Running it up the flagpole

Now the hard one (no pun intended) - tackling the subject of erectile disfunction. If you're squeamish don't read this one. 

When I first had surgery my primary recovery focus was on continence. I was certainly aware of the possible impacts on the ability to get an erection but I found was able to get stiff by stimulating myself after around a month, so I focussed on the continence side instead. That went very well, and so it was a little disheartening that the erections did not continue to improve at the same rate. This is apparently a fairly common state of mind as the bladder largely sorts itself out after three months but the erections can take a year or more. An erection also needs a relaxation of the pelvic floor, which is the opposite of what was worked on to improve continence, and I think that this can have an effect on recovery times. 

The problem for me was not getting aroused in the first place but the level of stiffness and maintaining it during sex. Pre-surgery I would have rock-hard hard-ons that lasted that way until ejaculation. Post surgery the initial hardness was probably 70% at best and would drop quickly, making it almost impossible to have penetrative sex. This affected me mentally far more than I had anticipated. My wife was wonderfully understanding but I found it too depressing to even try and we didn't even attempt to have sex for probably 6 months. That's entirely on me, and I should have made more of an effort and just enjoyed the shared bodily contact.

Pills

Initially my doctor put me a daily dose of Tadalafil, which is a vascular dilator / blood flow enhancer. The  idea of the Tadalafil is that it enhances blood flow which gets more blood into the penis and makes it more likely to rise. This can be assisted by as-required doses of Vasafil (aka viagra), although this is more of a hassle than the movies would suggest. First off it's best taken on an empty stomach at least an hour before sex, which somewhat ruins the spontaneity. Secondly it increases blood flow everywhere which lead to an unpleasant feeling of pressure in my temples and and flushing in my face - it was very reminiscent of when I tried poppers in my mis-spent youth. It also probably lead to an increase in acid reflux, although this is something I am prone to anyway so I can't definitively link the two. In short I've tried the Vasafil a few times and have never really noticed any benefits but have endured some unpleasant side effects, so that's not something I'll be trying again.

Another side effect you can get from Vasafil is priapism, where your erection does not subside. It is recommended that if you have an erection for more than four hours then you report to an Accident & Emergency ward. This is simultaneously horrifying and hilarious to think about, which is why I mention it. 

Tools & toys

My phsyio also put me onto a great website atouchysubject.com which focusses on post-surgery erectile rehabilitation. This covers a variety of tools & treatments and is well worth a look. Based on their recommendations I bought a Vacurect penis pump - the idea being that the normal male has around 5-6 erections per night which keep things moving down there, and the pump can be used regularly to 'force' an erection and simulate the nocturnal activity. You can also use the pump to mount a ring on the base of your penis which prevents bloodloss and keeps you erect for longer. I've had mixed results from the pump - 
  • It's recommended to use it daily if possible and it is difficult to find the private time to do so. I use it two to three times a week and create three to four erections each time, and it's time consuming, It's also a bit odd to shut the door and be doing it when my wife is outside. So I generally only use it when my wife is out of the house and normally finish off by masturbating. Having said that it is very gratifying the first time that you mount a ring which holds successfully and you are 'proper hard' again. 
  • It is difficult to use in the bedroom as it is incredibly undignified! You're both getting in the mood but by the time you have rolled over, pumped yourself up and mounted a ring the romance is lost. You want to keep going because you're not sure how long it will last but you have to take a step back and start again. It's also quite an unnatural feeling as the skin of the penis is very taut and the head starts to go a little purple after 10 minutes or so (the recommendation is to keep the ring on for no more than 30 minutes, but that would be quite uncomfortable). And finally the resulting orgasm feels less satisfying than normal. But on the flip side it does allow you to have penetrative sex, which is of course the main goal. 
I've had better success in the bedroom by using a 'Ribbed ring' from Xplay Gear.  This is a tight ring that slips over your penis shaft and under your testicles. It feels very odd to put on at first but it seems to do a better job of keeping an erection up with a more natural feel. And assuming that you can have an initial erection it is much less intrusive to use and in my view the orgasm feels better. It doesn't keep the erection quite as hard as the pump ring and is probably better for those men who have experienced a degree of recovery. 

I also got a Manta vibrator, a cool looking thing with a 'mandril' that clasps around your penis and vibrates in a variety of patterns. For me this was a bit disappointing - it does bring me to orgasm but it's not very intense or a particularly enjoyable sensation. 

Finally on the toys front I got a 'masturbation cup' - this was on special with some of the other doohickeys I bought so I thought why not. It's the sort of thing a teenage boy would love. But because it requires some force or rigidity to penetrate it has been handy to test the firmness of my erections with the various methods above in a private environment. 

I'm lucky enough that my surgery was early and nerve-sparing, which means that I'm still able to get an erection and am trying to find ways to maintain it. There are other options that are available if this is not the case, such as injections and an embedded pump. I haven't tried these so can't comment any further, but don't give up hope even if you are struggling to get an erection. Just run through each option in turn and find out what you need to do.

Other things 

One thing I've noticed is that the quality of orgasm has reduced post surgery. I'm sure this is a very subjective thing but for me they don't feel as 'all body' as they did before. Having said that I've noticed some improvements recently so I'm hoping this will improve as we get back into the swing of things

The final thing I want to touch on is the lack of any ejaculate. This is something that I didn't really think about but when you orgasm post surgery, you don't ejaculate anything. The penis spasms but nothing comes out - it is all just absorbed into your bladder and eventually leads to some slightly odd smelling urine. I think this is in part why the orgasm is less satisfying. It's very tidy,  but to be frank I miss ejaculating. So if you are considering prostate surgery, take the time to think about all the things you would like to come on and make sure you take the time to do that. Twice. Assuming your partner is aware in advance and is in agreement of course!

Now there's some advice you won't read anywhere else.
 

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