sexual response cycle pre- and post-RRP

Let me start off with a greeting and a progress report. It's been a
few months since I posted here. I had an open anatomical nerve-sparing
radical RRP on November 17, 2006 at Memorial Sloan Kettering Cancer
Center, after being diagnosed with prostate cancer at age 47.

Coming up on eight months now, for two weeks now I have not worn pads
during the day. I still wear one at night to be safe. After several
months of using Caverject 2x per week, I am now having erections with
oral medications only. Those who have recently been diagnosed and may
be considering surgical options may find encouragement in this.

I have a few questions that I'm hoping will generate some replies.
I'll answer my questions with my own experience, while asking what
others have found.

I haven't been able to locate much clinical literature that attempts
to describe men's subjective experience of the sexual side-effects of
prostatectomy. If anyone can point me to such studies, I would
appreciate it. I would also be interested in anecdotal reports or
personal experiences that anyone would be willing to share.

We all know that a man who has had an RRP does not ejaculate, but many
can have erections and most can still orgasm.

>From my own experience, I have not been able to tell whether not
ejaculating allows for a shorter refractory period, since production
of semen isn't required. It seems that I can get erect sooner,
following orgasm, than I could before surgery. Or is this my
imagination? I'm not sure. (Obviously everyone is different, but I'm
wondering what others have found.)

What is the difference in the typical length of time involved in the
various stages of sexual response for a man with a prostate vs.
without a prostate (i.e. excitement, plateau, orgasm, resolution)? It
seems to me that excitement and plateau take nearly twice as long; and
that orgasms are often just as intense -- or more so -- than pre-
surgery. However, there are times when I don't orgasm, despite a firm
or at least adequate erection, and get tired of trying. Such sex is
still enjoyable, though not as satisfying as when completed by orgasm.

Do men and their partners typically find a dry climax less satisfying,
more so, or about the same? My own experience is partially described
in the above paragraph. I'd have to say there are times that I miss
the warm spurting sensation of injecting semen, but other times (as
noted above) when muscular contractions seem more intense than I
typically experienced before surgery. Again, it's hard for me to
generalize with certainty, even for my own experience.

Is urinary leakage during sex a major annoyance to men or their
partners, and how do you/they deal with it? I have tried using a
condom, as well as a towel. Leakage seems to be decreasing for me and
is therefore less of an issue than before. But I haven't really found
an entirely good solution to this, other than hoping for continued
healing. Currently, I think this is the biggest negative side-effect
that I still have; but, as I said, it is getting better.

Best wishes to everyone in this unusual newsgroup, and thanks for the
openness in sharing information. It's been a tremendous resource for
me, for which I'm grateful.

Tom

Hello, Tom:

Good to hear that things are going well for you. I had my LRP about a
week before you did. It sounds like you're recovery is going a bit
better than -- though I cannot complain. I'm at about a pad a day,
and usable erections are just starting to happen, with a vitamin V
assist.

Sex seems ti be pretty good post-op for the wife and I. It was very
diffferent, of course, without the erection, and we did notice that it
takes a lot longer for me to climax.

The only literature I've seen on this was a book that the radiation
oncologist gave me while I was deciding on treatment. Called "Cancer
and Sexuality," a publication by the NCI, I think. I keep most of my
PCa literature at the office, and it's in turmoil (I'm moving to a
corner office on the top floor! behind the men's room), but I'll see
if can't dig it out and give you a proper reference.

How are your PSAs?

--charlie

On Fri, 06 Jul 2007 23:30:35 -0000, mountainguy1958
<mountainguy1958@gmail.com> wrote:

