No orgasm after prostatectomy

[paulryan]

Encountering shifts in sexual function, including hurdles in reaching orgasm, is a common occurrence post-prostatectomy—a surgical procedure involving the removal of the prostate gland. The prostate gland's pivotal role in sexual function, responsible for generating seminal fluid, means that its extraction can significantly influence sexual sensations and climax. Several factors contribute to the challenge of achieving orgasm after undergoing a prostatectomy:

1. Nerve Damage: The surgery poses a risk of damaging the cavernous nerves, integral for sexual arousal and orgasm, running alongside the prostate gland. Surgical interference with these nerves may lead to alterations or a loss of sexual function, manifesting as difficulty in achieving orgasm.

2. Emotional and Psychological Factors: The prostatectomy journey can instigate emotional and psychological impacts, such as anxiety, depression, or stress, which can exert an influence on sexual function. These factors may disrupt libido, arousal, and the orgasmic response.

3. Medications: Post-surgery prescriptions, like pain medications or hormonal therapies, can carry side effects affecting sexual function. Some medications may induce reduced libido or obstacles in achieving orgasm.

4. Changes in Anatomy: The removal of the prostate gland can bring about alterations in the anatomical structures pertinent to sexual function, influencing the sensations experienced during sexual activity, including orgasm.

If challenges in achieving orgasm persist after a prostatectomy, it is imperative to communicate these concerns with your healthcare provider. They can offer insights, support, and potential avenues for treatment. Consider the following suggestions that may prove beneficial:

• Open Communication: Engage in transparent conversations with your partner regarding the encountered changes. Collaboratively addressing concerns and exploring alternative avenues for pleasure and intimacy can alleviate anxiety and foster a gratifying sexual relationship.

• Sensate Focus: Participate in sensate focus exercises, concentrating on pleasurable sensations throughout the body. This exploration with your partner can unveil novel ways to derive sexual pleasure and enhance intimacy.

• Pelvic Floor Exercises: Undertake pelvic floor exercises, commonly known as Kegel exercises, to fortify the muscles influencing sexual function. Consult a urologist or pelvic floor physical therapist for proper guidance on performing these exercises.

• Sex Therapy: Contemplate seeking the expertise of a sex therapist, adept at working with individuals and couples grappling with sexual challenges. They can furnish support, education, and techniques to navigate changes in sexual function and amplify intimacy.

Acknowledge that each individual's experience is unique, and adapting to alterations in sexual function post-prostatectomy may necessitate time. Exercise patience, seek support, and explore diverse strategies to discern what best suits you and your partner.

[InternetTuffGuy]

I found this old thread today and if folks are still around, hoping to pick the discussion back up. Particularly curious if @wordboy is still monitoring these boards and if so, whether you found any improvement since you posted this thread. I hope that you have for your sake. 

I had my RP exactly 10 weeks ago at Johns Hopkins. Surgery went well, doc (Dr. Allaf who has performed several thousand) was very pleased. I had almost zero pee leakage issues after having the cath removed. No diapers, some dribbles at night for a few days, that was it. So I consider that a big win because I hate pee.

I had complications a week later with an intestinal infection that caused things to swell back up badly to the point where I couldn't eat or drink and got badly dehydrated - ended up in the ER for two days but once I was on antibiotics things improved rapidly and for the past 5 weeks I've been near 100%.

ED is a big issue and I am also unable to achieve orgasm which of course is frustrating. Just as @wordboy describes basically - things build up, here we go, Houston we have lift-off... and then big nothing. It's bizarre. It's actually not a huge deal to be honest but it would be nice to have one again.

I'm working on the ED. Can't take Cialis/Viagra because of a heart condition unfortunately. But we're doing our daily exercises and having the most fun we can. Lots of toys for her fill some gaps, so to speak (buh-dump-bump).

Oddly, the first time we gave it a go was 2 weeks after surgery when I was feeling up to it, and things went okay. Not full erect but I'd say maybe 60-70%. And then there was a nice orgasm. But then I had the intestinal-caused issue which sidelined me for a week, and after that - nothing has come close to that first experience. 

My nuts did hurt for the first 8 weeks or so and still don't feel 100% right.

It hurts to pee sometimes a little - particularly right when I need to go. I had a UTI once and the symptoms are basically the same just not nearly as severe. I recall the frequency and pain of peeing when I had the UTI as something like 8/10 discomfort and pain - now this is more like 2 out of 10. But it's not zero which is what I was used to 99.999999% of my life other than the one UTI and now post-RP.

I'm scheduled for a cystoscopy in 3 weeks if still no improvement in the urinary pressure/pain (again, no leaking problem which is good). But I don't think that the urinary symptoms are related to the ED/orgasm issues. 

Anyway, that's my story fwiw. Will keep this thread posted. I guess as with all of these types of things, if I stop posting at some point, it probably means things improved enough to being out-of-sight, out-of-mind. 

[wordboy]

Hi InternetTuffGuy. Thanks for your reply!

Hmmmm. I don't know if I found any improvement, per se. I think it's more accurate to say we found physical workarounds to enhance sensation at the moment of orgasm. Doing things the old way led to disappointment, so we had to recalibrate (try different things). As part of this, we learned not to change what we're doing at the last minute. e.g. Don't pull out. Changing at the last minute usually causes me to "miss" the orgasm proper.

Your complications sound nasty. Sorry to hear about all of that. I have no idea whether those additional complications have led to orgasm problems. Suspect not, but who knows? All I can say is that finding different ways to do things that the point of orgasm has made a huge difference. It still doesn't feel like it used to, because there's no ejaculation, but there are many times now when I say it felt almost like it used to. Often I think it feels just as good, but still different.

Re the ED, have you tried Caverject? It's excellent, if you can handle a needle. Much more effective than the pills.

[Ashley_ccnsw]

Hi InternetTuffGuy,

Thank you for reviving the thread to get some support during all of this. The side effects of treatment can be such a whirlwind for people, especially as they have to get to know their own body again. This sounds very tough and frustrating. I'm glad there are others online who have been able to share their experiences and offer ways to help through this. If you need any additional support, we have our 13 11 20 consultants who are oncology social workers and nurses who can offer some pathways for more information, there's also our counselling service if you need some help dealing with the mental frustration, and we also have our Cancer Connect service where you can speak to those with their own lived experience of prostate cancer over the phone.

Call our 13 11 20 line number if you need any of those.

All the best

Ash

CCNSW