John came in with his wife Belinda at the recommendation of his Urologist, two weeks prior to robotic assisted laparoscopic prostatectomy. They had largely come to grips with the diagnosis, the decision to proceed with surgery and John was undergoing a Physiotherapist supervised pelvic floor exercise program. They were unsure as to why they had come in prior to surgery to discuss erectile function as they had resigned themselves to the possibility that sexual intercourse would no longer be a component of their close and loving relationship.
Both were in their late 50s and prior to diagnosis they enjoyed sex on a regular basis. John shared that he had no erectile dysfunction and retained a healthy libido . The only significant medical history was of abdominal obesity and borderline diabetes. Lifestyle was healthy in all aspects. Examination of the penis and testes was completely normal.
They had been told by their surgeon that nerves would have to be sacrificed on one side of the prostate because of their closeness to the cancer but that nerve sparing on the other side was likely. We discussed the fact that, while these nerves would not be cut, they are incredibly fragile and almost always become bruised in the process of being kept out of harm’s way. This nerve damage results in severe erectile dysfunction until the nerves regenerate, which if it occurs, takes from 12 to 18 months.
They were informed that John was having approximately 6 erections every night to preserve erectile tissue health and elasticity and that these would cease after surgery because of the nerve damage. We then went over a program to maintain erectile tissue health and elasticity while we wait to see what degree of nerve regeneration occurs.
Because medications like Viagra and Cialis require significant nerve function we discussed why these would not be effective in achieving a full erection in the medium-term following surgery. Upon hearing that penile injection (virtually painless, simple to learn and safe) would allow a return to full erectile function within several months after surgery, they became quite exuberant. John admitted to being depressed at the thought of impotence following surgery because he enjoyed sexual intimacy with Belinda and distraught at being unable to satisfy her sexual needs.
He was apprehensive at the thought of self-injection but Belinda offered to inject him calling it a “new form of foreplay”.
We discussed the effect of his visceral obesity and borderline diabetes in causing blockage to the arteries of the penis over the next 12 – 18 months. I urged him therefore to undergo a supervised weight loss program to prevent this.
In the end they were delighted that they had come along to discuss penile rehabilitation prior to surgery and that options exist for them.