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Nerve sparing during prostate surgery

Nerve sparing or non-nerve sparing?

As you can see from the wonderful diagram below, the prostate gland is in a very inconvenient position when it comes to removal.

Nerve bundles around the prostate gland

 

Getting that gland out without utterly destroying those precious nerve bundles is a seriously tricky task.  Nerve sparing refers to the technique designed to protect and preserve the fine network of blood vessels and nerves that runs along both sides of the prostate.

Surgery to remove the prostate is called a prostatectomy.  I had one of these in 2011.  Getting my penis back in action has been a work in progress ever since.

Naturally, if you want to get an erection, you need the help of those nerves around your penis.  That’s where the question of nerve sparing comes in.

Steps along the way to recovery

I refer to my nerves tingling as a sign that there’s some response down below.  In the early days and months that followed losing my prostate, there was no tingling at all.  We did discover that men can have an orgasm without an erection.  This happened a couple of weeks after my catheter came out and it was totally unexpected.

First there was Viagra …

Using Viagra created interesting erections, with Percy not fully erect and sort of like an uncooked sausage. The orgasms that came with penetrative sex were painful in the early days and the nerves were more than tingling.  Thankfully, these painful orgasms eventually backed off over the next twelve months.

I discovered, when I was practising my pelvic floor muscle exercises, that I could activate my pelvic muscles to increase the nerve response.  Unfortunately, that came with more than nerve tingling – it felt like my pelvic floor was stinging.  I must admit, I probably wanted to hurry along the orgasm (not a good idea).  This was even more pronounced with oral sex.  As Fiona said, I needed to relax and enjoy the moment and not focus on the end.

Then came the needle …

When Viagra didn’t seem to work so well, I was prescribed an injectable medication called Trimix. This time, the orgasms felt more like they used to before my surgery, without the sting.  Rewarding myself with a chocolate after giving Percy his jab helps to get over the needle heebie jeebies.

Don’t forget to reconnect your brain

A vital part of penis rehab, in my experience, is to get the old brain-to-penis pathway working again.  Use your mind to imagine sexually arousing things.  This should send signals to the nerves below and hopefully leads to some response from Percy.  With practise, I found that the nerves started tingling, which has increased over the years, along with my erections.  It always feels good to see Percy rising to the occasion!

Of course, all this depends on what you and your partner really value in your post-surgery life together.  You may want to remain sexually intimate, or that part of your relationship may no longer be so important to you.  Whatever choice you make, working on your penile rehab and getting those nerves tingling is still critical to keep your penis healthy.

Back to the nerve sparing info

In a series of recent videos, Professor Declan Murphy (urologist with Peter MacCallum Cancer Centre) chats with Victoria Cullen (A Touchy Subject) about nerve sparing, non-nerve sparing and advances in nerve grafting procedures.