Men can experience pelvic nerve damage as a result of the surgery. The effects of nerve damage can vary. Your surgeon can best explain what was done during surgery and what you can realistically expect afterward. Damage to nerves can result in:
- Decreased sensation in the penis and scrotum
- Varying degrees of difficulty in achieving and maintaining an erection
- Difficulty ejaculating or retrograde ejaculation (semen goes into the bladder instead of out the penis)
- Decreased amount of semen or none at all
- Decreased force of ejaculation
- Difficulty achieving orgasm
Ejaculation may still be possible without a strong erection. Vice versa, a strong erection may be possible without the ability to ejaculate. Surgical scars in the rectal area may remain tender for longer periods of time than abdominal scars.
For the male, certain surgical procedures may cause partial or complete impotence. It is important to have a discussion with your surgeon to understand your surgery and whether there will be an impact on your sexual performance. Depending on your surgery, you may obtain an erection but be unable to ejaculate. Alternately, you may be unable to achieve an erection, but through physical stimulation, can ejaculate.
Strategies for Success
It’s important to take measures early after surgery to enhance erections. There are several options available.
Oral pills such as Viagra, Cialis, and Levitra are often used early during various treatments for prostate cancer to enhance erections. The medications have to be accompanied by stimulation such as sexual thoughts or physical touching in order to be effective. The medications are generally taken 30 to 90 minutes prior to sex. Research studies support early use of medications to enhance the return of erectile function. The medications also stimulate nocturnal erections which are helpful in regaining normal function. The medications must be prescribed by your physician. If you have a history of heart or kidney problems, you may be unable to take the medications.
A suppository, called Muse , can be inserted into the urethra (the opening that urine runs through when flowing out the penis) prior to sex. It dilates the blood vessels in the penis, making it erect. You must urinate prior to inserting the suppository to lubricate the urethra. If the suppository causes your partner to experience vaginal burning, a condom can be worn.
The vacuum (Encore, Pos-T-Vac, Osbon) is applied to the penis and creates suction that draws blood into the penis, making it erect. A band is then placed at the base of the penis to help keep the erection. The band should not be used for more than 30 minutes at a time.
Medication (Caverject or Trimix) can be injected into the side of the penis to create an erection. The thought of injecting the penis can be nerve-wracking, however, the effectiveness of the injections is high and this option should not be overlooked. An erection occurs in 10 to 20 minutes and can last approximately an hour. Occasionally, erections do not subside on their own. Erections lasting more than 3 to 6 hours are called priapism and can be harmful. Contact your physician for direction.
Different types of penile implants can be surgically inserted in the penis to allow for an erection. A semi-rigid type is available where the penis can be moved into an erect position. There are also inflatable types of implants where a pump placed in the scrotum is used to inflate and deflate the penis.
Face to Face
This position is helpful when you are able to achieve a partial erection. You lie on your back with your partner sitting on top. Your penis can be more easily inserted into the vagina.
Sexual well-being is more than just having sex. If you can’t achieve an erection or ejaculation, other forms of sexual expression can be explored. Simple touching of the skin can be very arousing. Masturbation by both partners can be satisfying as can oral sex. Sexual enhancers such as vibrators and artificial penises can be considered as well.
Remember, ostomy surgery has caused a change in your physical appearance, but deep-down you are still the same person. Try to accept the new you and get on with your life!