orgasms after prostate surgery

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myself3164
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Date Joined Mar 2012
Total Posts : 4
   Posted 3/26/2012 11:24 AM (GMT -6)   
i was told that if orgasms were possible for me after prostate surgery, they would be "dry." i realize that there would be no semen ejaculated, but when I can have an orgasm, I will shoot (with considerable force) urine. Is this normal? Is there any surgical procedure that can restore the nerves that were severed during the prostatectomy?

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4022
   Posted 3/26/2012 11:26 AM (GMT -6)   
I've never experienced that but have read of others here who experience that on a regular basis. Best piece of advice I read here about that is to reintroduce the shower into the sexual routine.

Do you empty your bladder before sex?
40 years old - Diagnosed at 40
Robotic Surgery Mount Sinai with Dr. Samadi Jan, 2011
complete urinary control and good erections with and without meds
Prostate was small, 34 grams.
Final Gleason score 7 (3+4)
Less than 5% of slides involved tumor
Tumor measured 5 mm in greatest dimension and was located in the right lobe near the apex.
Tumor was confined to prostate.
The apical, basal, pseudocapsular and soft tissue resection margins were free of tumor.
Seminal vesicles were free of tumor.
Right pelvic node - benign fibroadiopse tissue. no lymph node is identified.
Left pelvic node - one small lymph node, negative for tumor (0/1)

AJCC stage: pT2 NO MX

p_elliott
Regular Member


Date Joined Nov 2010
Total Posts : 143
   Posted 3/26/2012 11:29 AM (GMT -6)   
I have only ejaculated urine twice the problem has seemed to cleared up. As far as fixing nerve damage I think once it's done it's done and can not be fixed. There are things you can try to do about ED but there is no surgery to fix it.
 
 

Post Edited (p_elliott) : 3/26/2012 10:32:12 AM (GMT-6)


myself3164
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Date Joined Mar 2012
Total Posts : 4
   Posted 3/26/2012 11:34 AM (GMT -6)   
I think when I do not empty my bladder before intercourse, I am more likely to have an orgasm, but if I do pee first, it is more likely that I will not have an orgasm. I guess, I will just have to make sure that I have a towel next time.

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4022
   Posted 3/26/2012 11:44 AM (GMT -6)   
interesting. I've never heard of that connection.
40 years old - Diagnosed at 40
Robotic Surgery Mount Sinai with Dr. Samadi Jan, 2011
complete urinary control and good erections with and without meds
Prostate was small, 34 grams.
Final Gleason score 7 (3+4)
Less than 5% of slides involved tumor
Tumor measured 5 mm in greatest dimension and was located in the right lobe near the apex.
Tumor was confined to prostate.
The apical, basal, pseudocapsular and soft tissue resection margins were free of tumor.
Seminal vesicles were free of tumor.
Right pelvic node - benign fibroadiopse tissue. no lymph node is identified.
Left pelvic node - one small lymph node, negative for tumor (0/1)

AJCC stage: pT2 NO MX

NY-Sooner
Regular Member


Date Joined Sep 2009
Total Posts : 410
   Posted 3/26/2012 12:02 PM (GMT -6)   
I am 5 years post op and have no ED issues and can get rock solid erections without problems, but every time I have an orgasm,  I ejeculate urine with such force I can hit the ceiling.  Matter of fact, I ejeculate urine with more force now without my prostate,  than I ejeculated semen when I had my prostate.  Figure that one out!!!! 
 
 I have had this problem since day one, and my uro says it will not get better over time and you just  have to learn to live with it so get use to it.  I asked him if at leat I am going to ejeculate urine, is there a pill I can take that will change my urine color to white? Well as long as I am going to ejeculate fluid, at least let it look like semen. tongue No such pill so far.
 
 Worst than than the ejeculation problem, is the constant dripping as soon as I get aroused. I am dry other wise, but as soon as I get aroused I can feel my splinkter muscle relax and I will start to drip like a leaky faucet.  This really puts a damper on sex because now I have to put towels on the bed and be careful no to drip on my partner. My uro says if you ejeculate urine into your partner not to worry because urine is steril and it can't hurt her.  Just try telling that to a woman!
 
