Dear Dr Ren,
I’ve read your columns about coming too soon and struggling to come at all. Please address my more complicated issue.
I’ve been dealing with “watchful waiting” regarding my ever-growing prostate for years. Now my doctors have diagnosed cancer and recommend a prostatectomy.
I’ve enjoyed a rewarding sexual relationship with my boyfriend for almost three decades. How, precisely, will this change?
Pre-Surgical and Panicky
Dear Pre-Surgical and Panicky,
After radical prostatectomy (removal of the prostate), you will experience changes in your sexuality. Notably, you will no longer produce any semen. Subsequent to the surgery, you will have what is called a dry orgasm. Though sperm will continue to ripen, it will be reabsorbed by your body.
Orgasms will feel much like the pre-op ones except that they may come with less warning and will lack the contractions of the (now absent) prostate gland. They can also leave your penis very sensitive for several minutes afterward. To avoid most of this discomfort, remain lying down until you are completely soft again.
Erections return slowly, usually beginning three to six months after surgery and improving for 18 to 36 months. Be patient. They may be weaker and more dependent on how you achieve them. For instance, wanking will produce different orgasms from blowjobs, which will produce different responses to those from anal sex. You’ll learn what is true for you, and that may change with time. Your new broader list of options can actually be a plus!
Right after surgery, your orgasms will likely be weak and tentative, but they’ll improve. You may notice some sexual play produces pre-cum, which originates from the Cowper’s gland and is clear, tasteless and includes no semen.
Some urine may escape (climacturia) when you come, especially in the early months after surgery. The amount varies widely and is more common if you already struggle with stress incontinence (leaking urine when you cough, laugh, sneeze or exercise). You can minimize or correct this by doing Kegel exercises. This leakage of pee is not dangerous to your sexual partner, though it can be embarrassing. It tends to get better over time, and condoms (containment) and cock rings (constriction) can help deal with it.
You’ll want to get back to a normal sexual routine as soon as possible following surgery. Your erections can be helped with one of the PDE5s (Viagra, Levitra, Cialis) or a pop-in drug called Trimix, compounded by your pharmacist. Please note that alprostadil, one of the chemicals in Trimix (along with papaverine and phentolamine), might cause achiness, and this can be minimized or eliminated, so talk to your doctor about side effects. Suffering may be optional.
Along with PDE5s and Trimix, there are also penile injections (thin, tiny needles), pumps, pellets, implants and cock rings. There are many reliable choices and many combinations of choices. Experiment.
This is a life changer. You’d rather not have cancer or surgery or a protracted recovery time. You’d like to continue to enjoy the magnificent orgasms you’ve delighted in since you were a teenager. And you will have to grieve your losses and renegotiate your relationship. Tough stuff.
On the bright side, having surgery gives you the best chance to live a long life. And, importantly, surviving cancer offers you opportunities for insight and growth that you’d not learn otherwise. The various cancer support agencies are funded, organized and knowledgeable. Contact them and let them guide you down a path they know well. Your partner, too, can benefit from such support, and remember that our queer community can often provide sensitive assistance through issue-focused groups. Find them.
Sex after cancer surgery will be different, but it can still be the best part of your day!