Is Sex Possible After Prostate Gland Surgery?

I’m a cancer survivor. I write this post for men who live with the constant fear that someday, their joy for living will be interrupted by the threat of prostate cancer. One in six men will be impacted by prostate cancer sometime during their lives. One in thirty-four will die unnecessarily from prostate cancer.

This is an important subject, for which there is little information available anywhere; the Internet included. I searched for personal experiences and testimonials that could have enlightened me on this subject, and found none. Plenty of medical and scientific information can be found. But I wanted to hear the patient’s side of the story. Since I’m unabashed and have no fear of discussing any subject, I’ll ensure that there is at least one testimonial on the Internet that other men can use to learn how prostate cancer will impact them, and I’ll also remove some of the myths of having prostate cancer.

I apologize for the length of this discussion. However, upon finishing this post, you will have detailed “insider” information that may well qualify you as an expert on the subject of prostate surgery and its impact on a man’s ability to be sexually active. Again, it’s important that men know this information and do not face their prostate cancer with unwarranted fear.

The photo gallery that accompanies this post can be found —>Here<—.

The PSA Test

My personal physician has always been thorough in maintaining all aspects of my health. He saved my life by conducting yearly PSA tests for prostate issues. I didn’t even know he was doing these tests until, two years ago, he showed me a chart of my PSA tests over time. My PSA level was rising slowly and had exceeded 4.0, the danger zone.

He advised me to see a urologist, which I did.

Other factors can increase PSA in the blood stream. Inflammation in the body can raise your PSA. So the first thing that my urologist did was to prescribe large doses of acetaminophen for ten days to rule out inflammation.  My PSA remained high.

A latent infection in the body can boost PSA to unacceptable levels. My urologist gave me an antibiotic for ten days to rule this factor out as causing high PSA. This procedure also failed to bring down my PSA.

Biopsy – The Final Test

With those two potential causes of high PSA ruled out, the only way to determine if I had early stage prostate cancer was to biopsy the prostate gland. This is a fairly simple procedure that does not require hospitalization, surgery, or pain. It takes about thirty minutes and is normally performed right in the doctor’s examination room.

The doctor gave me a mild sedative and then inserted a combination camera and small needle into my anus while I laid on my side on the examination table. If I ever wondered what the inside of my bowel looks like, I found out by watching the doctors LCD examination display. I opted for watching a program on TV.

The prostate gland lies against the intestinal wall near your pelvic floor. So it is quite easy to gather biopsy material from it without surgery or making incisions. The small needle gathers the biopsy material from multiple locations of the prostate gland. I heard several snap sounds as samples were taken but felt almost nothing.

Men have nothing to fear from a prostate gland biopsy. It is not painful, nor debilitating. There is no recovery period necessary. Two saline enemas prior to leaving for the doctor’s office is all that is necessary to clean out the bowel for examination. Enemas are painless but a bit of a nuisance. Since I was likely saving my life, I felt the effort was well worth the nuisance.

The Biopsy Results and My Options

The results of the biopsy were ready in 3-4 days. The urologist communicated those to me on the phone. Great! No need for another doctor’s visit. My result was not good. The prostate gland is divided with the urethra running right through the middle of the gland. Stage three cancer was found in the left side of the prostate gland and stage four cancer resided in the right side. Stage four is the worst and normally means immediate surgery.

I want to stress a point and remove a myth about prostate cancer. Stage four prostate cancer does not mean that you will be die a slow death from this point going forward. Here are the options that were presented to me by my urologist:

  1. Inject the prostate gland in order to freeze it and stop the cancer from growing and spreading.
  2. Laparoscopically implant radio-active seeds into the prostate gland in order to kill the cancer and prevent it from spreading over time. The seeds would never be removed. I wouldn’t know that they are there. This is an out-patient procedure. No recovery period is necessary. It takes 20-30 minutes and I can resume my life normally after the procedure.
  3. Laparoscopically remove the prostate gland. This option requires one day in the hospital. Recovery time is a couple of days. No post-surgical medications are necessary.

