain due to the constriction rings. The way I accomplished that task was to mentally accept the pain as part of sex-related fetish. If you can really get a good erection, the constriction pain can become part of the animalistic experience. If you are having sex with someone else, just make sure they are ready for "the big one" before you start pumping. The pump does not allow you too much time to go for it, so make sure your partner has been prepared with plenty of foreplay.

Three months is a short amount of time to recover from a deeply invasive surgery. Give yourself time, and keep the faith that your wild side will emerge with great passion.

D.D.

[bumpintheroad]

The information that I have received about the Viberect ( per instructions) is that it should be used everyday and that it can take maybe 6 months to see any results. Is this a sales pitch, I don't know.As for me I have beed using it for about 2 months. At times it does produce somewhat of an erection but why I don't know if I look at something erotic it produces an erection/orgasm. I do have mixed feelings about porn but dammit it does work for me. ()You are right it is very noisy.) But then again I do feel guilty about it. It also seems to work better for me right after a hot shower.
When using the pump you will notice the "hinge effect" at the base of the penis. This is because the penis is erect past the constriction ring but not before the constriction ring. Hope this makes sense. Also what pump are you using? The ring should slide over your penis with the pump in place which keeps the penis engorged with blood.

For me ,at three years the orgasms are completely different in the way they feel. They are not the strong, pounding, convulsive type as pre-surgery. They are for lack of a better description almost just a good whole body type of feeling. True, they do not happen every time I have sex with my wife.
Again you are just 3 months post surgery. It takes time for your nerves to "wake up". Also talk to your urologist. Maybe he/she can also give you some insight and direction about this.

[javon99]

DesertDweller-
Thank you for the suggestions! I will try to incorporate them into my routine. I am still in the experimentation phase with no-erection very elusive orgasms, the torture pump, and even injections despite having many years of prior experience with needles. Everything is totally different now and not even close to what I expected after surgery. I can't even get a rigid erection with injections, which worked extremely well before. I suspect a major venous leak is at least part of my problem. That may also require more pumping with the VED, making the scrotal tissue more of an issue. Also, forget about trying to combine an erection with an orgasm. Funny, I used to think erections and orgasms were totally tied together! If I didn't miss the sexual experience so much, I would be tempted to just give up altogether. I often have second thoughts about my choice of surgery, even though I know something had to be done about the cancer....

Bumpintheroad-
I plan to continue with the Viberect, and hope it will help with waking up the nerves. So far, it has absolutely NO effect on creating an erection, but once in a while it can produce a tiny orgasm, which is better than nothing.

I understand the hinge effect with the pump. However, I haven't yet been able to achieve a rigid erection after removing the pump, so it really isn't a "hinge" for me yet. I have the pump from Firma Medical. It can be used in several different ways (a sensation seal balloon, a rubber disk-shaped soft-touch constriction seal, constriction rings, etc.) to keep the vacuum, but I have various problems with all of these. The sensation seal works best, but only for erection therapy inside the cylinder. I bought another one from Bonro Medical but had problems getting their very tight constriction disks off, so I returned it. At this point, I think I should have kept the Bonro as it worked better at not sucking up scrotal tissue, and the constriction disk was easier to deal with than the constriction rings. As for talking with my urologist, I have and have not received any answers other than "give it more time".

One added question: you say your orgasms are completely different now. How have they evolved with time since early orgasms shortly after your surgery? Are they any better now after your nerves have had time to heal?

[Andy425]

Javon: I am 2½ years post surgery. My uro, and others, have said that it takes a good 2 years for full nerve recovery -- to the extent that they will come back. They took one of my nerve bundles, so I am at a disadvantage.

Did they spare both of yours?

As someone mentioned above, orgasms are different now. Not as intense, and sometimes barely worth the effort. But, as like when we were young, the more excited you are the better chance of a good orgasm -- at least for me.

From my experience and from everything I've read here and elsewhere, things will never really be the same again, especially as regarding erections.