Some people suggest using a condom, but then I loose all stimulation and there goes the erection.  The only thing I have found that helps is using the position with the woman on top. In that way gravity keeps the urine from dripping and from ejeculating.  Also ddrink a lot of water an hour or so before sex helps dilute the urine thus reducing odor. 
 
 

Tenpin
Regular Member


Date Joined Oct 2011
Total Posts : 219
   Posted 3/26/2012 12:36 PM (GMT -6)   
When they told me that my orgasms would be dry, both my wife and I were looking forward to oral sex to completion (as this was one thing she was decidedly against, she would stop way before). Now with the urine issue both during foreplay and orgasm, that option has completely been taken off the table by her. I pray each night that that clears up. I was so looking forward to it. (cry, cry).

PS, the shower works well to hide the urine.
Age:49
Dx 9/29/11 (age 49)
PSA 3.9
Biopsy: 2/12 samples positive, Gleason 8 (4+4)
Robotic Prostatectomy 11/10/11 (nerves spared), Cath Removed 11/17
Pathology: T2c, Gleason 7 (4+3) clean margins, no sem. ves. involvement, Lymph nodes negative
Post Op PSA: 12/24/11=<.1

golfnooch
Regular Member


Date Joined Sep 2011
Total Posts : 346
   Posted 3/26/2012 1:14 PM (GMT -6)   
My first few orgasms post op were geysers of urine, regardless if I peed prior. Now, it's actually random. Some days, nothing, others, I will get a few squirts. I also experience sometimes that slow drip when i relax to enjoy stimulation. This is probably effected my sex life as much as the ED problem, as the wife is not too keen on being pee'd on in any fashion. Oral Sex, forget it...If i want that, I need to visit some of those kinky places.
Age 42, Fit, 175 lbs., no health issues. Had Testicular cancer at age 30 and have been clean since.

3/31/2011 - PSA 7.5
4/30/2011 - Second PSA of 6.5
5/31/2011 - Biopsy, Positive, Gleason 3+3, 6
7/15/2011 - Bone Scan Clean, MRI showed two tumors
9/28/2011 - Successful Robotic Prostectomy at UPenn, Presby, Dr. Lee
10/3/2011 - Post Op Pathology 3+4=7 Gleason, Tumor encased within the prostate
1/5/2012 – First PSA <0.1 Undetectable, 99% Continent, No erections

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 23848
   Posted 3/26/2012 1:44 PM (GMT -6)   
Never had the urine issue, but can see how that would be frustrating. I got use real quick to the "dry" ejaculations. I get a good amount of pre-semen from the cowpen's gland, so it's almost like before, in a sense.

The big "O" for me, is so much more intense and longer lasting than anything I experienced in Pre-PC days, I am at the point, where I like this much better, and no mess or restrictions to deal with.

Good luck on that

David in SC
Age: 59, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, original catheters 63 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06, 2/11 1.24, 4/11 3.81, 6/11 5.8, 12/11 14.0
Other: Spent total of 1 ½ years on 21 catheters, had Ileal Conduit Surgery 9/10
Member of Prostate Cancer & Chronic Pain HW Communities

myself3164
New Member


Date Joined Mar 2012
Total Posts : 4
   Posted 3/26/2012 1:48 PM (GMT -6)   
THANKS GUYS, FOR YOUR COMMENTS. I THINK WHEN I PEE PRIOR TO INTERCOURSE, I AM MUCH LESS LIKELY TO EVEN HAVE AN ORGASM, BUT WHEN I DON'T PEE FIRST, AND I DO HAVE A CLIMAX, I ALSO COULD HIT THE CEILING!! THANKS AGAIN, ram

Dave7
Regular Member


Date Joined Jul 2006
Total Posts : 197
   Posted 3/26/2012 3:49 PM (GMT -6)   
Try having sex without having an orgasm.  If the whole urine thing is a distraction, you may find that sex is more enjoyable for everyone if you take that distraction off the table.
 