I chose option “3”. I saw no point to having a dead organ reside inside my body.

Prostate cancer is normally a “slow grower”. Some men actually choose to ignore it, knowing that its slow growth won’t kill them until they are well into their 80’s or 90’s. Rapid growing prostate cancer is rare; but I had the rapid growing variety. Still, it was April and my doctor said that we needed to act before summer was out. I had a long fishing vacation in June so I chose to have the procedure performed in July. No rush.

The only cases of imminent danger of death due to prostate cancer are when men wait too long to see a doctor thus allowing the prostate cancer to spread to other organs. When this happens, the cancer often is still treatable but only through radiation or chemotherapy. There are cases where, what started as prostate cancer, has spread too far, infected other organs, and is terminal. This is a travesty since prostate cancer is fully treatable in its early stages.

Prostate Cancer and It’s Potential Affect on Sexual Intercourse 

This subject needs to be dealt with before we continue, as this is normally a man’s biggest fear; loss of his sex life. This subject area is also rampant with myths and misinformation.

One of the prostate glands primary functions is to manufacture semen. Treatment of prostate cancer, whether it be by freezing, implanting of radio-active beads, or prostate removal, will halt the prostate glands production of semen. Does this mean that a man’s sex life is over? NO! It just means that orgasms during sexual intercourse will not emit semen. Other than that, male orgasm remains the same exciting, throbbing, muscle spasm that it has always been.  Another myth removed.

There was a complication when my prostate gland was removed. This complication is not common when prostate cancer is discovered early. Regular PSA tests are effective at discovering prostate cancer early. Do not neglect this simple blood test for any reason.

The complication? On either side of the prostate gland are two nerve bundles; one on each side. I’m sure they have an anatomical name, but I have never seen an anatomical chart refer to them. My prostate cancer had spread to one of these never bundles so it had to be removed. The other nerve bundle was questionable.

These nerve bundles are responsible for stimulating an erection in a male. So they are important. If both nerve bundles are removed, a man cannot produce an erection. Does that mean his sex life is over if both of these bundles have to be removed? NO! There are options, which I shall describe in later in this post.

I chose to have both nerve bundles removed because I didn’t want to deal with the possibility that cancer still resided somewhere in my body.

Laparoscopic Prostate Gland Removal

This procedure requires no preparation. The procedure is performed in the hospital under anesthesia. After surgery, a one day stay in the hospital is necessary. The surgeon makes a tiny incision below the navel, and a couple more small incisions around the abdomen. He then uses a tiny scope and camera to remove the prostate gland via the incision below the navel. The entire procedure takes about six hours.

There is no pain involved either during or after this procedure. The incisions are so small that a band aid is all that is needed to cover them after surgery. The hospital stay is more for observation after receiving anesthesia than for anything else.

The whole procedure was uneventful except for some minor discomforts. Once you are on the operating table and totally asleep under anesthesia, your groin will be shaved of all hair and a catheter will be inserted into the penis and bladder. I don’t like catheters. They are irritating and bothersome. The catheter must remain intact for a week after surgery. When released from the hospital, I was given a small “knee bag” (called a Foley bag) to strap around my knee for urine collection during the day, and a larger bag to hang on the side of my bed for nighttime urine collection. When full, they are easily emptied into the toilet.

The only other discomfort I found with prostate surgery is that every nurse and LPN that comes on duty at the hospital wants to check your penis and catheter to insure that all is well. Forget modesty when in the hospital for prostate surgery and set up some bleachers in your hospital room so all the nurses have a comfortable place to sit while they are observing your penis and attached equipment. I figured I might as well allow cameras. I jokingly suggested to the nurses that they set up a camera and broadcast to a big screen monitor in the hospital lobby so that newcomers could watch! It’s that ridiculous and embarrassing. Now let’s get back to the serious subject of recovering from prostate surgery.

