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Medical Forum / Diseases and Disorders / Prostate Cancer / December 2004Impotence - Adult Material.
This morning I tried the second trimix injection. A couple comments. First, the injection itself is nothing. When I was first diagnosed and started reading I thought I could never give myself an injection in the penis. Forget that worry. I can feel the needle going in, but it is not painful, nor is the injection of the drug. I know we are all different, but I would implore you to not avoid the injection therapy because of fear of the needle. It is a big waste of time. Second, I was very pleased to note that the second erection was nowhere as uncomfortable as the first time. Someone here told me to stick with this because over time the pain/discomfort would go away as the tissues get flexible again. It has been over a year for me, so tissues down there are not in normal condition. I believe it now because the pressure, discomfort, was very much less this time. The affect of the injection seems to last only about a half hour. Is that normal, or should it last longer? Once erect it does not go down, even without stimulation, so it appears this is not like a normal erection. They told me with Caverject that stimulation was necessary to achieve the erection. It this supposed to be the same? Before I forget, the trimix dose that I have is 12 mg/ml Papaverine; 1 mg/ml Phentolatine; 9 mcg/ml (note different measure here) Prostaglandin. The recommended dose is 0.5 ml with more as necessary. This dosage does work for me so I will not try more. BTW, I also use the pump with this, mainly to try and encourage a little more length. I have lost a lot and the pump adds at least an inch. That does go away though when the pressure is released. Finally, and the negative here, the "pleasurable feeling" in the penis itself is gone. I may as well be touching my elbow. Is that normal? Is that something that should come back? I am sixteen months post RRP. No sign of natural erection returning, but I had ED problems going in. The Viagra/Calais do nothing for me. Thank you. Hope this helps someone out there. I am serious about the injections not hurting and whatever you do, do not wait for over a year to deal with this like I did. The sooner you start to work on the problem the better. I am not a doctor of course, but I really believe that. Happy Holidays. David S. Hello David. I was in a similiar boat. After about 3/4 of a year, I was given prostaglandin injections. I admint the bark is worse than the bite. I was afraid of needles, and especially in the penis. It was not a problem......It did help, and I used injections about 36 times since I kept a small log as to the date and the reaction..... I did best in the a.m. I was able to get a good result that did last about 1/2 hours, and would be plump and full for several hours later. Walking and getting up helped. At night I got severe achyness and pain after intercourse and erection would seem to last for 2 hours or so..... It took me 2 years and viagra the first time gave me severe headache..... After injections and pumping, I started to get some slight natural fullnes....hum.. I tried viagra several more times and it started to work. So, nerve healing takes time as I found out. And practicing does help. Good Luck..... John Loomis > This morning I tried the second trimix injection. A couple comments. > First, the injection itself is nothing. When I was first diagnosed and [quoted text clipped - 32 lines] > Happy Holidays. > David S. > Finally, and the negative here, the "pleasurable feeling" in the penis >itself is gone. I may as well be touching my elbow. Is that normal? Is >that something that should come back? I am sixteen months post RRP. No >sign of natural erection returning, but I had ED problems going in. The >Viagra/Calais do nothing for me. I am a IMRT patient, so my experience is different but similar. With radiation, you slowly go from your function pre-treatment to something less, whereas with surgery, you slowly go from nothing post surgery to something more, but in both cases you are end up with diminished function compared to where you started. Anybody who tells you differently is either kidding you or kidding themselves. Your sex life will NEVER be what is was. Period. It's not a physical possibility. I tried Viagra for the first time last night and I am happy to report that it helped much in the ED department, but not so happy to report that it did little in the pleasure department. As far as I'm concerned, the dry or almost dry orgasm is a mere shadow of normal function. I'd just as soon sneeze. My wife had a great time, so as I've said before, sex post PCa treatment is payback for when I was a self-centered kid. I watch while my partner has the fun. Which is its own reward, but mutual pleasure is better. So I don't believe there is anything out of the ordinary in your experience. >> Finally, and the negative here, the "pleasurable feeling" in the penis >>itself is gone. I may as well be touching my elbow. Is that normal? Is [quoted text clipped - 20 lines] > self-centered kid. I watch while my partner has the fun. Which is > its own reward, but mutual pleasure is better. Doug, There is no question that sex after treatment is going to be different. I experienced some of what you describe, but with time, I find my satisfaction increasing. I certainly continue to find it worth the effort. As your urologist will probably point out, the feelings associated with sex take place in your brain. It can take time to teach your brain to react appropirately to the changed situation in your reproductive tract. Men differ in how they respond after treatment. Some even find sex more pleasurable than before. And it does take time, so you should be patient and keep at it. > So I don't believe there is anything out of the ordinary in your > experience. >Men differ in how they respond after treatment. Some even find sex more >pleasurable than before. My take: If your sex life is more pleasurable AFTER PCa treatment, then you wasted your youth :-) Certainly everybody is unique and YMMV. I