My post surgery orgasms haven't been great.  They were so disappointing I quit going for them because the tradeoff for my libido leaving the room was no longer worth it.
 
It works for me.

Tigerfan53
Veteran Member


Date Joined Jan 2011
Total Posts : 776
   Posted 3/26/2012 5:36 PM (GMT -6)   
As you can tell from the responses, it is not uncommon to ejaculate urine during sex. I’ve had this happen a few times but it’s rare for me. I always make it a point to pee before, which I think helps prevent it from happening for me; and has no bearing on my orgasm. Fatigue and alcohol can exacerbate the problem. There is actually a word for orgasm associated incontinence, it is called climacturia. Your bladder neck is supposed to close at the time of orgasm to stop the urine flow. Also the bladder contracts during orgasm which adds to the problem. I’ve read that around 20% have this on a routine basis after a prostatectomy.

There are a couple of options you may want to explore. One option is the constriction band, called the ACTIS band. It is put on the base of the penis and is supposed to be very effective controlling both foreplay and orgasm associated incontinence. The other option is a medicine called imipramine that has been used to help this condition. It is a drug used to treat depression, but a side effect is relaxing the bladder and causing the bladder neck to contract better. Ironically it is not as effective for men who’ve had a prostatectomy. And just so you know, urine is sterile and will not cause a yeast infection or a urinary tract infection in your partner.

Condoms are certainly a valid option, but personally I can’t imagine using a condom at our age. I would think using a condom would be worse than the urine leakage. Just my opinion of course.
Diagnosed Dec 2010 at age 53
PSA 5.3
Biopsy: 50% in 1 of 12 cores, Gleason 6
PSA 5.6
RRP on 6/6/2011
9/8/2011 PSA undetectable
12/8/2011 PSA undetectable

NoMoProstate
Regular Member


Date Joined Jan 2012
Total Posts : 20
   Posted 3/26/2012 5:51 PM (GMT -6)   
I think you've gotten your answers, but thought I'd throw in my experience. I've had only one REALLY intense orgasm post-op (4 mos now), and it was while standing. I noticed that I had some extra pressure in the area where the prostate used to be (internal muscles bearing down--kegel style). Apparently I was "tweaking" some sensitive tissue left over next to where the prostate was. That particular orgasm was also wet. Urine ejaculated in spurts, just like a pre-op orgasm.

Since then, I've usually been sure to empty my bladder twice, if I don't want to deal with urine. I should note that I'm still slightly incontinent (2-3 pads/day). My Uro told me it's common for most men to retain urine after a single trip to the toilet. I found I usually retain at least another 5-15 ccs. I can get rid of most of that by waiting about 2 mins after going the first time and trying again. Since then, my orgasms are almost always completely dry, particularly if I'm on my back and depending on how long the "act" took (if I was actually making more urine in the meantime). (Being on your back should cause the least strain on the bladder and therefore the external urinary sphincter, as well.... I'm pretty sure "gut size" also has some bearing on the physics here, as well as overall core strength).

I will note that in my case I am certain there is some left over enervated tissue remaining after the prostatectomy. I'm 100% ED right now. I was able to achieve stronger orgasms pre-op by repeatedly/rhythmically bearing down around the prostate area with muscles (kegel), prior to orgasm... also using those muscle to stave off orgasm, if I wanted to prolong sex. I've noted that on occasion, post-op, I have been able to have a similar sensation be rhythmically contracting the pelvic floor muscles in that area. It increases the intensity of the orgasm considerably. I'm about 40% right now on whether I get ANY of those intense, uncontrollable internal contractions at orgasm. They happen way more frequently however if I concentrate on this rhythmic floor muscle activity. Otherwise, the orgasm/contractions seem to be much more externally focused... tending to involve only or mostly the penis (with maybe very weak or almost non-existent contractions internally).
2009: PSA 4.5; antibiotics; PSA 3.0; dx bact. prostatitis
6/2011 45yo: PSA 4.3; DRE neg
7/21 PSA 6.3; DRE neg
8/12 BX: T1C, 3+3, 4/12 cores; max 12% 1 core; PV~45cc
11/21 LARP; margins -, lymph -; nerves spared
12/1 Cath remv; 12/3: ~5 pads; 12/6: 1-2 pads
12/14 Rx Cialis 5mg+VED; 100%ED
1/2/2012 8 pads!!
2/12 PSA <0.01 ~4pads
3/5 biofeedback
3/12 ~3 pads
3/26 ~1-3 pads! (yay biofeedback!)