I was released from the hospital the day after my procedure. Recovery was a cinch. No pain medication was necessary as the only pain I experienced was where the catheter entered my penis. The catheter causes irritation and the tip of my penis was bleeding a little. Placing antibiotic ointment around the catheter where it enters the penis helped relieve the irritation and bleeding.

After one week of recovery, I returned to the urologist office for an examination and to have the catheter removed. As a safety precaution, I had to prove that I could urinate normally without the catheter. Since bladders do not like catheters either, the bladder will occasionally rebel and not let urine pass. To test this, a nurse injected a large syringe of saline solution into a port on the catheter tube, up the tube and into my bladder until I was no longer able to hold the volume of saline in my bladder. I warned the nurse. She then pulled the catheter out with one swooping motion, gave me a pitcher, and left the room hurriedly.  My job was to urinate in the pitcher so that the nurse could measure how much saline solution I succeeded in pushing out of my bladder. I was successful in attaining the desired result, so the catheter didn’t have to be reinserted for another test. I was relieved in more ways than one.

One other minor inconvenience that I should mention is that leakage will occur for a time while the bladder and penis get used to not being catheterized. This period can last as long as 4-6 weeks, at which time you must place a feminine pad in your underwear to prevent wetting yourself.

There is a 20% chance that you will be permanently incontinent after the procedure. This was unthinkable. Fortunately, I was one of the lucky 80%. These percentages have improved in the patients favor with new technology, like robotic surgery. Since I know nothing of this new technology, I cannot comment further. Discuss this with your doctor prior to surgery.

I found the whole procedure of prostate removal to be quite uneventful. I was glad to be alive without the worry of cancer growing somewhere in my body.

Is Sex Possible When Men Cannot Produce an Erection Naturally? – YES!

Since both never bundles adjacent to my prostate gland were cancerous, they had to be removed. I knew beforehand that natural erections were going to be impossible. And I was not ready to give up sexual relations with my spouse. Here are the alternatives that were presented to me by my urologist.

  1. Vacuum tube – a large plastic cylinder that, when placed over the penis, seals against the body thus permitting the creation of a partial vacuum when air is manually pumped out of the cylinder. The negative pressure within the cylinder encourages blood to flow into the penis thus producing an erection.
  2. Viagra, Cialis – Prescription tablets that when taken orally, stimulate blood flow to the penis causing an erection. Both medications require arousal.
  3. Injections – Alprostadil is injected into the side of the penis with a syringe and needle prior to having intercourse. The urologist teaches the patient how to do this so the injection can be prepared and used safely at home.  The injections are prepared by a compounding pharmacy and received via UPS. Ten injections cost about $50. A urologist will set all this up. He tests the patient with specific quantities of Alprostadil in his office with repeated injections until the penis reaches a length and girth that is satisfactory to both the patient and the doctor. This is the only way to determine specific dosage requirements, which are different for each patient.
  4. Penile implant – see procedure below

Pros and Cons of the Four Options for Producing an Erection in Men with ED (erectile dysfunction)

Option “1”, the vacuum tube, was definitely not an option suitable for me. This technology had been around for awhile and I had issues regarding whether such a ridiculous procedure even worked at all. I was surprised, upon investigation, to find that some doctors recommended temporary use of the vacuum tube in order to make the penis longer prior to installation of a penile implant. I discarded this suggestion also.

I tried option “2”,Viagra, which failed miserably. I also tried option “3”, the injections, which is a solution that my urologist promoted. I found those to be unsatisfactory as well.

Even though my urologist assured me that the shaft of the penis is not really capable of feeling much of anything (the penis is highly sensitive only at it’s head), I found the injections to be painful. The needle insertion was not painful. But later in the day, after having stuck a needle in my penis a couple of times, my penis ached to the point of having to take pain medication for relief.

