Recent Findings About Regaining Potency After Radical Prostatectomy
It is important to remember that regaining erectile function takes time after radical robotic prostatectomy. Most studies in the literature use endpoints of 18-36 months after prostate cancer surgery. Nerve tissue can be easily damaged during robotic prostatectomy, regardless of the skill of the surgeon, and takes a long time to regenerate. It is believed that early postoperative medical therapy can aid an earlier return to potency.
Dr. Ahlering, a physician with UC Irvine Medical in Orange County, CA. has pioneered the use of electrocautery-free preservation of the neurovascular bundles which are essential for the return of potency after prostate surgery. A recent study by Dr. Patrick Walsh and associates at John Hopkins has shown that mono and bipolar cautery near the potency nerves severely impact the erectile function of dogs. Mono and bipolar cautery are routinely used by many institutions to limit the bleeding during surgery by heat-sealing or ‘cauterizing’ the bleeding vessels.
The nerves for potency are intertwined with a bundle of blood vessels, which must be controlled during prostate cancer surgery to prevent large blood losses. Thus to preserve the nerves of potency, a surgeon also must prevent the bleeding of these vessels also. Cautery is considered a standard method of sealing the blood vessels, allowing the nerve bundles to now be properly visualized.
For comparison we show the standard data on open prostatectomy potency :
When Can I Return To Sexual Activity
Let the surgery heal for three to four weeks before attempting anything. After one month after the robotic prostatectomy, it is recommended that you resume sexual activity. Stimulation of the nerves is thought to be a first step on the journey back to potency. Remember that you can still experience the pleasures of orgasm and other sensual stimulations without full erections. The average time to recovery for erections adequate for intercourse is 6-12 months, but in some men it is even longer. You should also be performing kegel exercises regularly to help your return to potency.
Other Cancer Treatment Effects On Ejaculation
Some cancer treatments reduce the amount of semen thats produced. After radiation to the prostate, some men ejaculate less semen. Toward the end of radiation treatments, men often feel a sharp pain as they ejaculate. The pain is caused by irritation in the urethra . It should go away over time after treatment ends.
In most cases, men who have hormone therapy for prostate cancer also make less semen than before.
Chemotherapy and other drugs used to treat cancer very rarely affects ejaculation. But there are some drugs that may cause retrograde ejaculation by damaging the nerves that control emission.
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Theme : Importance Of Intimacy
Intimacy, both physical and emotional, was a priority for men and their partners. Participants discussed the importance of non-penetrative sex. Most men and their partners felt that non-penetrative sex was a helpful way to maintain intimacy. Some participants felt the relationship was stronger after prostate cancer treatment. The participants said the following:
Man 21: I was fortunate to find this woman and it just enhances every single aspect, whatever, if youre going to a social event, youre going on a vacation, you are just being intimate around the house, youre sharing thoughts and dreams. It just encompasses what life is all about. Some people dont care about it, but for the men that do its devastating.
Partner 5: Anything I could tell anybody going through this is like, If you guys are not intimate, and able to talk with each other now you’d better get that straight before the surgery. Better get it straight because you’re gonna need each other, and you’re gonna need the intimacy more than you’ve ever had it
Man 15: I miss the holding of hands. I miss hugging and things like that. I dont thats not sex in the definition of this survey. But thats what is available to me in my current physical conditionand so yes, its important.
Enlarged Prostate This Treatment Can Help You Avoid Sexual Side Effects
Benign prostatic hyperplasia , or enlarged prostate, is a common condition in men older than age 50. BPH occurs when the prostate gland becomes enlarged and begins to press on the urethra the tube that carries urine out of the body.
When the prostate continues to grow, it can lead to urinary symptoms that include:
- Leaking or dribbling of urine
- Frequent nighttime awakenings to urinate
- Urinary retention or urgency
- A weak urine stream
BPH is not prostate cancer and it doesnt lead to cancer. However, the two conditions may have similar symptoms in the early stages
So its important that men who experience these symptoms be evaluated by a mens health specialist to rule out cancer and determine the best treatment options to relieve their symptoms.
Without treatment, BPH can lead to serious complications in some men, including incontinence, kidney or bladder damage, urinary tract infections and bladder stones. In some extreme cases, BPH can cause a total inability to urinate and require emergency catheterization.
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S Men Can Take To Improve Or Recover Orgasms
This doesnt mean that some men dont have difficulty experiencing orgasm after radical prostatectomy. The missing sensation of fullness and the lack of ejaculate are big changes. But there are some things you can do to correct the problem, according to Dr. Kacker.
