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Cancer: Prostate board


Give your husband some time to heal. Most doctors begin penile therapy after six weeks. During surgery, your husband's urethra was cut completely in two and resectioned. Those sutures haven't healed in just two weeks. This wouldn't be a good time for stretching. Injury at this stage would have a negative effect on urinary function. After six weeks, it seems typical for doctors to prescribe Viagra or Cialis to stimulate blood flow, as well as recommend a vacuum pump to improve blood flow and prevent atrophy. Although doctors don't seem to discuss this prior to surgery, the recovery of erectile function is a longer term process that requires patience.
Most people are attracted to the robotic surgery in large part because of its potential for greater precision that one hopes will result in a greater shot at nerve sparing and total recovery. I think we all then make the leap to believing that if the nerves are spared, everything will be just as it was before.

The reality is that although the nerves have been spared, they have experienced a lot of trauma and in most cases don't just snap back to full function overnight. There is a healing time for the nerves as well, that based on my own experience and what others have shared, can be anywhere from six months to two years. Age and sexual health prior to surgery seem to play a role in the recovery potential.

Hopefully, once the physical healing of the surgical area is complete in six weeks or so, your doctor will suggest an aggressive rehabilitation program to stimulate the nerves back into action. Typically this includes drugs like Viagra and Cialis to stimulate blood flow, even though these drugs will not likely facilitate an erection in the early months. Vacuum pumps (like the Osbon ErecAid system) are also prescribed and regular production of mechanically induced erections is encouraged. The pump can be used either for therapy, or with elastic rings that trap blood in the penis to sustain an erection, for intercourse. Regular use of the pump also combats penile shrinkage which naturally occurs after surgery and from nonuse.

After a brief period of time using the drugs and pump, my doctor also recommends injection therapy (tri-mix, other possibilities include Caverject and bi-mix) which will produce medically induced, usable erections. The intent of all of these therapies is to jump-start the nerves that produce erections in expectation that eventually they will operate on their own.

This all requires a lot of patience and hard work, but the goal is highly desired. Of course, it is possible to produce orgasms very soon after surgery, which will now be dry, prior to recovering erectile function. Having regular orgasms is another important part of rehabilitation.

While it is possible to approach all of this with discouragement and an attitude that sex has now just become a lot of hard work, it is better to use this time to be more creative sexually and make sure both of your needs are being met. I have found in my own recovery that stimulation is an important antidote to my body's physical dysfunction. So it is important for both partners to be engaged in this recovery.

It would have been nice to know all of this prior to surgery, but I don't think it would have outweighed the need to get rid of the cancer, for which I am very grateful. I didn't ask a lot of questions, probably because I didn't want to know. Now that it's important to me, I'm working very hard with my wife to get back to full speed. At least this is therapy that has a fun side to it and a lot of upside potential. Good luck!