>Let me start off with a greeting and a progress report. It's been a
>few months since I posted here. I had an open anatomical nerve-sparing
>radical RRP on November 17, 2006 at Memorial Sloan Kettering Cancer
>Center, after being diagnosed with prostate cancer at age 47.
>
>Coming up on eight months now, for two weeks now I have not worn pads
>during the day. I still wear one at night to be safe. After several
>months of using Caverject 2x per week, I am now having erections with
>oral medications only. Those who have recently been diagnosed and may
>be considering surgical options may find encouragement in this.
>
>I have a few questions that I'm hoping will generate some replies.
>I'll answer my questions with my own experience, while asking what
>others have found.
>
>I haven't been able to locate much clinical literature that attempts
>to describe men's subjective experience of the sexual side-effects of
>prostatectomy. If anyone can point me to such studies, I would
>appreciate it. I would also be interested in anecdotal reports or
>personal experiences that anyone would be willing to share.
>
>We all know that a man who has had an RRP does not ejaculate, but many
>can have erections and most can still orgasm.
>
>>From my own experience, I have not been able to tell whether not
>ejaculating allows for a shorter refractory period, since production
>of semen isn't required. It seems that I can get erect sooner,
>following orgasm, than I could before surgery. Or is this my
>imagination? I'm not sure. (Obviously everyone is different, but I'm
>wondering what others have found.)
>
>What is the difference in the typical length of time involved in the
>various stages of sexual response for a man with a prostate vs.
>without a prostate (i.e. excitement, plateau, orgasm, resolution)? It
>seems to me that excitement and plateau take nearly twice as long; and
>that orgasms are often just as intense -- or more so -- than pre-
>surgery. However, there are times when I don't orgasm, despite a firm
>or at least adequate erection, and get tired of trying. Such sex is
>still enjoyable, though not as satisfying as when completed by orgasm.
>
>Do men and their partners typically find a dry climax less satisfying,
>more so, or about the same? My own experience is partially described
>in the above paragraph. I'd have to say there are times that I miss
>the warm spurting sensation of injecting semen, but other times (as
>noted above) when muscular contractions seem more intense than I
>typically experienced before surgery. Again, it's hard for me to
>generalize with certainty, even for my own experience.
>
>Is urinary leakage during sex a major annoyance to men or their
>partners, and how do you/they deal with it? I have tried using a
>condom, as well as a towel. Leakage seems to be decreasing for me and
>is therefore less of an issue than before. But I haven't really found
>an entirely good solution to this, other than hoping for continued
>healing. Currently, I think this is the biggest negative side-effect
>that I still have; but, as I said, it is getting better.
>
>Best wishes to everyone in this unusual newsgroup, and thanks for the
>openness in sharing information. It's been a tremendous resource for
>me, for which I'm grateful.
>
>Tom

Hi Tom,

I'm 3+ weeks post op from my RLRP, which I had done at Cornell. I'm
afraid I'm too early in the game to be of any help. Regardless, I
wanted to thank you for your post, because these are all thing that
have crossed my mind and as you stated, finding documentation on this
is not easy from the limited amount of looking I've done. Best of luck
to you on your continued recovery.

--
PSA @ 45 yrs. = 4.7 02/06/2007
Biopsy 03/16/2007 G7(3+4),T2c
RLRP 06/12/2007 G7(3+4),T2cN0M0 Neg margins

Tom:

I had my laproscopic RP a bit more than a year ago. I have been dry since
about 6 weeks after surgery. It was probably then that I tried and
succesfully had a very limp orgasm.

Since then I have tried Levitra, the VED pump and finally penile injections.
The injections really do work and after the initial unpleasantness result in
as natural a sexual experience as can be expected.

I do leak during sex. And it is a turnoff for my wife. But we put a towel
under her. I suspect that the single urethral sphincter muscle that is left
after surgery also gets relaxed during an erection and doesn't hold like it
should.

Orgasms take a lot of work and are nowhere near as satisfying as before
surgery. But I am 60 and that may have something to do with it. I also
believe that the prostate gland does have a lot to do with developing an
orgasm and not just simply providing the semen.

But my PSAs are undetectable, so all is not bad!!!!

David

On Jul 6, 11:28 pm, chasjac <chjacob...@elmira.edu> wrote:
* * *
> corner office on the top floor! behind the men's room), but I'll see
> if can't dig it out and give you a proper reference.

Thanks I would appreciate that.


> How are your PSAs?


Three-month PSA was 0.01; at six months it was 0.00, the two of which
my surgeon told could be considered equivalent. Margins were clear.

Good luck to you.

Tom

On Jul 7, 11:00 am, "David&Joan" <djmarch...@cox.net> wrote:
***
> The injections really do work and after the initial unpleasantness result in
> as natural a sexual experience as can be expected.
>
> I do leak during sex. And it is a turnoff for my wife. But we put a towel under her.
***
> Orgasms take a lot of work and are nowhere near as satisfying as before
***
> But my PSAs are undetectable, so all is not bad!!!!