Men can achieve an orgasm on their own with manual stimulation or with a partner through manual or oral stimulation. Just remember that an erection is not needed. Using a vibrator on the head of penis is often helpful. Vibration can stimulate the nerves in the penis and increase the signals being sent to the brain.
Is Another Treatment Option Better For Preservation Of Erectile Function
The growing interest in pelvic radiation, including brachytherapy, as an alternative to surgery can be attributed in part to the supposition that surgery carries a higher risk of erectile dysfunction. Clearly, surgery is associated with an immediate, precipitous loss of erectile function that does not occur when radiation therapy is performed, although with surgery recovery is possible in many with appropriately extended follow-up. Radiation therapy, by contrast, often results in a steady decline in erectile function to a hardly trivial degree over time.
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Urine Leakage During Ejaculation
Climacturia is the term used to describe the leakage of urine during orgasm. This is fairly common after prostate surgery, but it might not even be noticed. The amount of urine varies widely anywhere from a few drops to more than an ounce. It may be more common in men who also have stress incontinence.
Urine is not dangerous to the sexual partner, though it may be a bother during sex. The leakage tends to get better over time, and condoms and constriction bands can help. If you or your partner is bothered by climacturia, talk to your doctor to learn what you can do about it.
Can I Have An Orgasm Without An Erection
Yes. An erection is not necessary for orgasm or ejaculation. Even if a man cannot have an erection or can only get or keep a partial erection, with the right sexual stimulation you can experience an orgasm. Your orgasm has little to do with your prostate gland. As long as you have normal skin sensation, you can have an orgasm.
What You Never Lose: The Good News About Sexual Function
While regaining erectile functiom is not possible for all men, it is important to remember that erection is just one part of a satisfying sex life. The other parts remain intact despite prostate cancer surgery. Sexual feelings, sexual fulfillment, climax and the sensation of orgasm are still available without erection.
What Other Problems Might An Enlarged Prostate Cause
A small number of men may find it difficult to empty their bladder properly this is called urine retention. If youve been diagnosed with an enlarged prostate, your doctor will look at your test results to see if youre at risk of urine retention. You may be more likely to get urine retention if:
- youre aged 70 or over
- your prostate is very large
- you have a raised prostate specific antigen level
- you have severe urinary symptoms and a very slow flow.
Chronic urine retention
This is where you cant empty your bladder fully, but can still urinate a little. It usually develops slowly over time. Chronic means long-lasting. The first signs often include a weak flow when you urinate, or leaking urine at night. You may feel that your abdomen is swollen, or that youre not emptying your bladder fully.
Chronic urine retention is usually painless. But the pressure of the urine can slowly stretch your bladder muscle and make it weaker. This can cause urine to be left behind in the bladder when you urinate. If you dont empty your bladder fully, you might get a urine infection, need to urinate more often, leak urine at night, or get painful bladder stones. You might also see some blood in your urine. Chronic urine retention can damage your bladder and kidneys if it isnt treated.
There are treatments for chronic urine retention, including:
- passing a thin, flexible tube called a catheter to drain urine from your bladder
- surgery to widen the urethra.
Acute urine retention
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How May Erectile Dysfunction Affect My Sex Life
Most men find that their sex life is different after prostate cancer treatment. Some men question their manliness when they cannot have an erection or find that they are not interested in sex. This can happen even if you are not currently in an intimate relationship. You may find this upsetting. Even if one of the medications or erection aids is helpful, having sex using these things may take some getting used to. It may not feel entirely natural. You can talk with your doctor or healthcare team about these feelings. Counseling may also help.
If you have an intimate partner, it is important for you to talk to your partner about how you are feeling. There is an old saying that a problem shared is a problem halved. Not everyone wants a sexual relationship. Dont try to guess or assume what your partner wants. Have an open and honest discussion with your partner.
This may seem unnecessary in long-term relationships as people tend to assume they know all there is to know about their partner but this is not always the case. With time, you and your partner may be able to find satisfying ways to have a sex life even though you have erectile dysfunction. Your partner will also have concerns about your sex life as well as concerns about your health. Talking about your feelings is very important during this time.
Theme : Treatment/provider Satisfaction/dissatisfaction
Some men reported dissatisfaction with the treatment they received, while others were happy with the treatment and the care they received around the treatment. The majority of men talked about being happy they were cancer free. Several men talked about their frustration with their providers sole focus on the surgery and the lack of resources or help with side effects from treatment. Men who were dissatisfied talked about the lack of support and help from their providers while men who were satisfied with their care commented on the support and help they got from the provider throughout treatment. Some men felt the provider did not really understand them in terms of their priorities and their feelings about sexual function. Some patients regretted the particular treatment they received or that they received treatment at all. The participants said the following:
Man 17: Uh, were alive, ok? I was Gleason 7. My statistical life expectancy would be about 12 years, you know, thats average. Could be less, could be more. If I did not get treatment. And, uh, my mentality– and still isI got it out, out of my body.
