Why Men Withdraw From Sex After Prostate Surgery

Many men experience a reduction and/or a loss of their sex drive after their prostate is removed. This reduction can be a result of a variety of reasons such as:
1. Coping with cancer-the emotions of fear and/or anxiety can impact sexual desire.

2. Depression- men often experience post-surgical depression. When men are depressed they don't typically experience depression the same way women do. Women typically become sad. Depressed men are frequently agitated, irritable, and easily angered. They could experience a loss energy and interest in previously enjoyed hobbies and activities. Depression often leads to a noticeable reduction in desire and/or  interest in sex.

3. Losing urinary control- After prostate surgery the majority of men lose the ability to control urination. This lack of control may great impact a man's desire for sex.

4.Climacturia is a medical term describing orgasm-associated incontinence. Few if any men are told it's very possible they will leak and or urinate during their orgasm. For some men and/or women, urinating during an orgasm is either highly embarrassing or a complete sexual turn off, so the couple may avoid sex due to the appearance of climacturia. 

5. The Loss of Ejaculation- After surgery men lose their ability to ejaculate. This can affect the pleasure men feel. Some men will avoid experiencing orgasms because of the sense of loss or sadness they feel after an ejaculation free orgasm. 

6. A change in the quality or intensity or  painful orgasms-For some men there is a significantly reduced intensity of their orgasms so there is a reduction in pleasure. This could serve as a turn off. Some men will experience painful orgasms after surgery, and there is a built in desire to avoid pain.

7. A reduction in penis size-Some men report a noticeable reduction in the size of their penis. This may cause some degree of shame-which will greatly impact a man's interest in sex.

8. Erectile Dysfunction-The majority of men will experience the loss of their ability to experience an erection for a minimum of 18-24 months. The inability to experience an erection can have a devastating impact on a man's libido and desire for all forms of physical contact. 

I don't know why I haven't read this any where else but this seems obvious to me that prior to surgery each man had a number of triggers which could result in an erection. Some of those triggers for an erection were:
1. Sight-Men often get aroused as a result of seeing something that turns them on.
2. Sound- Certain sounds or sex talk can arouse men. There is a whole industry based on the power of sex talk to arouse men
3. Smells- Certain smells can arouse a man to experience an erection
4. Fantasy- Men have the capacity to use their imagination to think about sexual experiences that arouse them, resulting in erection.
5. Words-Some men are aroused by reading about sexual encounters.
6. Touch- Certain forms of touching can create a state of arousal.

After surgery, men lose their capacity to respond with an erection to each and every one of their sexual triggers. There is a powerful emotional reaction to this loss. After surgery, these previously exciting triggers elicit feelings of loss, disappointment, frustration, anger and shame. Couples are unpleasantly surprised when they discover their pre-surgery sexual history is lost to both of them. Unfortunately, very few couples are provided with counseling or help in grieving these losses. Typically men withdraw emotionally and physically from their partners resulting in their relationships becoming highly stressed.

I believe the complete and total loss of sexual exciting triggers leaves couples confused about their sexuality and sexual relationship. I suspect it takes a compete re-wiring of the brain for a man to learn he can be sexually aroused with a flaccid penis. It's challenging for couples to find new ways to enjoy sex post-surgery many couples lose their way. 

To re-claim your sexuality post-surgery takes time, effort, experimentation, and new experiences to re-program your mind and body to experience arousal in completely different ways than you did prior to surgery.  Men must learn how to find pleasure, enjoyment, and orgasms with a flaccid penis, This isn't a simple or easy lesson for a man to learn but it's an essential lesson to learn in order to re-claim and renew sexuality post-surgery. For some men this is a temporary challenge for others it’s permanent.

My wife and I met this challenge and successfully established a new sexual relationship. However our new sexual relationship didn’t take away our desire to resume the closeness and pleasure of sexual intercourse. We made a decision that surprisingly few couples make with regard to treating ED that's unresponsive to medications or injections. 

Four years after my prostate surgery I decided to schedule surgery for a penile implant. If all goes well I'm six or seven weeks away from resuming that part of our sexual relationship.I'm looking forward to a restorative surgery after experiencing a surgery that took so much away.

Rick Redner & his wife Brenda Redner are the authors of: I Left My Prostate in San Francisco-Where's Yours?