To add insult to injury, the injections produced a 5-7 minute erection which was not acceptable to either me or my spouse. I do not recommend this solution. Regardless, this is a popular option for many men.

If a penile implant is to be used, be aware that medical insurance companies will not cover the cost of a penile implant, unless you have tried two of the other options listed above and found them to be unsatisfactory.

I didn’t even know what a penile implant was. It sounded scary, but appeared to be my only option. My urologist enlightened me.

This option is popular among men with ED due to prostate surgery. It has an average 90% satisfaction rate among men. This sounded great, even though I still did not know what was involved.

Once again, surgery and an overnight stay in the hospital are required, although some doctors perform the procedure as an out-patient service. There is no preparation necessary prior to entering the hospital.

The Hardware Components of a Penile Implant

All of the hardware needed for a penile implant is installed via one incision in the male scrotum, just under the point where the penis meets the scrotum and the two connect.

The penis has two chambers on either side of the urethra that contain a spongy-like substance. To form a normal erection in a healthy male, the body pumps blood to these chambers during arousal, until the penis is fully erect and hard.

When installing a penile implant, the spongy substance in these chambers are removed and a small, latex-like balloon is fitted into each chamber. If order to do this correctly, the urologist precisely measures both the length of the penis and the length of the chambers for each patient during surgery. The implant comes in various sizes in order to produce a precise fit.

A pump is installed in the scrotal sack and has three connecting tubes. One tube connects to a latex-like reservoir of saline fluid, which is hidden in the lower abdomen. The other two tubes connect to the base of the latex-like balloons that were fitted into the sides of the penis.

This sounds complex and burdensome. But none of the implant is noticeable once installed. After surgery the penis will be a bit longer and harder when flaccid (at rest) due to it’s need to support the newly installed hardware.

Recovery time for this procedure is six weeks for full healing of the incision. This is an uncomfortable time when both the scrotum and the penis are heavily bruised from surgery and enlarged due to swelling. Loose trousers are advised until swelling subsides, which normally only takes two weeks. Sitting during these two weeks is a challenge due to the swollen, enlarged scrotum. Standing is also a challenge because gravity goes to work on the scrotum and produces an annoying ache. Laying down frequently is the only option.

No sexual intercourse is permitted during the six week recovery period. A return trip to the urologist is necessary in order for the patient to learn how to operate the pump and release button, which reside inside and at the bottom of the scrotal sack.

Once out of surgery and back in the hospital room, a cast-like dressing covers the entire groin area. A hole is left at the top of the dressing where the penile head and attached catheter protrude. Antibiotics and pain medication are administered via an IV that connects to the hand. These medications are unnecessary after leaving the hospital. Sleeping must be accomplished on your back or sides.

Before I left the hospital, my doctor removed the dressing that covered my groin area. A nurse removed the catheter. Once again, I had to prove that I could urinate on my own. The wound on my scrotum bled slightly for two weeks and then healed nicely.

An erection is accomplished on-demand by squeezing the pump in the scrotum a few times with the fingers  until  an acceptable erection is achieved. The pump pumps saline fluid from the reservoir in the abdomen into the two chambers on either side of the penile shaft. With the implant, you can literally choose the length and girth of any specific erection.

CORRECTION MADE 1/22/2015 – you cannot choose the length of your erection after surgery. During surgery, your urologist took a measurement in order to determine which appliance size best fits your anatomy. His measurement measured from your pelvic bone to the end of your flaccid penis (non-erect). From this, the urologist somehow determines how long your penis would be when erect, but the urologist is usually wrong and you wind up with a “short dick”. Avoid this.

Urologist usually joke that their patients accuse them of making the penis too short after this surgery. This is no joke. They do just exactly that. I lost at least two inches in erection length and nobody seemed to care (except my wife). Again, avoid this.

PRIOR to having surgery, produce a normal erection or have your wife stimulate you to erection. Once fully erect, use a tape measure to measure from your pelvic bone to the end of your penis. Record this measurement and be precise.