Man 1: I think back. Maybe I shouldnt have done it . And go with the shorter quality of life rather than a long life a longer life with the situation.
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How May Erectile Dysfunction Affect My Sexual Relationships
Prostate cancer and its treatment can affect your desire for sex. Every man is different but the feelings caused by having cancer and the physical stress of treatment can affect the way you feel about your body and your relationships. Some men talk about feelings of a loss of their role within the partnership or family. This can sometimes affect a mans self esteem and confidence. For others, the physical effects of treatment may lead to tiredness and a lack of energy. Physical changes after some treatments can also affect the way you feel about your body and appearance . All of these things may result in a lack of interest in sex.
If you are feeling tired or under stress, tell your partner how your feel. Loss of interest in sex does not mean you lose interest in a loving and supportive relationship. There are ways to remain physically intimate without having sex. If you are used to a close physical relationship, it is important to remember that hugs, cuddles and kisses maintain intimacy, provide support, and do not have to lead to sex.
What Is The Importance Of Preserved Erectile Function
In considering the impact of the various treatment approaches for prostate cancer on their quality of life, many patients place paramount importance on the possibility of retaining natural erectile function. This matter is frequently important to young men who by age status are more likely to have intact erectile function than older men however, for all men having normal preoperative erectile function irrespective of age, preservation of this function is understandably important postoperatively.
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Does Hydrocele Affect Your Sex Life
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Surgery To Remove The Prostate
You no longer ejaculate semen if you have had a radical prostatectomy. This is because the prostate gland and 2 glands called the seminal vesicles are removed. The seminal vesicles make the liquid part of the sperm. Your testicles will still make sperm cells but they will be reabsorbed back into your body.
You are still able to have an orgasm, but it will be a dry orgasm. Some men say that a dry orgasm without semen feels normal. But other men find that their orgasm is less intense and pleasurable. The loss of a visible ejaculation can be significant for some men and their partners. Some men say that it feels different but they have managed to find ways to adjust to this.
If you are used to having anal sex and you are the receiving partner, surgery to remove the prostate gland can change this experience. Some men can find the penis rubbing against the prostate gland pleasurable. So if the prostate gland is no longer there, anal sex might feel different. You could look at different ways of enjoying sex and being intimate. Counselling and sex therapy might help.
How Long Does Erectile Dysfunction Last After Prostate Surgery
While ED is common right after prostate surgery, you may regain sexual function after some time. This may range from several months to 2 years. Also, remember that ED can be treated. By working with your doctor, you will be able to recover from prostate surgery and find an effective ED treatment that is right for you.
Can Erection Rehabilitation Be Applied To Improve Erection Recovery Rates
A relatively new strategy in clinical management after radical prostatectomy has arisen from the idea that early induced sexual stimulation and blood flow in the penis may facilitate the return of natural erectile function and resumption of medically unassisted sexual activity. There is an interest in using oral PDE5 inhibitors for this purpose, since this therapy is noninvasive, convenient, and highly tolerable. However, while the early, regular use of PDE5 inhibitors or other currently available, “on-demand” therapies is widely touted after surgery for purposes of erection rehabilitation, such therapy is mainly empiric. Evidence for its success remains limited.
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Hormone Adjustments Can Help With Orgasm
Sometimes hormone levels contribute to orgasmic problem. Many men with low testosterone have problems with orgasm, but treating prostate cancer patients with testosterone is still very controversial. Other hormones can also play a role. For example, a low thyroid hormone level or a high prolactin level can make it more difficult to reach orgasm. Even if you have a normal hormone levels, there are a few hormonal medications that may be able to help.
Another hormone that plays a role in orgasm is oxytocin. The level of oxytocin increases in both men and women during sexual arousal. Taking an under-the-tongue formulation of oxytocin five to 10 minutes before sexual activity can help some men achieve orgasm. Its safe and no side effects have been reported, says Dr. Kacker. You need a prescription for oxytocin, and its available only through special compounding pharmacies, not through retail pharmacies.
Cabergoline is another medication that can help with orgasm problems. It blocks the release of prolactin, a hormone that appears to play an important role in the refractory period after orgasm when men cant have another orgasm for a while.