Part 2: Reconnecting Sexually After Prostate Surgery
Part 2 of 3: Our expert’s give you tips on what to discuss when consulting your doctor about returning to sexual activity after prostate surgery.
BY DR. JONI FRATER & ESTHER LASTIQUE

DepositPhotos Honest conversations with your doctor will eliminate stress in your marriage. “ His erectile difficulties may be medical in origin, so a trip back to the doctor together is your next step.”

Our first article focused on communication because there is no solving any issue without finding ways to open up and talk about it. In this second installment, we are going to discuss sharing one another’s concerns with your doctor and seeking help.

As we work through this issue together, please bear in mind that we are not physicians and that post prostate surgery sexuality is not our specialty. However, the research we have conducted over the years has proved useful for many couples and, in sharing that with you, we feel you will be better equipped to take up this issue with your prostate specialist.

After prostate surgery, it is not uncommon for men to suffer from erectile difficulties for six to 18 months. If he is having trouble getting or maintaining an erection, there is good reason he is avoiding you sexually. His orgasm is going to be different and he probably won’t ejaculate. This is normal after prostate surgery. It is interesting to note that when a couple’s sex stops, in more than 90 percent of the cases, it is the man’s decision—made nonverbally and unilaterally. This includes the elimination of any sensual, playful and erotic touch. Many men get very depressed when their sexual ability is compromised. While this is understandable, his depression (and any medication he may take for it) can worsen the situation, making him anxious and even more concerned that his lack of control over his erection makes him less of a man.

Nothing could be further from the truth. His erectile difficulties may be medical in origin, so a trip back to the doctor together is your next step. Make an appointment and make it clear that you are coming in together to discuss the progress made since surgery and sexual difficulties since the operation. Explain that you would like all of the information necessary to resume a healthy sex life, including options for tests and medications available.

Once in the doctor’s office, your first order of business is to make sure your husband is healthy enough for sexual activity. What most women do not realize is that shortly after surgery, an erection may be impossible or painful. If it is four months after surgery, he may be experiencing erectile problems due to low hormone levels. We recommend you ask his doctor to run the following tests on his hormone levels:

- Free Testosterone
- Prolactin
- SHGB (sex hormone binding globulin)
- Total testosterone

Request all four tests be run, no matter what the doctor says. It is the comparison of all of these pieces of information that will reveal if he has low testosterone. If his testosterone levels are low, it would explain his lack of desire. Low testosterone is important to address because over time it can lead to loss of lean muscle mass and weaker bones. One of the most important comparisons these tests reveal is how much of his produced testosterone is being carried out of his body unused by SHGB. If this level is high while his "free testosterone" is low, try giving him a supplement of Nettle, which may bind with his SHGB instead of his much needed testosterone. His desire levels should increase because he will have more testosterone floating in his blood stream. This will also improve his brain function and his attention span.

Another culprit in low testosterone is cortisol. Known as the stress hormone, cortisol also binds with testosterone and carries it out of the body unused. Reducing stress is vital to a healthy libido, especially if he is already stressed out about his performance and his health. Once he is cleared for sexual activity, one of the sources of his stress should be eliminated.

Be sure to also have your husband cleared for any possible cardiac issues. Remember that erectile dysfunction is first and foremost a sign of cardiac illness that may be four to five years from developing into a cardiac event. If he is overweight or has high blood pressure or diabetes, he may be experiencing these difficulties as a side effect of his condition. We recommend making lifestyle changes that will improve all aspects of his health, including his libido. These include a healthier diet, regular exercise (nothing more strenuous than a walk at least three times a week is necessary) and reducing stress. Although we shouldn’t have to mention this, if he smokes, he needs to quit now. After prostate surgery, the last thing he should be doing is putting more toxins in his body, and studies prove that smoking leads to erectile dysfunction. (If the Surgeon General put that warning on every pack, all men would quit tomorrow!)

Your doctor should discuss the medication options available to you. If his testosterone levels are low, testosterone can be taken either in gel form or by injection for more severe cases. Used properly, after 30 days the gel should return his testosterone levels to normal. (There are advisories that female partners should not handle this gel, as it can alter your levels of testosterone too.)

The other medications to consider are erectile enhancement drugs. Viagra, Cialis, and Levitra are three of the most popular brands and you should ask for samples so you can find out which one works best for your situation. While there are side effects, for men after prostate surgery, ED drugs may also help to restore his confidence in the bedroom. Just make sure the doctor clears him for their use before he starts popping little blue pills. (ED drugs are contraindicated for anyone taking nitrates like nitroglycerine and most high blood pressure medications.)

The scary reality is that after prostate surgery, sexually he may never work the way he did before. That is one of the many things he’s afraid of. After the doctor clears him for sexual activity, the next step is to begin to experiment together sexually.

Our final installment to this article series will address the things you can do differently in the bedroom to maximize pleasure for you both while discovering what your new sex life will look like. We will also discuss sexual enhancements that are over the counter, which can add a little variety. Never fear—just because things are different, there is no reason your sex life as a couple can’t be as magical and passionate as you want it to be. Necessity is the mother of invention and creativity is the key to a great sex life.

For now, start small and gently. Continue to reconnect physically in small and non-sexual ways like holding hands and massage. Try having more kissing time without any expectations for a sexual encounter. Remember the crazy making out sessions that you had in the beginning of your relationship? It will raise both of your oxytocin levels, making you feel more loving and more loved. If it gets sexual, go with it within one another’s comfort zone. Spend more time together and connect emotionally too, talking about fun stuff like hobbies or fantasy vacations, and see a funny movie or two. Laughter is great medicine and enjoying one other is the true secret to a long, happy and passionate life together.

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Part 1: Reconnecting Sexually After Prostate Surgery

Dr. Joni Frater & Esther Lastique are the founders of www.SexEdBootcamp.com and the authors of "Love Her Right: The Married Man’s Guide to Lesbian Secrets for Great Sex!"

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