Sex After Robotic Prostatectomy: Penile Rehabilitation

I have previously written about sexual function and how it changes after prostate cancer surgery.

As men are being diagnosed with prostate cancer at a younger age and at an earlier stage, the preservation of erectile function and the ability to maintain satisfactory erections has become more important. My partners and I offer a variety of options to assist in the recovery of erections including having a vacuum device specialist come in to the office once a month, teaching patients how to give penile injections and intra-urethral suppositories, and prescribing viagra, levitra, and cialis on a maintenance, preventative basis.

One of the most frustrating things is insurance companies not paying for maintenance medicines even though most urologists feel these medicines help erections return sooner and possibly more fully. There was an excellent review of the literature by Dr. McCullough of NYU that I read this weekend. He is one of the world’s authorities on erectile dysfunction.

This is a great source of information for urologists who can receive 1.5 CME credits.
I will start giving this link out to patients with a letter to see if it helps get them at least partial payment from insurance companies.
I hope patients report any positive experiences with insurance companies paying for their PDE5 inhibitors after surgery.

I have been personally prescribing 1/2 of a pill of the maximum strength to be taken on Mon, Wed, and Friday evenings.

Sexual life after prostate removal

This post is for all the men who have prostate cancer or are worried about prostate cancer. One of the most feared side effects of therapy for prostate cancer is the impact on sexual health.

prostate diagram

click to expand the image

Hopefully this will give men a better idea of what to expect and take some of the fear of the unknown away.

The prostate makes the liquid in the ejaculate. This is necessary for the sperm to work and therefore to have children. Other than having children, the prostate is of little use later in life and only causes problems with urination (BPH) and is a leading cause of cancer.

nerves surrounding the prostate

click to expand the image

The “nerves” that go to the penis course very close to the prostate. They are only a few millimeters from the prostate and can be affected by surgery or radiation. These nerves are solely responsible for erections, or the ability of the penis to get hard.

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