was 52 years old in otherwise excellent health and physical condition prior to treatment, and the difference between before and after is HUGE. My point is not to be depressing or to wallow in it, but simply not to sugarcoat the problem for those newly diagnosed patients who read this n.g. for guidance. ALL PCa treatments have a substantial effect on the reproductive system, and it is an irrefutable fact that a man's sexual response will be different after than prior to treatment. How much different, and how to cope and adjust, are issues unique to each patient. Just don't go into treatment with wild optimism, because you WILL be disappointed. > >Men differ in how they respond after treatment. Some even find sex more > >pleasurable than before. [quoted text clipped - 5 lines] > otherwise excellent health and physical condition prior to treatment, > and the difference between before and after is HUGE. My sexlife is just awful. But, I will say that due to RRP, I have learned a whole lot of stuff I wish I knew in my youth. >>Men differ in how they respond after treatment. Some even find sex more >>pleasurable than before. [quoted text clipped - 15 lines] > each patient. Just don't go into treatment with wild optimism, > because you WILL be disappointed. Well said, Doug! My sex life is non-existent at 2 years post-op. I don't cope well with it, and really have nowhere to talk about it. I guess I wallow in it... and I know other people get tired of hearing about it. So I cry in the shower.... or otherwise keep it to myself as much as I can. ;( MikeH > >>Men differ in how they respond after treatment. Some even find sex more > >>pleasurable than before. [quoted text clipped - 22 lines] > > MikeH I am also 2 years post op, age 52 and am in the same boat, Mike. Sex did mean a lot more to me than I thought it did(pre RRP). But I had to do what I had to do, don't know if I will ever get completely used to having ED. I just try and immerse myself in other activities. Little by little I find that the depression caused by my non-existant sex life is changing. Maybe getting better. I still love my wife and what life has to offer, just have to call what's left good. Take care, Tom Portland, Oregon I'm also lonely and sad at times... 3 yrs. post-rrp. Caverject gives me an acceptable boner-unless I hit a vein, which I do around half the time. I can use the pump for a little self aggrandizement, and I can make myself climax, but w/ little size and little real thrill. Somehow, I still think my wife and I will get things going well again...sometime. Jack > > >>Men differ in how they respond after treatment. Some even find sex > more [quoted text clipped - 44 lines] > Tom > Portland, Oregon I'm able to achieve orgasm 3-4 weeks post-RP even with a completely flaccid "toad". It ain't the eye-rolling orgasm I got pre-RP, but THAT muscle is now in a jar or dumpster at the hospital. But my present orgasms seem to fill the square, and in fact the urge to have one happens more often now that pre-op. And it's a lot less messy than before, which offers some stealth advantages. Now that you mention it . . . see you later. I.P. > I'm also lonely and sad at times... 3 yrs. post-rrp. Caverject gives > me an acceptable boner-unless I hit a vein, which I do around half the > time. I can use the pump for a little self aggrandizement, and I can > make myself climax, but w/ little size and little real thrill. > Somehow, I still think my wife and I will get things going well > again...sometime. > >>Men differ in how they respond after treatment. Some even find sex more > >>pleasurable than before. [quoted text clipped - 22 lines] > > MikeH I am also 2 years post op, age 52 and am in the same boat, Mike. Sex did mean a lot more to me than I thought it did(pre RRP). But I had to do what I had to do, don't know if I will ever get completely used to having ED. I just try and immerse myself in other activities. Little by little I find that the depression caused by my non-existant sex life is changing. Maybe getting better. I still love my wife and what life has to offer, just have to call what's left good. Take care, Tom Portland, Oregon There was an article in the British Journal of Urology (I think it was October 2004) where they surveyed men post prostatectomy about orgasm. 37% had none 37% said it was less 20% said it was the same 4% said it was better For me, its just as intense, but over the time from surgery to about 8 months post op it stretched out to about 3 times as long. I think some of that change may have been due to using lots of ED drugs. I use the injections at least 4 times a week, and the pills on all the other nights. I've gotten a lot of natural function back, and the pils now work pretty well. I just like the shots better. There is an element of aquired taste. They get better over time. Caverject used to hurt like hell, so I switched to bimix. Now I'm back on caverject and it feels great. Everybody is different. PCa has been very difficult, but my sex life has been no less. It does require more effort, and certainly costs a lot! Steve > > >>Men differ in how they respond after treatment. Some even find sex > more [quoted text clipped - 44 lines] > Tom > Portland, Oregon Steve: First, thank you for the British Journal article. That was very interesting to me. I fall into the middle somewhere. It takes over an hour to an hour and a half to achieve orgasm (worth the trouble??). When I do reach orgasm, however, it is very different in two ways. One, it hurts, i.e., the dry pumping. Pleasure and pain at the same time. I hope the pain part diminishes over time. So far it has not. Second, the orgasm continues for a pretty long time, at least compared to what I had experienced in the past, if I continue the stimulation. The orgasm stops right away if I cease the stimulation. I imaging that is something like what they mean when they say that women are capable of "multiple orgasms"? When you say the Caverject hurt, I assume you mean the effect of the drug, not the injection itself. I had the same experience. I know the same drug is in the trimix that I now use, and at some point I will try the