Some harsh truths about radical prostate surgery

By Ginger Manley | Posted: Saturday December 20, 2014

Dear Ginger

I have read what you have written and I have to say I think you are way too optimistic in what you say about men who have radical prostate surgery. You make it sound like there's almost no difference before and after surgery. I'm here to tell you and your readers there is a big difference. First of all a man loses length, then he needs to use either injections or one of those vacuum devices, and most women are just not going to be excited by any of this. Finally, even if he got some erections in the year or two after surgery, by the time five or seven years have passed he probably cannot do anything even with assistance. I just wanted to set the record straight.


Dear Don

Thanks for writing to set the record straight. I am sure what you say will ring true for lots of men who have had radical prostate surgery. It sounds as though I have missed the mark in my columns about the sexual downside (pun intended) to radical prostate surgery--the kind of surgery done for cancer rather than the kind of surgery done for prostate enlargement (BPH).

I've given a lot of thought to what you wrote and have re-read my past columns on the topic to see where and how I may have minimized or overly simplified the sexual problems that develop after this surgery. I am sorry if I have sounded too encouraging or optimistic.

This surgery is typically done when a man is between 55 and 75 years old--just as he is beginning to have some age-related sexual losses. Until nerve-sparing surgery was developed about thirty years ago, almost all men who had radical prostate surgery could expect complete loss of sexual function. That fact improved somewhat with nerve-sparing and now even more with robotic surgery.

However, the reality for almost every man who has prostate cancer surgery, whether done robotically or not, is that a great deal changes in the sexual realm, and none of it is positive. Until a few years ago most men were given little if any instruction about what to expect sexually after this operation. More than one man has told me the surgeon seemed surprised to hear a man or his mate question the sexual  side of things--it seemed to them that the doctor thought it was good enough that the cancer had been removed and that should satisfy everybody.

For some men and their mates that is enough to know. Recently a man in his early 60's who is six months post surgery told me that he had not spoken with his surgeon about the sexual downside and as far as he was concerned he and his wife were both just grateful that they would probably have another twenty or more years together. For you, Don, that would not be nearly enough to know.

Here are some facts. Once a man has radical prostate surgery his penis will become shorter than before. He most likely will never be able to have an erection without some kind of assistance, either mechanical or medicinal or both. Even with assistance his erection will never feel the same as before surgery and his mate will definitely notice the difference. He will probably not be able to ejaculate. It will be up to a year before he will know how much if any of his function will recover and it will not get any better after then. In many cases he will lose more function over time and eventually may not be able to have an erection even with assistance. There is no treatment that leads to recovery of these functions--no pills or other operations. All treatment aimed at assisting the man to have an erection is temporary and does not cure the problem. Some spouses or mates are very accepting of all of this, others are neutral, some are relieved to have this part of their lives over, and others are very sad to lose this option for sexual union.

In the last few years more urologists are helping with these problems by starting a man on a penile rehabilitation program before surgery and then continuing it immediately after surgery and for some months thereafter. I covered this in detail in the March, 2014 column. Briefly summarized, the program consists of daily low dose erection medicine, like sildenafil, taken before and after surgery; pelvic floor physical therapy before and after surgery; gentle massaging and stretching of the penis to limit formation of scar tissue; use of a vacuum erection device (VED) before and after surgery to encourage return of blood flow. After surgery some men also start on intercavernosal injections (shots into the base of the penis) and/or insertion of MUSE™ pellets through the end of the penis. Much less often a man may be a candidate for an implanted penile prosthesis.

If a man is several years out from surgery and has either lost function or has never tried some of these rehabilitation techniques, it may be useful to inquire about whether he could try them at whatever point he is at. Typically three to seven years from surgery a man cannot expect to get very much if any response to these interventions, but it is never hurts to inquire.

Don, I hope I have done a better, more realistic job this time. Basically I have affirmed what you have said and I have added a few more facts. If I still have missed the mark, please let me know, and thanks for giving me another chance to get the word out. As I continue to say, silence is the greatest risk to sexual well-being.

 [GM1]Please make link


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