Hi All, 

Over the past year I’ve done a lot of research on issues relating to sexual function after RP. I started out with this because my dear husband was rendered impotent by his surgery.  The doctor had given him the usual treatment: a prescription for Viagra, which we kept on renewing.

We watched and waited, and there was some progress, but not enough.  W knew it took time and were confident that the “miracle” would  happen tomorrow.  After 7 months had elapsed and dear husband was still unable to function, we called the surgeon, who referred us to an ED doctor who was a colleague of his.  Anyway, the doc didn’t work out.  After three months he hadn’t even finished the “testing.”

I was fed up with all of this, so I decided to look for a competent impotence specialist on my own.  I remember spending 3 hours in the library reading Castle Connolly’s Metro NY Top Doctors book. But it worked:  I got some good prospects. DH went to see two doctors, and the second one turned out to be just right.  His name is Arnold Melman, and he is a world-renowned expert on ED.  He has written many books, including one on Viagra. And he was pleasant and unpretentious.

We found out from Dr. Melman that a lot of men who have RP are not given optimal treatment afterwords to help them function sexually or prevent long-term ED.  He also said that the benefits of nerve-sparing RP were exaggerated.  I felt that I was privileged to have access to a doctor of this caliber, and so I wanted to share what I had learned with the public. The first thing Dr. Melman told Ted was: 

“You don’t need the Viagra [in his case, because it wasn't working].  You’re just giving a gift to the drug company.”  

Anyway, this doc gave us some good ”insider” advice, which I decided to share.  My first post on this subject, “Sex After Surgery” was written back in November 2006. I try to keep up with the research. 

I will be discussing “penile rehabilitation” a lot and also impotence after RP in general.  I want to share with you something I wrote today in response to a question about using a pump (VED) after RP:

It’s no secret that many men suffer from impotence after RP.  It’s hard to pin down the actual numbers, because they play games with the statistics.  For example, how do you define “erectile function?”  Let me count the ways.  Does it include men who can have intercourse unaided, or only with meds.  And just how hard does the tumescence have to be? You get the picture.

On the other hand, there *are* men have no problems with erections after surgery — take the surgeon, for example (:-).  Other guys are able to function sexually using Viagra or other oral meds.   This message is directed towards men who have not had success with the above. 

There are two issues involved in “penile rehabilitation”:

(1) enabling a man to have an erection after surgery

(2) helping to speed up or restore natural erectile function,  thereby preventing long-term ED.

  I am talking about second topic here.

If you are unable to have intercourse after two months, you should see an ED doctor.  (For help in finding a competent one, see my post on “Sexy Secrets For Finding An ED Doctor.”)

There’s a lot we don’t know about penile rehab, but the best prospects at this moment appear to be *injections* along with Viagra.  The following is from Dr, Raina et al, renowned experts on ED:

“Early cavernosal injections following RP facilitated sexual intercourse, patient satisfaction and potentially early return of natural erections. Early combination therapy with sildenafil allowed a lower dose of intracavernous injections, minimizing the penile discomfort.”

www.nature.com/ijir/journal/v18/n5/abs/3901448a.html.

*Note that there is no mention of the VED (pump).

So why are so many guys told to use the pump after RP?  Makes me want to jump out the window. 

Here is an example of the “gold standard” in penile rehab today.  A *top* expert in sexual medicine at Sloan Kettering, Dr.John Mulhall, prescribed this for a new RP patient recently:

====>Re:  *Before Surgery*

Six weeks before surgery, the patient was advised to take 25 mgs. of Viagra six nights a week, to be taken before bed (a 100 mg. pill cut in fourths to save money) to increase blood flow to the penis prior to the operation.

======> Re: *After Surgery*

*Dr. Mulhall and his associate Dr. Nelson Eddie Bennett, Jr., both made it clear that they saw no benefit in using a vacuum erection device (VED) after RP for penile rehab because it only “circulated old blood” to the penis*

Scardino says the same thing on page 366 of “The Prostate Book”:

“VED’s do not produce an actual physiological erection and therefore don’t promote the circulation of fresh, oxygenated blood.   Therefore, they may not help avoid fibrosis [scarring] after radical prostatectomy.”

So even if the VED doesn’t work for penile rehab, most men are told to use it anyway, with or without pills.  No mention of injections (I call it “the Pinprick.”) 

I have seen info in the medical lit which says that the pump *does* work for penile rehab, but they do not point to specifics. And, in the last few days, I have *again* reviewed all the articles I have on this subject, and I have not seen any proof of the above.  My husband is from the “Show Me” state, so I gotta see the “beef.”

I do know of one knowledgeable person online who is the moderator of a newsgroup but certainly not a doctor, who described state-of-the-art treatment for penile rehab as injections plus oral meds *and the use of the pump 15 minutes a day.”  I doubt there is any harm in using the pump and it can give you an erection. 

Ideally, injection therapy should start about six weeks after RP.  Naturally, men don’t like the prospect of shooting up there, but you *can* get over it.  Give yourself a chance.  Also, you can have a sex life right away.  (For more info, see the post on my blog, “How I Became the Trimix Lady.”.) 

I have to add that there is a risk of scarring or “fibrosis” from using penile injections. Some men get “Peyronie’s Disease,” which results in curvature of the penis. They say this is rare, but I don’t believe it.  In my husband’s case, after about 8 mongh,. his penis started to bend in the middle at a 45 degree angle.  I guess the advantage is that you can fold it easily .  (Husb has refused to consult his ED doc about this)

*So you have to be careful of how you inject — do it on both sides.  (I will be posting specifics about this.)

A final note: I have no medical training at all.  So you should ask an ED doctor about all this just to be sure.

And just for fun:

 This is my favorite story in the world: how I came up with the word “pinprick” as a substitute for “injection”.  I was looking for a way  to convey to guys that shots for ED aren’t so bad after all.  So I told them the injection is just a “pinprick, no big deal. I think it worked for some people.

What made me think of this word?

When I got engaged to my husband, the first thing we did was call both of our parents to tell them the news.  We conferenced everybody in on the same line.

The first question my very devout mother asked after they were introduced was: “Did your son have a “Bris?” In other words, was he circumcised?  Great way to get acquainted.  (I never heard the end of that.)

His stepmother replied after a pause, “I think so, but it was done by a doctor, not in any ritual way. Isn’t that right, Chuck?”

Well, my mother wasn’t satisfied with this.  She insisted that Ted had to be circumcised *properly.*  So I asked her, “How can a man be circumcised twice?”

She replied, “It’s no big deal — just a ceremonial thing.  All they’ll do is give him a ‘pinprick’.   And maybe recite a blessing.  Then we’ll all have a little celebration.”

Anyway, T. wasn’t interested in having a “circumcision party,” and he refused to get it done, even for me.  Just to get my mother off my back. 

And that’s probably why he got the PC — measure for measure.  Ted had refused the “pinprick”  then, and now he’s getting pricked all the time

My mother always gets her way.

Best to you all and have fun.

All you need to know about PC: Get It From a Wife!