David,

Congratulations. Health is most important. Continence, imho, is
second. And it sounds like sex is good for you both. What more is
there?

I was just getting used to Caverject shots when the NP who was
prescribing them suggested I stop, and only use pills, since he
thought I was at risk for priapism. Initially, I felt let down by
this, mainly because of the way he came across when he told me. Only
after thinking about it did I realize that it meant I was healing. I'm
in agreement with you; injections are not that bad, and they
absolutely do work (sometimes too well).

Tom

We've discussed post-op intensity of orgasm before on this NG --
probably many times.

Mine are about as intense as ever -- a lot more pleasant when the
stunningly beautiful wife is involved, of course. We had our first
post-op real intercourse with a barely usable erection recently, and
it was much like it had been before.

I think it just varies from one man to another.

--charlie

On Jul 7, 7:55 am, Paul wrote:
> I'm 3+ weeks post op from my RLRP, which I had done at Cornell. I'm
> afraid I'm too early in the game to be of any help. Regardless, I
> wanted to thank you for your post, because these are all thing that
> have crossed my mind and as you stated, finding documentation on this
> is not easy from the limited amount of looking I've done. Best of luck
> to you on your continued recovery.


Paul,

Good luck to you, and keep working at it. I would imagine this
instruction is fairly typical following a prostatectomy. I recall a
young nurse urging me to "stimulate" myself as often as possible after
I was home, not just during sex with my wife, "so you'll have
something to tell the doctor about," she said. Good advice.

Tom

On Sat, 07 Jul 2007 22:52:17 -0000, mountainguy1958
<mountainguy1958@gmail.com> wrote:

>On Jul 7, 7:55 am, Paul wrote:
>> I'm 3+ weeks post op from my RLRP, which I had done at Cornell. I'm
>> afraid I'm too early in the game to be of any help. Regardless, I
>> wanted to thank you for your post, because these are all thing that
>> have crossed my mind and as you stated, finding documentation on this
>> is not easy from the limited amount of looking I've done. Best of luck
>> to you on your continued recovery.
>
>
>Paul,
>
>Good luck to you, and keep working at it. I would imagine this
>instruction is fairly typical following a prostatectomy. I recall a
>young nurse urging me to "stimulate" myself as often as possible after
>I was home, not just during sex with my wife, "so you'll have
>something to tell the doctor about," she said. Good advice.
>
>Tom

How long did you wait before the self stimulation? I get fleeting
moments where I feel like I'm going to get aroused but nothing happens
and I haven't provoked it so to speak. I was on Viagra for the first
two weeks though, and suspect that meybe it was just a left over tease
from the meds...

--
PSA @ 45 yrs. = 4.7 02/06/2007
Biopsy 03/16/2007 G7(3+4),T2c
RLRP 06/12/2007 G7(3+4),T2cN0M0 Neg margins

On Jul 8, 9:37 am, Paul wrote:
[snip]
> How long did you wait before the self stimulation? I get fleeting
> moments where I feel like I'm going to get aroused but nothing happens
> and I haven't provoked it so to speak.

I started about 4 weeks post-op, in the shower, by myself. I stayed
out the bed and did not involve my wife because I wasn't sure about
leakage and how she'd react to that.

It seemed to take forever, but I suppose it was less than fifteen
minutes. I needed to do lots of fantasizing to get through it. And
it never got erect -- it might have gotten a little longer; that's
all. But I did have a very pleasant orgasm at the end. A very little
amount of urine came out, sort of like an ejaculation but much less
intense. Even though I emptied my bladder, there was enough left over
and a strong enough muscle contraction for this to occur. But it did
feel weird at first, all that sensation and no semen. "A great sound
and fury, signifying nothing." (I know, I know; it's bad luck to
quote it, but it's what I think about at every orgasm ...)

But I was able to discuss with my wife how it all worked then, so
she'd know what to expect. We started making love once again -- it
requires creativity and a sense of humor, but doesn't sex anyway?

If you have the green light from your uro to start experimenting, go
for it.

