43, 4 months post Davinci, no guidance on sexual function CONFUSED

Penile Rehabilitation
Hey Alevine,

Many very good urologists seem to drop the ball when it comes to telling their prostate cancer patients how to treat their ED. Your not alone and their is help you can get.

Dr. John Mulhall (a leading prostate ED expert) addresses your questions in his book,
"Saving Your Sex Life, A guide for Men With Prostate Cancer". He lays out a Penile Rehab program for men who have had their prostate surgically removed. The program does include the daily use of 1/4 strength PDE5 inhibitors (i.e. 25 mg Viagra).

The goal of the program is to get fresh blood into the penis on a daily basis.

Dr. Mulhall also has a video (about 1.5 hour) that covers much of the same information:
www.mskcc.org/mskcc/html/94910.cfm

Many men who post to this site buy their Viagra (or levitra) from the internet. Seems the most popular supplier is All Day Chemist from India.

Sorry to hear about your situation
Your story is one of the reasons why I am so adamant in encouraging men w/early stage PCa to avoid surgery at all costs. The medical professionals who are so quick to recommend cutting out your prostate are the same ones who ignore or are incapable of adequately addressing your pleas for help to deal w/the problems of incontinence and ED which often follow.

To answer your specific questions, the penile pump has often been used by men as a sex toy to temporarily increase penis size (both length and girth) but there is no proof that any permanent gains in size result from its use. The pump is recommended for post surgical PCa patients in order to promote blood flow to the penis (which no longer occurs naturally). It it will not help you to actually achieve or retain an erection BUT using it regularly will keep your penis from atrophying (yes, that's possible -- Google it) until your normal erectile function returns. You probably don't need to do it more than 2-3 times a day.

Viagra (like other ED drugs) is designed to promote the chemical changes in your body necessary to create an erection by promoting blood flow to the penis in conjunction w/sexual stimulation. Viagra is designed to be taken immediately (usually win an hour) before you want to have sex. There are 2 different types of Cialis -- a low dose version taken daily and a high dosage version that is taken up to 3-4 hours before sex is planned. Neither of these nor any other ED drugs will work if there has been any damage to the penile nerves (ie., if the nerves were NOT actually spared) or if the nerves are still traumatized and recovering following surgery.

I use the daily 5mg version of Cialis that costs me $120/mo; much less than the higher dose/per event verisons of Cialis and Viagra. You can buy cheaper overseas versions of all of the ED drugs but there are a lot of counterfeits. So, you need to be very careful about the source. HOWEVER, if the brand label version of any ED drug is not working for you, there's no reason to waste money buying cheaper overseas versions of it. Nothing will work if your nerves are not intact or have not yet recovered following surgery.

Fact is, you may never be able to achieve a normal erection again BUT it's way too early to judge that in your case. Most men regain some erectile function w/in a year to 2 years. But even if your situation is permanent, all is not lost. If that happens, you can get a penile implant which will allow you to simulate a normal erection and engage in intercourse (but unfortunately not ejaculate, which is eventually lost w/any form of treatment) with your wife again.

So, as difficult as it may be, try to be patient. Give your body time to recover and your erections may return. Keep using the pump to prevent the penis from atrophying and try using a known brand name ED drug from time to time (every 2 months or so) to see if actually helps you to regain an erection. After you see an demonstrable result w/a known ED drug, you can look into buying more for less on the Net. In the meantime, if you are really depressed about this problem, I encourage you to seek out the help of a qualified sex therapist (or other mental health professional) so that you can get support you need to deal w/this problem.

Good luck!!!

alevine1nc said:

Thank you Beau2! I started watching the video from Dr. Mulhall on Penile Rehab and I am amazed that there is nothing offered like this at Duke Medicine! At least this gives me some kind of start. I've been using the pump off and on (something Dr. Mulhall doesn't seem to mention) but I don't know how long I should be using it. How long should I maintain the erection with the pump each time? Anyway, thanks for the good info. I will also get the book.

I've ordered some Viagara from All Day Chemist, but Dr. Mulhall recommends in his video 25mg of Viagara every night. IS it possible to cleanly split 100mg pill into quarters? All Day doesn't sell anything less.

Again, thanks for giving me a direction.

Pill splitter
Hey Alevine,

Go to your pharmacy and buy a pill splitter. Its basically a razor blade in a plastic holder. I've been using one for a few years. Once you get use to them they work real well. I did crush a few pills to start ... swallowed the crushed med ... worked fine. The companies do tend to make the pills in none round shapes, so it is more of a challenge to split them .... but once you get the hang of it there is no problem.

Mulhall's book does have a short chapter on VED's. He does not seem to be an advocate for the use of the VED for penile rehab (does work for sex), because according to him it only minimally increases the amount of oxygen in the penis. He recommends the use of PDE5 inhibitors (i.e. viagra, levitra, cialis) and injections.

You may want to loook into
You may want to loook into the University of Michigan. They have a great post op regiment for ED.