Sex After Prostate Surgery
David B. Samadi, M.D.
Vice Chairman, Department of Urology
Chief of Robotics and Minimally Invasive Surgery
The Mount Sinai Medical Center
I am fortunate enough to work with internationally known expert in the field of sex after prostate surgery, Natan Bar-Chama, MD.
His expertise in sex after prostate surgery is part of the all-rounded approach
for the treatment of prostate cancer
with the advanced technology of robotic radical prostatectomy. The program includes individualized evaluation of sexual function
prior to radical prostatectomy and specific methods to sex after prostate surgery
“The harshest onset of erectile dysfunction (ED) and sex after prostate surgery comes with facing the reality of prostate cancer
. One day you are healthy and the next day, after a standard yearly physical and a prostatic specific antigen (PSA) blood test
, you find out you have cancer. Your first reaction and that of your sexual partner will be to get through it, save your life, fight the cancer and get rid of it, nothing else matters. But something else does matter, especially to you—sex after prostate surgery
and your ability to have an erection. Although you cannot ignore the prostate cancer, you wonder about your ability to have sex after prostate surgery. And once the cancer threat is passed, and you know you’ll survive and you get your normal life and routine back, sexual performance will suddenly be very important again. Facing ED as a result of prostate cancer treatment can be devastating, but let me reassure you that there is sex after prostate surgery.
Back to Top
Sex After Prostate Surgery:
Robotic radical prostatectomy
is the most commonly recommended treatment to men who have localized prostate cancer
and reasonable life expectancy. Robotic prostate surgery is the procedure in which the prostate and a small rim of tissue around the gland are completely removed with the intent to insure that all cancerous cells have been removed.
I will make every attempt to spare the nerves that surround the prostate in order to optimize your sex after prostate surgery. This procedure is called bilateral nerve sparing technique since the nerves on both sides of the prostate are spared. Men who undergo this procedure have a reasonable chance of regaining complete erectile function for sex after prostate surgery in 12 to 24 months
. If the cancer, however, is bulging to one side, the surgeon must cut the nerve on that side of the gland to remove it. This procedure is called unilateral nerve sparing technique since the nerves on one side of the prostate are spared. If the cancer is bulging on both sides of the gland, the surgeon must cut the nerves on both sides of the prostate. There are instances where all the nerves surrounding the prostate must be cut to remove the gland called bilateral nerve resection. In this instance the patient will rarely regain erectile function or sex after prostate surgery. However, for those patients who require loss of the penile nerves on one or both sides, there is a nerve reconstruction procedure. It involves a nerve graft. During robotic prostate surgery, a piece of a nerve in the leg called the sural nerve is harvested and transplanted to the pelvis after removal of the prostate. This nerve graft will function as a conduit for regeneration of the penile nerves enabling sex after prostate surgery. This procedure is has been performed by Dr. Samadi
and his peers at Mount Sinai Medical School.
After nerve sparing radical prostatectomy
, whether or not you regain erectile function to have sex after prostate surgery is also determined by your age. The younger you are, the better your chance of regaining complete function
for sex after prostate surgery. On the other hand, if you experienced partial ED before surgery, you have a lower chance of regaining full erectile function and having sex after prostate surgery.
Back to Top
Resuming Sex after Prostate Surgery:
If you encounter ED in the early months after surgery, there is still a possibility that normal function for sex after prostate surgery will resume in about 12 to 24 months. And even if you face ED during or beyond that amount of time, there are many treatments available to you. With the use of these treatments, the large majority of men with ED after radical prostatectomy can resume satisfactory sex after prostate surgery.
Oral medications for sex after prostate surgery:
As you start feeling better after surgery, begin being intimate again with your partner to reestablish the physical and emotional closeness you had prior to surgery. Celebrate together the fact that you’ve been victorious over cancer! Anticipate that you will soon regain the ability to have an erection and sex after prostate surgery. You might want to start by trying the simplest method of treatment, the oral medications such as Viagra, Cialis and Levitra.
Penile injection therapy for sex after prostate surgery:
If oral medications are not effective, don’t put off having sex after prostate surgery
. It is important to continue to be sexually active, or in other words to “exercise” the penis for sex after prostate surgery. Some researchers believe that erections enhance tissue oxygenation and suppress fibrosis (scarring). Until the nerves regenerate or recover sufficiently to respond to oral medications, penile injection therapy is the most effective and reliable way of restoring erectile function and sex after prostate surgery. In a recent study it was shown that it is very valuable to use injection therapy to aid erections soon after surgery to increase the chances of the return of normal function.