Good luck,

charlie

On Jul 8, 9:37 am, Paul wrote:
> How long did you wait before the self stimulation? I get fleeting
> moments where I feel like I'm going to get aroused but nothing happens
> and I haven't provoked it so to speak. I was on Viagra for the first
> two weeks though, and suspect that meybe it was just a left over tease
> from the meds...


The day the catheter came out which, if I'm not mistaken, was a week
after the operation.

Here's a post on the subject that I made to this group roughly three
weeks post-surgery: http://preview.tinyurl.com/3x59va

Tom

On Sun, 08 Jul 2007 14:46:58 -0000, chasjac <chjacobson@elmira.edu>
wrote:

>On Jul 8, 9:37 am, Paul wrote:
>[snip]
>> How long did you wait before the self stimulation? I get fleeting
>> moments where I feel like I'm going to get aroused but nothing happens
>> and I haven't provoked it so to speak.
>
>I started about 4 weeks post-op, in the shower, by myself. I stayed
>out the bed and did not involve my wife because I wasn't sure about
>leakage and how she'd react to that.
>
>It seemed to take forever, but I suppose it was less than fifteen
>minutes. I needed to do lots of fantasizing to get through it. And
>it never got erect -- it might have gotten a little longer; that's
>all. But I did have a very pleasant orgasm at the end. A very little
>amount of urine came out, sort of like an ejaculation but much less
>intense. Even though I emptied my bladder, there was enough left over
>and a strong enough muscle contraction for this to occur. But it did
>feel weird at first, all that sensation and no semen. "A great sound
>and fury, signifying nothing." (I know, I know; it's bad luck to
>quote it, but it's what I think about at every orgasm ...)
>
>But I was able to discuss with my wife how it all worked then, so
>she'd know what to expect. We started making love once again -- it
>requires creativity and a sense of humor, but doesn't sex anyway?
>
>If you have the green light from your uro to start experimenting, go
>for it.
>
>Good luck,
>
>charlie

Charlie, thanks for the comments. I suspect I'll wait until the 5 week
PSA and consult with my uro at that time. I suppose in any marriage or
long term relationship, love making requires creativity otherwise it
just becomes a formality. So what if the creativity is a little
different. If your spouse is truly commited to the relationship, then
you get past it and figure out a way to make do with what you have to
work with.

--
PSA @ 45 yrs. = 4.7 02/06/2007
Biopsy 03/16/2007 G7(3+4),T2c
RLRP 06/12/2007 G7(3+4),T2cN0M0 Neg margins

Dear Tom,

It's great to hear that you are doing well.

> I haven't been able to locate much clinical literature that attempts
> to describe men's subjective experience of the sexual side-effects of
> prostatectomy. If anyone can point me to such studies, I would
> appreciate it. I would also be interested in anecdotal reports or
> personal experiences that anyone would be willing to share.

Tom, I would like to recommend that you get in touch with Thom Forbes,
who is 54, from Westchester Cty., and had RP in January '07 at MSK
(Dr. Guilloneau). He is also a patient of Dr. Mulhall's.

I met TF online recently and have conversed with him a bit. He sounds
very knowledgeable and thoughtful. Thom recently started a group for
men (and women) who want to talk about PC and sex. I recommend that
you join the group or contact him for more info. There used to be a
mailing list called PCAI which discussed the above topic, but it has
been defunct for some months.

The group below is open to all who are interested in having a frank
discussion about PC and sex.

Thom Forbes
http://blog.prostatecancerandsex.com
http://groups.yahoo.com/group/prostatecancerandsex

Also, there is a book I came across recently which has gotten very
high marks from readers and is also recommended by Thom. It is
available for about $10 at Amazon. Look under Ralph and Barbara
Alterowitz for the exact name. What impressed me about this book is
that it apparently discusses "penile rehab", which every man who has
had surgery for RP should know about.

Take care.

Leah

On Jul 8, 7:49 pm, callalily <lfc...@aol.com> wrote:
***
> The group below is open to all who are interested in having a frank
> discussion about PC and sex.
>
> Thom Forbes
> http://blog.prostatecancerandsex.com
> http://groups.yahoo.com/group/prostatecancerandsex
***



Thanks!