Post-surgery ED question

I'm 71 and had an RP in mid-May, so about three months ago. The incontinence aspect is improving, down to one pad per day and none at night, and I know that recovering erectile function takes more time. That said, I'd like any input on any approaches that might help with that part of recovery.

Prior to surgery, I had no issues getting a solid erection, and often had early morning ones as well. My surgeon told me before surgery that regaining erectile function would likely be at about 80% of pre-op experience, but with the caveat that retaining that capability may or may not occur depending on any complications arising during the surgery. My nerves were spared but my prostate was unusually large, so I'm sure the nerve bundle got stretched a bit getting the gland out.

With respect to erections, I know there are two element to this. Blood flow into and pinching off the outflow in the penis are what I would call "plumbing issues." The nerve signals that control the plumbing responses are what I would call "electrical issues." It's a bit like pumping water into a tank; you can fix leaks in the pipes all you want, but if the pump isn't plugged in, the tank will stay empty!

I'm also aware that lack of use of most body parts can cause atrophy of those parts, so keeping the penile tissues "in shape" is a concern. I have a vacuum pump to keep cells from losing elasticity, etc.

Three things are often mentioned as options for post-surgery ED issues: Cialis, the pump, and implants.

In discussion with my PCP recently, he felt that doing nothing about the ED issue would not be wise in long term...the atrophy potential. He gave me an Rx for Cialis 5mg (once daily) to see if that has any effect. So far, (after 10 days) I've noticed NO effects, but not surprised by that either.

My question is this: I think Cialis is a drug that affects the plumbing aspects of ED, but doesn't do anything to address the electrical side of the issue. Am I missing something on that? Given the cost of this stuff, I'm not inclined to spend money to buy a drug that won't help the underlying issue, which I suspect is electrical.

Any insight or suggestions?

Thanks, Ken

14 Replies

  • Ken, welcome to the group no one wants to join. I had 'nerve sparing' RRP in 2003 at age 49. Tried the pump, viagra, muse, nothing worked - for 13 years. This spring I was introduced to "TRIMIX". Results are like magic. It is a simple injection - and no it does not hurt - but the mental hurdle of sticking your member is a big one. The results are worth the effort. I wish you well.

  • I rejected the idea 12 years ago, & assumed it would not work if viagra failed. Here is a video I just found. The procedure doesn't seem that bad (this is on a patient):

    Slightly different:


  • A recommendation on the injection: After withdrawing the medication, discard the needle and use a different (NEW) needle. Pushing the first needle thru the stopper on the vial of medication dulls the needle! I have used this technique injecting for years (not penises) and find it results in the lest possible discomfort.

  • Ken,

    I suspect that it is useful to masturbate every day. Dr. Strum once advised: "Use it or lose it." To get more blood into the penis during this, you need to be leaning forward, rather than being flat on your back, say.


  • You are probably right about the plumbing/electrical issues. Your nerves have been banged around, and may take a long time to fully recover. In the meantime it is very important to keep your erections going. That is what the Cialis low-dose and the vacuum pump are useful for.

    I have talked with some guys at my local PCa support group that have not tried to regain sexual function for more than 6 months after their surgery (thinking it was better to recover from surgery first). They have reported loss of length, and great difficulty in getting it started again.

    So don't give up, it may take time but is worth it. I would say that after my surgery it gradually improved over the course of 2 years until I got back to what I considered "normal".

    Best wishes for your recovery,


  • Dan, Patrick and Dan, thank you for your input and suggestions. I don't think I'm at the point of going the Trimix option yet but it sounds like I should be making more frequent use of my vacuum pump along with regular masturbation. On the Cialis question, it also sounds like that can help keep the cellular structure from losing functionality. I guess it will just take time to see if and how the nerve bundle recovers.

    Jacking off...not a bad kind of physical therapy either! <LOL>


  • You are only taking a low dose. I would suggest you try taking 10 mg Every day for at least one month.The maximum dose in patients without heart disease can be 40 mg daily.