Advise your urologist that you expect the same length of erection AFTER surgery as you had before surgery, REGARDLESS OF ANY MEASUREMENTS THAT HE MAY TAKE IN ORDER TO FIT YOU WITH AN IMPLANT. Be forceful. Otherwise you are going to wind up with a “short dick” and intercourse will be hell for the rest of your life. Urologist can’t seem to get this right. So head off this disaster in advance of your surgery.

Once surgery is complete and your genitals are completely healed, pump up you penis. Doing this will hurt for a couple of months as the tubes that were installed on either side of your penis terminate at the head of the penis with a hard bullet-shaped piece of plastic on both sides of the penis. These “bullets” support the head of the penis as the fluid-filled chambers on either side of the penis do not extend into the penis head. However, when fully inflated, these “bullets” press against the tender head of the penis and it hurts. That will go away over time.

Nevertheless, do your best to fully inflate your penis to erection. Then take the same measurement from pelvic bone to the end of the penis as you did before surgery. The resulting measurement should be the same after surgery. If it isn’t, you got shafted (no pun intended) by your urologist and an explanation from him/her is in order. Unfortunately, there is no way to resolve this issue except to do the surgery again so that a larger appliance can be installed.

I got “shafted” so intercourse is a bitch since I have a “short dick” to work with. Don’t let this happen to you.

Let Us Move On and Get Back to What We Were Talking About

You must use the fingers to press a button on the side of the pump to return the saline fluid back to the reservoir thus making the penis flaccid (at rest). Some men prefer to leave the penis partially inflated and that is permitted. After surgery, it is difficult to find the button on the pump in order to release fluid that is keeping the penis erect. This is due to scar tissue inside the scrotum, which will eventually go away.

Men love this device. Not only can they produce an erection on-demand, they can stay erect for as long, and as often as they want.  No arousal necessary. There is virtually no impact on orgasms. Orgasms are without semen, but are the same throbbing, muscle spasm that they have always been.

The satisfaction rates among women who have partners with an implant are even higher than that of men! My urologist indicated that this is primarily due to the implants ability to sustain an erection indefinitely and the implants uncanny ability to add girth to an erection.

If you are interested in personal testimonials and more detail from actual penile implant patients, there is a great blog on Blogger.com that deals only with penile implants. Language and photos are for adult viewing only. You’ll find that blog ->HERE<-.

In conclusion, I hope to have accomplished the following with this post:

  1. Encouraged men to take action with regard to their prostate health.
  2. Removed most of the fear and myths surrounding this important subject.
  3. Proved, by relating my own personal experience, that prostate cancer does not imply the loss of sexual relations.
  4. Demonstrated the prostate cancer treatment options, although inconvenient at times, are painless and can return men to their normal enjoyment of life without fear of cancer.

If I can save one man from dying of prostate cancer due to misinformation or no information, than writing this post was well worth my effort. I’m not embarrassed one iota from having related my personal experience. If I have to be the first to communicate a testimonial  on this subject, than so be it. Prostate cancer is a killer. But with early detection, it is no threat to your health, your pride, or your enjoyment of sexual intercourse.

If you are accustomed to receiving regular digital rectal exams of your prostate gland for abnormalities, that isn’t enough. This exam is a judgement call at best since since the physician must rely upon “feeling” something abnormal. My personal physician won’t even perform a digital rectal exam of the prostate gland.

You can find an abundance of information on these subjects by using Internet searches to locate your specific topic or term. If you want more information, do the searches and inform yourself. The number of men who die from prostate cancer each year is unacceptable. Education and regular PSA testing are your best weapons to insure that you do not become a cancer statistic.

Men, if you have questions that you would prefer to submit privately, I can answer your question, or find an answer for you, if you submit your question to thefolks@ThisIStheNorthwoods.com. I am the only one who monitors this mailbox.

The photo gallery that accompanies this post can be found —>Here<—.

 

 

 

 

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