Living Well

February 4, 2010

Prostate Cancer: My Experience with Sex and Potency following a Prostatectomy

Here is where most men want to know the effects of a prostatectomy.  It is in the area of sexual performance following this surgical procedure for prostate cancer.  What follows is my experience.  I am not trying to speak for all men because the range is huge related to sexual performance following this procedure.  I want to honestly respond to my situation related to the mechanics, but I also want to give some insights related to my emotional response to these things.

Sexual potency, as I understand it, will be affected to some degree in the treatment of prostate cancer, no matter the treatment method you choose.  Whether you choose hormone therapy, radiation, or other means including surgery for the treatment of your prostate cancer, there will be some decrease of potency; the ability to get and maintain an erection during intercourse.  Again, I can only speak of my experience following a prostatectomy.  You will have to have a candid conversation with your doctor about this issue if you choose another form of treatment for prostate cancer.

Because of the male anatomy and the nerves that operate the prostate and seminal vesicles, there is no way not to damage some of them in a surgical procedure.  Surgeons will use nerve sparing surgical procedures, but reality must also be understood here:  some nerves will have to be cut and you will lose some potency following this procedure. The goal is to return your potency to the best it can be following surgery.  This may take as much as 18 months to become restored or to reach the peak of your potency.  It is a time for patience and focusing on what matters in life.  That is why I spent time in an earlier blog writing about one’s personal attitude toward sexuality and the sexual act.  If this subject is not considered when you have prostate cancer, it can become a stumbling block for you in seeking medical attention and in your attitude during recovery. 

Again, there is a range of potency following a prostatectomy.  It can be less than 65% up to 70% or so with the help of ED drugs like Viagra, Cialis or others.  The ability to have an erection at 100% the strength pre-surgery is not a reality.   But, my experience is that I can have good sex and maintain an erection during intercourse that makes lovemaking enjoyable.

One of the first things that struck me about potency is that I can still have an orgasm.  It is different, but it still feels very good.  What is also interesting is that because I no longer have a prostate (which mixes the semen and sperm) or seminal vesicles (which produce semen or ejaculate) there is no longer an ejaculate.  Because there is no ejaculate, sexual intercourse is actually clean—no body fluids to deal with after intercourse.

An erection does not happen as quickly following this surgery.  While I am still stimulated visually, it takes manual stimulation to help achieve an erection.  I can maintain an erection for a period of time, but it is not as long in duration as it used to be.  Without an ED drug, I have a more difficult time getting and maintaining an erection.

The use of ED drugs is helpful.  I use Viagra.  But there is a loss of spontaneity with these drugs.  Most of them require you take them at least 1 hour before intercourse so that they are in your system.  Also, you cannot eat a meal in the 45 minutes before you take the drugs if they are to have their full effect.  Thus, you have to time you opportunity.  I chuckle to myself when I see the ED drug commercials and they say, “When the time is right.”  That is exactly the point.  You have to plan to use these ED drugs.  This changes the communication about sexual activity with your spouse.  You do have to plan and communicate that the ‘time is right’ for you to engage in sexual activity.  It will take energy, planning, and communication.  My advice is not to allow this to become a barrier, but to talk frankly with your spouse about this timing and the use of ED drugs.

 You can take ED drugs in various dosages.  I use either 100 mg or 50 mg.  I find that with the 100 mg, I am able to have an erection for up to one day.  So, if I take it on a Friday evening, I can still have the ability to get and maintain and erection the following day.  The 50 mg allows me to have an erection for about 4 to 6 hours.  Finding the right dose will be trial and error with your doctor.

The side effects are also as they describe in advertisements.  I begin to get a stuffy nose as the medication is taking its full strength; so I know when it is fully in my system.  I also get flushed and warm in my face.  I do have a slight back ache after the drug begins to wear off.  And, for me, the most pronounced side effect is that I do get a headache.  With the higher doses, my headache is more intense than with the smaller doses.  I am fortunate not to have experienced nausea, which is a potential side effect.

One thing to keep in mind about ED drugs is they will not help you have an erection, but will help you maintain one once you do have it.  What this means is that if you are not able to have an erection, the ED drugs will not provide one.  The drugs, as I understand, work to seal off the blood that flows into the vessels (soft tissue) of the penis, making the blood engorge the penile tissue and “sealing” it so that the tissue stays erect for a longer period of time.

I would also say one other thing about ED drugs and my use of them.  They do not always guarantee that I will be able to keep an erection during intercourse.  I have been pretty lucky most of the time, but there have been occasions when my erection begins to fade way during intercourse.  This is disheartening for me and I feel badly for my wife in this moment as well.  But it is a part of the relationship change and enhancement.  It means that you and your spouse will have to discuss this potential and to support each other during your lovemaking and the times beyond.  Lovemaking will not be simply about performance, as it may have been in one’s youth.  It will really be about intimacy and pleasure with your spouse that can take on new meaning and new adventures in the bedroom.

I have been candid here related to my experience with sexual potency following a prostatectomy.  I did not find as much information as I would have liked in my own journey, so I share my experience in the hope that it will give encouragement in your own journey.  No part of my experience is meant to dishearten you, but to help men know there is potential for a satisfying sex life after this procedure.  It will just be different and will open new discussions and intimacy with your spouse.  And in the end, I believe this is what love is really about—sharing ALL the moments and commitments of life with the person who is your spouse.

Blessing, grace and peace.

David Neidert

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