Post Edited (NoMoProstate) : 3/26/2012 11:59:37 PM (GMT-6)


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3220
   Posted 3/26/2012 6:00 PM (GMT -6)   
I have ED but can still orgasm. There is no urine squirt and no mess at all. Very convenient - I guess.
You don't really know what you'll get. Well you do know one thing. You won't be squirting semen.
Jeff

myself3164
New Member


Date Joined Mar 2012
Total Posts : 4
   Posted 3/26/2012 6:19 PM (GMT -6)   
AGAIN, THANKS EVERYBODY FOR YOUR COMMENTS. I JUST TURNED 72, AND LOVE SEX AS MUCH AS I EVER DID. I HAD THE PROSTATECTOMY WHEN I WAS 58. KAGELING WAS A BIG HELP IN RECOVERING MY ERECTION CAPABILITY. SOMETIMES WHEN I JUST CAN'T SEEM TO "GET OFF," DURING INTERCOURSE, I WILL USE A VIBRATOR, AND WHEN I CUM USING THE VIBRATOR, I SHOOT LIKE I WAS 18 YEARS OLD AGAIN.

cfree2004
New Member


Date Joined May 2012
Total Posts : 15
   Posted 5/23/2012 9:31 AM (GMT -6)   
My input to this forum is this: After being diagnosed with VERY agressive prostate cancer, I had major robotic complete, removal of everything, (prostate, seminal gland, and both nerve bundles) in 2004. Severe ED since then, topical nerve damge to right thigh..permenant ! No erection possible, no seman, no ejaculation, and orgasms were reduced to about ONE (1) percent of what they used to be.
Result is cancer free for over 7 years now which is a blessing but for the past seven years my sexual abilities have been reduced to NOTHING !!!!!! Very frustrating to say the least.
Age 58 2004
Prostate cancer found May 2004.
PSA 12.+
Biopsy 12/12 all positive cancer. Very agressive
Gleason 9
Oct 2004 Robotic Prostectomy
Removed Prostate, Seminal gland, both nerve bundles.
Path report> cancer contained in prostate
30 days after surg., PSA <.02
Check regularly since

Bootheel
Regular Member


Date Joined Oct 2007
Total Posts : 300
   Posted 5/23/2012 10:25 AM (GMT -6)   
I went 4 years with this problem after RRP.  It became even worse after salvage radiation.  I finally opted for an Artificial Urinary Sphincter. No more urine during sex at all.  Not even during orgasm.  Works like a charm for me.  Kind of gave me my life back.  I would try everything first (kegels, etc.) before making any decisions.

Neoman
Regular Member


Date Joined Nov 2010
Total Posts : 153
   Posted 5/24/2012 5:31 AM (GMT -6)   
I read these posts last night and during the night thought about the issues you guys have ( I have a AUS so I do not have this issue besides having no erections either).

Your sphincter that you have left if you had your prostate removed is the exterior sphincter that would have to open up during orgasim so the fluids and sperm to flow out. Your main sphincter was in your prostate behind the glands that produced the fluid that kept the urine in the bladder.

Sooo if I can see this issue being non fixable because of the location and the purpose of the two sphincters.. Do I make sense..?

