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Leah
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We need to talk about sex.
That’s never easy, but this is an emergency:
A professor and long-time PC patient I’ve spoken to who is familiar with research about sex and prostate cancer told me that *50% of the time* couples will incur serious damage to their marriag after the man has had treatment for PC. I have to caution you that this statistic may apply only to hormone therapy, but either way, it looks bad.
So I hope we can have a prolonged conversation about sex after PC. I’d like to discuss it from a woman’s point of view. And I’m going to start at the very beginning: How does sex work?
My new maxim is:
*Behind every successful man with PC is a woman who does the research.*
I know some guy won’t like that, but too bad. In our case, my first job after dear husband’s surgery was to figure out what caused ED. And that nearly drove me crazy.
As an urban woman who has no car, no lawnmower, sprinkler or garden hose, and no knowledge of plumbing or hydraulics, I felt lost. Because this is the way men talk about their bodies.
Scardino was my first read. He declares in “The Prostate Book”:
“The penis is a marvel of mechanical engineering.”
Too bad for me. I’m not mechanical. Nor visual. I’m a left-brainer with two left hands. Just so you know I have finished college, law school and passed the bar, but learning the mechanics of the lower half of the male body was the most difficult intellectual challenge I’d every faced
I remember sitting in Barnes & Noble for a couple of hours staring at the male genitalia in the “Atlas of the Human Body.” I couldn’t even tell whether the page was right-side up! And everybody around me thought I must be some kind of pervert.
Then there was the diagram in “The Prostate Book” of how an erection works. I looked blankly at the page for what seemed like an eternity. Then Ted came to the rescue.
Scardino explained that an erection is a sort of “valve.” Of course, I knew a valve is a pipe, but I didn’t know it’s a pipe with a stopper at one end. I had to look it up in the dictionary. That was the key to understanding the whole thing. And most embarrassing of all, DH had to explain to me the difference between a vein and an artery.
Then it got even better: Scardino wrote:
“The same hydraulic principle [as an erection] applies when you inflate a bicycle tire. To make the tire rigid, you have to force in sufficient air and then keep it contained under pressure. A leaky valve would make it impossible to maintain rigidity, and the tire would go completely flat.”
Wow. My husband had a flat tire. A leak in his penis. But something just didn’t sound right. I had read plenty about ED, but I’d never heard of a guy complaining of a leaky organ.
Then there was my favorite Scardino quote:
“Erectile nerves run along the outside of the prostate like strings along a package.”
Duh? I imagined the prostate tied with ribbons — blue, of course. But dear husband translated: “I think he just means the nerves are on the outer surface of the prostate.”
One of my favorite people in the PC community, Curtis P., never seems to have met a machine he didn’t like or understand. That’s why the guys love the way he describes things: You might call his lingo “Man-go.” “Man-go” is very technical. Not for me, but I’m learning.
But I have to say Curtis has taught me a lot, not just about auto mechanics but physiology as well. For example, Curtis wrote this about the process of getting an erection, and it sounds pretty accurate (remember, this is not medical advice):
——————————————————–
“Part One – The Nerve Process”
This [the erectile nerves] can be viewed as the electrical wires to run the piece of equipment. Take for example – a motor. If the wires are broke or in any way damaged to where it can’t get the signal to the motor, the motor will not run — even though the motor itself is in perfect running order.
“Part Two – The Actual Mechanical Unit Itself”
If it is working and there are no problems with it, such as leaking [in the veins, possibly as a result of damage from surgery], then erections will take place. [A little simplified. You need to get the smooth muscles of the penis to relax to allow blood to flow in, etc.]
So, this is where the different theories start at:
(1) Does one take Vitamin V (Viagra), in order to help reduce the shutdown process [give a boost to the "wires," the erectile nerves]? Or:
(2) Does one “hotwire” the unit with a shot of postaglandin [ingredient in injections for ED]?
Let’s dive into this situation even more. In the RP itself, if the nerves were NEVER disturbed, then, the patient would have the same erections post op as they did going into the surgery. So, this is the joker in the deck. One knows that when you pull on the nerves, stretching them, or have to strip the pca off of the nerve, you are going to cause damage.