    Cialis only increases the potential for erections ; you need maximal stimulation as well ( although the drug data sheet is too coy to emphasise this latter point ).

    As you say Cialis will not help any electrical problem but the latter often resolves itself after 6months +.

  • Thanks, I'll have a chat with my doc about that.


  • I would concur with the suggestion that you increase the dosage of Cialis or Viagra that you are taking (although I am NOT A DOCTOR). Before my RP, a tech who was operating the CT scan told me that he had used double the dose recommended, and I have been doing about the same. Ditto the advice regarding masturbation.

    Also you might look into purchasing these meds through Canadian pharmacies, where they are MUCH less expensive. HOWEVER, all such pharmacies are not created equal, so be sure to do your research. Some meds come from the EU, many from India and other developing countries.

    The program at MSK consists of taking the modest doses you refer to and then on a weekly basis taking a full dose (eg, 20 mg for Cialis, 100 mg for Viagra) to attempt to get an erection firm enough for penetration. Don't worry if this doesn't happen right away.

    Also, I was told that even if you do get erections, there may be a "lull" after a time, i.e., you may get erections for a time and then experience a few months where you do not get them. This is counter-intuitive but two MD's from Sloane confirmed it. Has nothing to do with your capacities in the future, relates to the overall shock to the nerves.

    One possible happy piece of news -- again first told me by the tech I mentioned -- is that you may find that the nerves in the penis are MORE SENSITIVE than before the surgery! I have found this as well, and there have been time when I just kept saying "God bless Dr. _______!" This can be true with masturbation as well as in sex with your girlfriend, wife, etc.

    Best of luck in all aspects of this.

  • BTW, I envy you the level of responsiveness you were experiencing prior to surgery. Even if it proves true that you come out of this with 80%, it's 80% of a very high level of function!

    Use of a "cock lassoo" has also been recommended to me by MSK staff. Don't think it's a miracle solution but it can't hurt. Don't keep it on more than about 20 minutes.

    Good luck,


  • A booklist on prostate cancer and sexual issues:

    It's not as simple as you think. There's a nerve-conduction issue (which is electro-chemical), and a biochemical link between the nerves and the muscles that must relax to enable lots of arterial blood flow, and a "hydraulic" requirement that the corpus cavernosa should be in good condition.

    Cialis / Viagra etc (as I understand it) helps the biochemical link, from erectile nerves to erectile tissues:

    . . . without working erectile nerves, you won't get an erection using oral drugs.

    However, Viagra (maybe Cialis, too) has been used to treat cases of peripheral nerve damage, so it may do some good for you, even if you're not seeing erectile activity.

    The injectible drugs (Caverject / bi-mix / tri-mix etc) work _independent_ of the erectile nerves. I've been using bi-mix for nearly 8 years -- it's a Godsend. You need a doc who understands what he/she is doing, since not all injectible drugs work for all men.

    Mulhall (who is wise on these issues) thinks that the best post-surgical treatment consists of both oral drugs (Viagra etc) for the nerves, and injections to keep the erectile tissues in good shape. There are several videos on the MSKCC website dealing with these questions.

    I used a VED for a year after surgery. It kept my penis from shrinking, but did nothing for my nerves, and was never quite good enough for sex.

    I started injections about a year after surgery. My wife says that the first real smile she saw on my face, after surgery, was when I did that first injection.

    . Charles

  • Three months post surgery is still very early to begin to panic. It can easily take a year or more to reach your new normal. However, as you know and as has been reflected by many you need to keep everything in good working order and fully exercised. Masturbation, the pump and the medication should now be a routine part of your day, every day.

    Keep up your spirits and enjoy the fact that you are here to work on and resolve this issue.


  • Thank you all for the replies, insights and suggestions! I'm not in any panic mode about all this, I know it's early, but don't want to miss something I should be doing now but didn't know about. This is the value of a group such as this...and thank you again.


  • You might consider using the cialis every other day since it has a 36 hour half life and see how that works.

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