Caverject again because of the refrigeration requirement for the trimix. Does anyone know if there is a significant difference in the cost? 20 ml of the trimix cost me $58.00. Thank you. David S. >There was an article in the British Journal of Urology (I think it was >October 2004) where they surveyed men post prostatectomy about orgasm. [quoted text clipped - 14 lines] >a lot! >Steve Davis S, For me, it also stops if the stimulation stops. There is no inevitability like there was pre-op. The good part is that if the stimulation is right, I can keep it going a long time. Experimentation is worth it. We are living in modified bodies, and they work a little different. I have discovered that the shots allow me to have intercourse again an hour after the first time ( a big plus!). The injections hardly hurt me at all now that I have had a lot of practice. Caverject used to sting like hell for several hours when I was using it during the first few weeks post op. When I tried it again a few months later it was great. My doctor said he hasn't had anybody retry if it didn't work at first. Caverject costs about $23 per Impulse System here before insurance. It's too early yet for me post-op but can I ask you guys a question? Someone said you can have an orgasm without an erection, and that small quantities of urine may be ejected? What does this mean in terms of nerve sparing - that it worked, or that it did not? If you can achieve this shortly after the RRP is that a good sign for the future? Or should you expect the penis to at least get some blood pumped into it, even if it is not enough to achieve penetration? >Davis S, >For me, it also stops if the stimulation stops. There is no [quoted text clipped - 9 lines] >didn't work at first. Caverject costs about $23 per Impulse System here >before insurance. Hi, guy..... What it means is that the nerves that bring on an orgasm are not the same as the nerves that give you that erection. SO.... without an erection.... you can still stimulate yourself enough to reach that point of orgasm. You still feel contractions.... just have no prostate to provide the ejaculate. I've been able to make this happen since a few weeks post-op.... but with both nerve bundles spared, I still don't have my erections back two years later. As is used on some other lists, YMMV, meaning *your mileage may vary*.... we are all unique.... and our response after surgery... and return of function.... varies from person to person. It *would* be good to get a vacuum pump and start using it on your penis by about 6 week post-op if all goes well. This will get the blood supply flowing to the penis again. Do it a couple of times a day and keep it pumped up for a few minutes.... just for the exercise. Of course, at some point you may want to consider using the pump with rings to hold the erection and try to use it. Any *exercise* you can do with it will help get the blood pumping. Take care.... be well! MikeH > It's too early yet for me post-op but can I ask you guys a question? > [quoted text clipped - 4 lines] > Or should you expect the penis to at least get some blood pumped into > it, even if it is not enough to achieve penetration? I normally hate "working out". For this exercise, though, I'm making an exception, just because Strum encourages it. I.P. > Any *exercise* you can do with it will help get > the blood pumping. Answering questions is what we are here for. That and arguing about what is okay to discuss in this ng (ha). Yes, if you read up on it you will find that erection, orgasm, and ejaculation are all different functions in the body and controlled by different parts of the various body systems. Orgasm, they tell me, is something that takes place in the brain, so what is done in the surgery does not change that (physically; I don't know about psychologically). On the urine, that is one of those things that vary by the person. I do not leak any urine in orgasm. Some have reported here that they do. No idea what causes the difference. I have read here many times that urine is sterile if there is no urinary tract infection, so it is harmless. However, it can be a problem if the partner is put off by the urine in their body. I can understand that. Nerve sparing has nothing to do with orgasm (as far as I know). The nerves that are referred to here have to do with erection. Right guys? Ejaculation, of course, is a thing of the past because those organs are removed in the surgery. I guess the seminal vessels are not ALWAYS removed in RP, what I have read says "usually" removed with the prostate. If the seminal vessels are not removed I do not know if that means that ejaculation is still possible? Anybody know? Most guys, I think, would tell you that getting blood in the penis is good therapy. The ED specialist told me that the penis is like a sponge, so there is an effect on the tissues, atrophy I suppose, in the absence of erections. Use a pump or other means to get the penis erect. In my case there is no "enjoyment" in this practice. You can't stimulate the penis while it is in a plastic tube. Also, again in my case, the sensation is definitely not the same down there. Good luck to you. Thank you. David S. >It's too early yet for me post-op but can I ask you guys a question? > [quoted text clipped - 4 lines] >Or should you expect the penis to at least get some blood pumped into >it, even if it is not enough to achieve penetration? hee, The orgasm without erection has nothing to do with nervesparing. Being able to achieve orgasm is goog because it means you can still have an orgasm. There is evidence that having any kind of erections is good for getting erectile capacity back, and helps prevent scarring in the penis. I am always sceptical when someone says it is "too early".Using the injections, I was able to have intercourse again less than two weeks post op. I think they also help speed up recovery. I'm 10 months out now, And I've gotten a lot of function back, and steady (but slow) improvement continues. I can have intecourse with no drugs, but it is still much better with help. Good luck. Steve |
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