The skill of the surgeon is a very big factor in this — can he remove the prostate without disturbing the nerves? Some don’t and some do. And what about the unknown factors? The size of the prostate? Where the prostate cancer is located? Is it in more in the front of the body or is it deeper inside? This has a direct impact on erectile function afterwards.
So, what’s the best method to regain erections post op?
——————————————————-
This is where Curtis and I parted company. He went on to recommend the VED for “penile rehab.”:
“Yes, it is all about simple hydraulics. The penis gets hard for the same reason you can use one hand to lift your car with a hydraulic jack.”
??? I don’t know how to use a jack, certainly not with one hand.
My suggestion at the time was to “hotwire” the engine, i.e., to use injections as ED therapy or rehabilitation.
Then there was the guy who wrote me comparing an erection to using a sprinkler. I think I got his point. Sort of.
Anyway, eventually I went on to do a lot of research on ED on behalf of my husband and others, and it was a slog. Difficult, but worth it.
So my next job is to learn how to use a computer.
More on sex. What exactly is sex? And do people need it, or is it just a luxury? What do women want?
Posted by:
Leah
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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!
Posted by:
Leah
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Folks, on August 13th I’ll be celebrating my first anniversary of participating in online conversation. It also happens to be my birthday.
When I initially posted to a bulletin board I was looking to spread the gospel of penile injections for ED, and I thought that would be the end of it.
My husband had had an RP about 10 months before (Oct. 15, ’05), and since then we had not had “normal sex”. We were advised to learn to “use our bodies in different ways”. Easier said than done. I did learn to French-kiss at forty-something, but things just weren’t the same.
Also, your mother doesn’t teach you how to, uh . . . manually stimulate a man. And “Ol’ Man River” must have surely known somethin,’ but he “didn’t say nothin’ (as usual). So I had to learn by trial and error.
I was stroking his penis in largo, e.g., slow and gentle, but I eventually learned that it only worked if I speeded up the tempo and the pressure, do it in allegro vivace, maybe.
Eventually we found a top-notch ED doctor who gave dear husband an injectible potion called Trimix. Like all guys, DH was not exactly keen on shooting up *there*. But after Dr. Melman gave him the first shot, his fears vanished. (He says to tell all you guys that it can be done. Don’t give up.)
Now this was SEX!!! Better than the real thing. Erections came in XL and above only. I am sure for a guy who hadn’t “seen action” down there in almost a year, this was a most welcome sight. And with Trimix *you* are in control. Just like with the Tempur-pedic bed, *you* set the firmness. And the pace. You can go on forever as long as time is no object.
Our first session with the elixir was proceeding at a leisurely pace when I happened to glance at the clock. I noticed it was coming up on an hour. I was getting a little tired, but being the competitive type I decided to go for a record — I held out for exactly an hour and a minute. Then I collapsed. Boy, did I need a drink and a Power Bar! But that was just a “dry run.”
I must tell you, dear readers, that if you take a breather, a “seventh-inning stretch” so to speak, you *can* even have a “double-header”. If you so desire.
Anyway, them came August 13, my birthday, and DH got me a beautiful bouquet of flowers. Monochromatic, pink and purple tones. Exquisite. I am a “flower child” in the sense that there is nothing I love more in the world than some pretty blossoms.
That same day DH went off to Vermont on a bike trip, and I became the “Trimix lady”. I had never had an interest in online conversation, but I felt I had an almost sacred duty to tell the world about this miracle cure for ED. So I rhapsodized a bit about it in alt.impotence and alt.support.cancer.prostate. I thought this would be a one-time thing. But then I got some nice notes from people in the groups (as well as some propositions), and I became hooked on prostate cancer conversation.
The biggest problem with injections for ED is that men are very put off by the prospect of “shooting up” there. But these fears can be overcome. After dear husband’s first shot at the doctor’s office, his fears went away.
Also, injections have been shown to play a role in “penile rehabilitation,” or restoring natural erectile function after surgery. Other methods have *not been proven* to do this. I have been researching and speaking out about penile rehab for almost a year, and this is something I will definitely be focusing on here.
Like everything, injections have a downside. You have to be sure to do it on both sides of the penis. Or you can end up with a “Leaning Tower of Penis.”
I just wrote to someone that Trimix could give an erection to a corpse who was doing his taxes:-))
Next article: Pump and Circumstance