Can't Achieve Orgasm and Considering Penile Implant

[Dbeckman]

I had a robotic prostatectomy in July of 2015. It was Gleason 9, 4+5, positive margins and 3 of 14 lymph nodes removed were cancerous. I lost my right nerve bundle during surgery. I recovered well with no incontenance issues.

I started using trimix in the fall with great success. My PSA gradually started increasing over the next 8 months. My med oncologist sent me to a radiation oncologist. Even though my PSA was not high enough to trigger a decision to move forward with radiation (1.0), my radonc recommended proceeding with adjuvant radiation given my history. The reco was 6 months ADT and 39 days of radiation.

I am now 4 months post radiation and 2 months post ADT. I was on ADT for 2 month before and after radiation. I have not been able to achieve orgasm for 7 months now (started about 1 month after ADT began). I also noticed Peyronies beginning a few months after surgery.

I'd like to know if anyone else has had trouble reaching orgasm and or have peyronies following surgery and/or ADT. If so what did you do? Does orgasm come back? Also, I have been injecting all this time but am considering a penile implant. Does anyone have any advice or experience with implants? Any recommendations on doctors? Thanks in advance for your help!

[Neal-Snyder]

D,

My issue was ED, after surgery for extra-capsular PCa. I could still get orgasms then, & after EBRT with 4 months Lupron. I got Peyronie's from the erection-causing injections. When I quit the injections, Peyronie's went away.

We didn't think the pump did a good job. I got a 3-part implant that is excellent. It was state-of-the-art 11 years ago when we got it. My Kaiser urologist let us play with the two implants that were covered & the one we chose. The 3-part one was so far superior that we sprung for the "Cadillac."

Later, I had to go on long-term hormones. My ability to reach orgasm went away, but having the implant meant that everything else was still there to enjoy. I never lost what I call "psychological libido" for my wife. I think this is something more guys could accomplish if they want to & they know it's possible, which is why I like to share it.

It seems to me that you also got ED, from the 6 months of hormones, right?

I don't know if there are new kinds of implants since I got mine, but I think it's very worthwhile to get one that lets you get good & hard.

N

[Dbeckman in reply to Neal-Snyder]

Thanks for your reply! I am hoping I am able to reach orgasm after my testosterone gets closer to normal. My last 3 mth injection was in July. My peyronies started shortly after penile rehab while using a pump and trimix injections. My doc thinks it was due to surgery. He suggests surgery for peyronies or penile implant to take care of both peyronies and ED. The latter is appealing since I can stop injections. Since they took my right nerve bundle during prostatectomy, ED will always be an issue for me. Again thanks for passing on your experience with the pump.

[AlanMeyer]

D,

You haven't said how old you are. Of course the older you are, the more difficult it is to achieve erections and (with or without erections) orgasms.

I have no personal experience with penile implants, however from what I have read from others, the penile implant will do nothing at all to increase your likelihood of an orgasm and might, if anything decrease the chances.

Your equipment has taken a tremendous beating. You had surgery, radiation, and ADT. It could take time to recover capability. Furthermore, you may still have effects from the ADT. Testosterone does not recover immediately after the end of a "30 day" or "90 day" hormone injection. In my own case, it took at 5-6 months after my "90 day" injection before the T level got near its baseline value. That period is different for different men and for the same men with different lengths of ADT treatment or at different ages (I was only 57 when I was treated.) You can find out more about this by getting your Testosterone level tested to see if you are back in the normal range for your age yet.

If you are having sex with a partner (as opposed to just masturbation), there are some things you might try. One is to concentrate hard on learning to satisfy your partner better and better. Eliciting a great orgasm from your partner can be a tremendous turn-on and a source of tremendous satisfaction for you as well as her. I'll also note that most women don't get orgasms from penetrative sex. They get their strongest orgasms, and for many women their only orgasms from oral or sometimes manual sex. In fact, many older women get very dry and find penetrative sex painful. Oral sex is what they most want. I say that not only from my own monogamous experience but also from reading books on sex written by women. Thinking about penile implants may be diverting you in the wrong direction here.

Also, if you have a willing partner, try to get her (or him if that's the case) to learn more about what you like. Talk freely. Tell her what works and what doesn't work. Guide her. Express strong appreciation for each new little thing she tries - even if it doesn't work. Show her that you appreciate her efforts and experimentation and encourage her to keep trying.

Again, if you have a willing partner, experiment with sex for which an orgasm is not the goal - this is after she has achieved her orgasm. Ask her to play with you softly, with oral sex or with manual sex with lots of lubricant ("Liquid Silk" is a good one) in a way that won't rub you raw or wear you out. Work with her to try to go for longer periods of stimulation, maybe a half hour if possible. Hold her and enjoy her while she's doing it. One of two outcomes is likely to happen. One, you'll have a great time. It will be something you'll look forward to. And two, there might just be a surprise orgasm in it for you.

If you have no partner you might still try masturbation, just to enjoy the pleasure of it without a goal of achieving orgasm. You might still like it a lot.

Sex is so psychological! Work with it. Try new things. Relax with it. Communicate freely with your partner. Fall in love all over again.

Best of luck.

Alan

[Dbeckman]

I am 61. I get my next Blood test the end of Jan so hopefully my T level is a lot higher than the 27 it was in October. Thanks for your great advice on sex. My wife and I have gotten in a rut of expecting dissappointment - injection interferes with spontaneity, gotta get going before my erection subsides, no orgasm for either, mentally stressed and on and on. You offer great solutions for improved romance PCa or not. ED will always be a problem for me (took right nerve bundle) and the implant could deal with both peyronies and injections - hopefully time will bring back my testosterone and my orgasm. Thanks again!

[AlanMeyer in reply to Dbeckman]

One more suggestion:

Having an erection and getting an orgasm are two different things. It's possible to have an orgasm without an erection and, of course, to have an erection without achieving an orgasm.

Before you have an essentially irreversible surgery that, whether better or worse, will make a permanent change, I recommend that you experiment with sex without it. See what you can achieve and what you can enjoy and what you can do for your wife.

I'm 70 years old now, 13 years past my primary (so far successful) radiation treatment. In my case, hard erections are long gone. I think my last usable one was about eight years ago. Orgasms, though sometimes possible, no longer happen for me every time. However, my wife and I have a great time in bed and I look forward to it every time. Sex is not at all the same for me as it was when I was 25, but although it's different, I can't say that it's worse. It is still always pleasant and quite exciting for at least part of every experience.

If you have a loving and interested wife, and it sounds like you do, you may have a similar experience. So before you accept a big, invasive, surgical intervention I suggest that you try to see what you can achieve without it. Take it slow. Work at it. Don't try it once or even ten times and decide it's not working for you. When it doesn't work, think about what didn't work so well, what to do to make it work better, and try again next time. Concentrate on what will make it better for your wife because I think that's the key to making everything better.

When you reach a point that things are going really well, and I think you have a good chance of reaching such a point, then think about whether you really want a surgery or not. You may still want one. You may not. But if you do decide that you want one it won't be because something other than a stiff penis was problematic in your sex life and you were hoping that a surgery would fix whatever it was.

Best of luck.

Alan