NEO
Bladder Cancer fall 2008, age 53
MVAC Chemo fall 2008 to Jan 2009.
RC of Bladder/Prostate Feb 2009
Stage 2 high grade bladder cancer
also detected after RC surgery, Tc2 high grade Prostate cancer, Gleason 7(3+4)
Had AMS 800 implanted July 2009 but surgeon nicked uretha and the cuff had to come out. Then developed infection and they took it all out. Reimplanted Oct. 12 2010 after fistula/infection

pogmothoin
Regular Member


Date Joined May 2010
Total Posts : 84
   Posted 5/27/2012 10:18 AM (GMT -6)   
I'm nearly 2 yr post-op followed by RT and HT. I still have some urine dribble but mostly before now when i'm getting excited. Early on i would spurt some during orgasm. But that has faded. Thankfully it doesnt bother my girlfriend. (One of many reasons she's a keeper)

When i had my RP the surgeon had to take about half the nerve bundle on each side, but i also had a bilateral nerve graft performed that day as well. My urologist,Catalona, wasnt sold on grafts but he does have a plastic surgeon he teams up with to do that if a patient makes that request. That doc, Dr Kim, was studying in Texas when these grafts were being pioneered about 10-12 years ago and he performs them occasionally. He told me that there are no guarantees if it works it would take about 18 months to see results. When i had to have RT i didnt hold out any expectations, figuring the grafts and remaining nerves were fried, but at 20 months i started seeing some response. There is still some slow improvement and now I'm at about 80% or so, and a decent amount of that is possible on a good day even without pills.
Age at diagnosis 5/10: 49
PSA: 5/08 1.6, 5/10 4.7
Initial GS 7 (4+3)
Biopsy: 14 out of 15 positive, up to 95%
Bone scan and CT clear
RRP on 7/20/10 by Dr William Catalona at Northwestern
about 40% nerve-sparing on each side, with bilateral nerve graft performed
Final GS 7 (4+3) with a tertiary amount (less than 5%) showing at 5
PSA 8/23/10 1.59, confirmed 8/26/10 1.7

Jazzman1
Veteran Member


Date Joined Sep 2010
Total Posts : 953
   Posted 5/27/2012 12:34 PM (GMT -6)   
It's amazing the stuff they forget to mention when they're talking you into a prostatectomy.
Age 57

Biopsy 8/10
Three of 14 cores positive: 10%, 60% & 80%
Stage T1C; Gleason 6
---------------------------------------------------------
open RP at Cleveland Clinic 11/10
Post-surgical pathology: Gleason 7 (3+4)
Three positive margins; Stage T2c(+)
PSA since surgery: <.03

AdVance sling: 12/11 -- Much drier than before

pogmothoin
Regular Member


Date Joined May 2010
Total Posts : 84
   Posted 5/27/2012 1:00 PM (GMT -6)   
Jazzman, if you're talking about the nerve graft, it's anything but common. I'd wager a number of urologists aren't even aware of it, or maybe only in passing from medical literature and they likely discount it as unproven. Before I had my surgery it occurred to me that nerve grafts can be done elsewhere on the body, so why not here? I started doing a little digging and about the time I decided to drive to Chicago for Catalona to do the cutting, I asked him if it was possible to have a graft. He mentioned that he isn't convinced of the effectiveness, but there is a doctor he collaborates with who can do that when requested. As I understand it, the graft doesn't transmit signals, it just serves as a bridge for the fibers to regrow. Keep in mind that the original nerves are an array of tiny hair-like fibers spanned out on each side of the prostate, while a graft is a single, thicker fiber. I have no idea how he made the connection, but apparently it is possible. It spans a gap of about 3" on each side. My graft was taken from the sural nerve on the side of my left foot. Since I needed a bilateral graft, he took about 6" from my foot and since he had to take that much, most likely I'll always have a loss of sensation there. For me, it's well worth that price. The nurses didn't seem to quite know what to make of me during post-op recovery. You're supposed to have patients walk almost immediately, but I wasn't supposed to put any weight on my foot. One of them brought me a walker but it was built for someone about a foot shorter than me, so I had to request a pair of crutches for me to hobble around. IIRC, at the time of my surgery, during a span of about 10 years Dr Kim had done a few dozen grafts during prostate surgery, with only about 5 prior to me needing a bilateral graft. Considering that I had radiation afterwards, I can't help but think that my choice of finding a facility with a RapidArc machine helped deliver the treatment accurately enough that my nerves have survived as well as they have. Even before I knew I'd need radiation I knew it was a gamble to try a graft procedure, but I'm glad I did.
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