Sex after prostate surgery – a clinical perspective

Sex is different after prostate surgery – if an erection is obtained at all.

The percentage of men experiencing erectile dysfunction (ED) after prostate removal ranges from 25 to 90% depending on what journal article you read. Additionally, the technique (Robotic vs. Open) seems to not make a big difference (Hu et al. 2009). With this blog post I’d like to share my clinical experience in helping men with penile rehabilitation after prostate surgery.

• Choose the right surgeon rather than the right technique. A surgeon who has performed 1000 open surgical procedures is better than a robotic surgeon who has done 100 procedures. Make sure the surgeon saves the nerve plexus that innervates the penis. Just ask them and make sure that’s the plan – don’t think is a given.

• Be realistic.  You’ve had up to 5 erections (other than during sex also during REM sleep) since you were a teenager and for the first time, after surgery, you’re not having one. Don’t think you’re going to obtain a satisfactory erection anytime soon – realistically, it can take up to 2 years (regardless what the surgeon says).

• The healthier your ability to sexually perform before surgery the sooner you’ll regain erections after surgery. Simple tips: exercise 4 to 6 times a week, lose some belly-fat and eat a nutritious, plant-based, whole food diet.

• Consider pelvic-floor biofeedback training (PFBT). A recent randomized study showed significant improvement in sexual function in men after prostate surgeries that were treated with PFBT. (Prota et al. 2012)

• Start taking a Phosphodiesterase 5 (PDE-5) medication (Viagra, Levitra, Cialis) daily a few weeks before surgery. This approach will tell you which one works best with the least side effects. This way, after surgery, you know which one works best and you can consume daily. You need to see your doctor and be monitored for this approach. Do NOT buy these drugs online as you never know what you are really getting.

• Integrate a natural approach. Epimedium is an herb that has been used for centuries for sexual dysfunction. It promotes circulation in the penis by stimulating the production of Nitric Oxide, the most important chemical involved in dilating blood vessels for healthy erections. Epimedium also potentially helps promotes circulation even when nerves are injured shown in one animal study. (Shindel et al. 2010)

• In addition to a good exercise regimen and eating whole foods,  XY VGR, which contains ample levels of Epimedium along with L-citruline, Rhodiola, Pomegranate extract and Reveratrol has helped a significant number of  my post-prostatectomy patients. Taking 2 pills two times a day on an empty stomach seems to work best. Don’t expect a “home run” though. You may get a “double” or a “triple” with time. It should take about 3 weeks to work. XY VGR can also be safely combined with PDE-5’s – many have improved their post-surgery sexual function with this approach. Epimedium has shown to increase testosterone levels in rats. Personally, I have not seen a great increase in testosterone in patients consuming products containing Epimedium. Still, prostate cancer patients should be closely monitored by their doctor when taking products with Epimedium. Patients on Androgen (Hormone) Deprivation therapy (ADT) should abstain from taking any product with Epimedium.

• Penile injections (known with the trade name Caverject or Edex) may work best. If you’re able to get over the fact that you are injecting medicine right in the shaft of your penis, then you can benefit from its effect. Priapism, an erection that will not subside after 2 hours, is a major side effect – at least that’s what I noticed. A few of my patients have had to awkwardly visit the emergency room with priapism.

If sexual rehabilitation is of interest there are many treatments that can be helpful after prostate surgery. Sexual health should not deter one from a prostatectomy if that’s the treatment most suitable. I hope this information helps the reader Rebuild, ReClaim and ReNew your sexual health after prostatectomy.

A good book resource specific to today’s topic is: Reclaiming Sex & Intimacy After Prostate Cancer by Dr. Jeffrey Albaugh.

References:

Hu, J.C., Gu, X., Lipsitz, S.R., Barry MJ, D’Amico AV, Weinberg AC, et al. (2009) Comparative effectiveness of minimally invasive vs open radical prostatectomy. JAMA 302: 1557–1564.

Shindel, A. W., Xin, Z.-C., Lin, G., Fandel, T. M., Huang, Y.-C., Banie, L., Breyer, B. N., Garcia, M. M., Lin, C.-S. and Lue, T. F. (2010), Erectogenic and Neurotrophic Effects of Icariin, a Purified Extract of Horny Goat Weed (Epimedium spp.) In Vitro and In Vivo. The Journal of Sexual Medicine, 7: 1518–1528

Prota C, Gomes CM, Ribeiro LH, de Bessa J Jr, Nakano E, Dall’Oglio M, Bruschini H, Srougi M. Early postoperative pelvic-floor biofeedback improves erectile function in men undergoing radical prostatectomy: a prospective, randomized, controlled trial. Int J Impot Res. 2012 Sep;24(5):174-8.