Back to Top
Penile implants for sex after prostate surgery:
In some cases, no erectile function will return after radical prostatectomy. In such cases, you may want to explore the option of a penile implant in order to have a permanent solution to your ED and enjoyable sex after prostate surgery. A penile implant is an excellent option that is associated with a very high rate of patient and partner satisfaction. Dr. Bar-Chama is highly qualified in penile implant surgery with a vast long-term experience.
Other treatment options for sex after prostate surgery:
If the oral medication, penile injection therapy or penile implants are not satisfactory or indicated, other treatment options might be appropriate to achieve enjoyable sex after prostate surgery. Individual evaluation of each patient will help in understanding the various options and recommendations.
Orgasm and ejaculation during sex after prostate surgery:
During sex after prostate surgery
, you will be able to achieve orgasm; however, you will have no ejaculation since the prostate is no longer available to produce the fluid.
Back to Top
Sex After Prostate Surgery: Here's How
NEW YORK, Aug. 16 , 2012
- A patient, a surgeon, and a robot walk into the operating room – but it's no joke. With prostate cancer as the punch line, preserving erectile function and enjoying sex after prostate surgery is no laughing matter. Many men with prostate cancer are eager to get it out, but potential trade-offs are a big concern. How can I be sure my sex life will live as long as I do? In truth, prostate cancer treatment and recovery is highly individual, but one surgeon is setting the bar pretty high.
Mount Sinai Medical Center's robotic prostate surgeon, Dr. David Samadi, explains how he and his robot are optimizing quality of life for men after prostate cancer and sex after prostate surgery. "We shoot for three success factors – prostate cancer cure, sexual potency, and urinary continence," said Dr. Samadi. "To get there we need three critical components – the right patient with localized prostate cancer, a superior robotic surgery technique, and patient commitment to recovery."
For a man who spends nearly every day next to a robot, Dr. Samadi gives credit where credit is due; his electronic co-worker is just another member of his dedicated surgical team. Here's his take on making room for the robot:
"Robotics are an important part of my evolving surgical career, but I didn't just jump from traditional and laparoscopic surgery to the robot. There's a seasoned transition behind the way I operate. I found a way to improve outcomes by combing proficiencies in all three surgical principal," he said.
Those surgical outcomes speak loud and clear. In Dr. Samadi's care, and with proper compliance to post-surgery follow-up, 96 percent of patients regain urinary control in 2-3 months and 85 percent have sex after prostate surgery within 12-24 months.
But how exactly does he do it? While some might think it's as simple as saddling up to the highly regarded da Vinci robot, Dr. Samadi says that's far from the answer.
"If my only responsibility was to remove the cancerous prostate, my job would be much easier," he acknowledges, "But patients deserve much more than that. It was paramount that I find a way to remove the prostate gland without damaging functions critical to a comfortable and enjoyable life after recovery."
SMART Surgery Explained
In essence, Dr. Samadi's SMART (Samadi Modified Advanced Robotic Technique) robotic prostate surgery accomplishes more by doing less.
Unlike traditional prostate removal surgery that approaches the prostate from the outside in, SMART surgery accesses the prostate from the inside out. Without cutting or damaging three critical areas – the endo pelvic fascia, the neurovascular bundles, and the urinary sphincter – Dr. Samadi optimizes post-surgery sexual function and urinary continence.
Further, the dorsal vein complex is left unstitched until the end of the procedure, allowing Dr. Samadi to control the length of the urethra and minimize leaking after surgery. He uses only cold scissors and clips, never highly nerve-damaging cautery, and every surgery from open to close is completely in his hands.
Of course, the robot enhances each of these steps. Improved visibility, less blood loss, and greater dexterity all come from the precision of robotics. But as much as we love technology, patients still want to know: What happens if the robot breaks?
That's where Dr. Samadi's 3-in-1 expertise comes full circle. He cautions, "Robotic surgeons are becoming more widely available, but patients need to ask hard-hitting questions. Is your robotic surgeon experienced in traditional oncologic surgery or are they simply a newly-trained robotic technician?"
The answer for Dr. Samadi is perfectly clear to the more than 4,000 men and families for whom he's helped make prostate cancer a distant memory.
Dr. Samadi leaves men with these encouragements, "Choose treatment wisely, but choose your surgeon even more wisely. And don't hesitate to take advantage of ED tools such as oral medication or penile injections to jump start sex after prostate surgery. You may only need them for a short time, but they'll get you back on track faster. Patients have to play an active role in their recovery from diagnosis to happy, healthy sex after prostate surgery."
Back to Top
Share on Facebook