DR THOMAS STUTTAFORD
Congratulations. One man in five is impotent by the age of 50, so you are doing well if, despite your operation, you are still able to have sex at the age of 74.
You don’t tell us the nature of your prostate operation. If it was a Turp (trans-urethral prostatectomy), you would be unlikely to have forward ejaculation. After this type of surgery men ejaculate backwards into their bladder, which isn’t harmful, rather than forwards into the vagina. The Turp operation is designed to treat benign enlargement of the prostate, the condition in which the patient’s urinary stream has become feeble, and they are having to pass urine more often and with greater difficulty.
Any surgical interference with the genitalia may disrupt its normal functioning. One of the first signs of an erection that isn’t quite as firm as it had been is that the glans, the tip, seems softer. As you gain in confidence your ability may well return to its earlier state.
If rather than having a Turp you had a radical prostatectomy to remove a cancerous prostate, there is invariably an inability to ejaculate. The seminal vesicles (the two small sacs that store semen) have been removed, together with the prostate and that part of the urethra where it is joined by the tubes carrying the semen. With the modern nerve-sparing surgery, 50 per cent of patients preserve their potency. Even though they may be technically potent, because their erection is strong enough to penetrate and can be maintained long enough to complete intercourse, the erection is rarely as good as it was.
The penis is composed of three spongiform barrels. The larger and more powerful pair, the corpora cavernosum, lie beside each other, like the barrels of a double-barrel shotgun. The third piece of spongiform tissue lies beneath them and the urethra runs through it. It is known as the corpus spongiosum and it expands to form the glans. As the urethra is cut through during the operation, the corpus spongiosum and the glans are rarely as firm as previously. The penis after a radical prostatectomy looks shorter and, with its droopy tip, acquires some similarity to Concorde.
If your operation has been the comparatively simple Turp, try not to concentrate so much on penetrative sex and the appearance of your penis. It may be bad for your morale to find that after 74 years your constant companion is not what it was. However, you might find that your wife is not as concerned as you. There are many other forms of sexual activity and ways of expressing physical love. You both might benefit from a visit by your wife to Ann Summers.
If you have had a radical prostatectomy because of malignancy, the important message is that the average extension of life from having this surgery is nine years. Of course some people will live much longer, and others less long. The surgery has been carried out to try to save your life or, if it can’t save it, to extend it. Men are often, and I speak from personal experience of a prostatectomy, unduly concerned about the adverse effects of the operation.
I always reassure myself that it is worth sacrificing a few pleasures to remain alive. In any event, if someone doesn’t have surgery their terminal symptoms will also in time induce impotence and other debilitating symptoms, and once in the graveyard they will find that there is no sex, and they might have been better without it, but alive.
SUZI GODSON
Normal is relative. For a healthy 24-year-old a rigid boner and a jet of the white stuff is normal. For a 74-year-old who has just had prostate surgery, an erection with the consistency of uncooked bratwurst and retrograde ejaculation is normal.
Unlike you, many men who have had prostate cancer in their seventies conclude that, given the rather gloomy alternative, an extra ten or twenty years is a fair trade-off for the indignities of impotence. They console themselves that ageing takes a natural toll on everyone’s sex life eventually and don’t pursue treatment because they feel embarrassed about drawing attention to their impaired sexual function. It’s a shame because men who refuse to give up on life, love and sexual intimacy are often pleasantly surprised to find that the range of treatment options is so widespread.
First up are the pills. Viagra, Levitra and Cialis all work by relaxing the blood vessels in the penis, which increases blood flow, encouraging erection. They should be taken about one hour before sex on an empty stomach and can’t be used more than once in a 24-hour period. None works without sexual stimulation and all are effective for different lengths of time. Viagra and Levitra work for about four to five hours and allow sexual activity for up to six hours. Cialis works for 17½ hours, though in some men this window extends to 36 hours, which is a significant advantage. Viagra, Cialis and Levitra are safe, but not if used with nitrates (heart disease medication) as they can cause a significant drop in blood pressure.
If you have heart or liver problems, your GP will probably recommend Uprima, a tablet that is dissolved under the tongue. It works within 20 minutes and the erection lasts a maximum of two hours. The other option is Muse, a tiny pellet (half the size of a grain of rice) that is inserted into the urethra. It dissolves into the erectile tissue and, if the penis is massaged, causes an erection within ten minutes which lasts about two to three hours. Caverject is a small plastic device that automatically performs an injection on the side of the penis. Though this sounds like the least sexy option, it is a self-administered treatment that feels like a pin prick, works within 10 minutes and gives a firm erection for up to 45 minutes.
Vacuum pumps are probably the most mechanical means of achieving erection. The limp penis is pushed into a suction cylinder and pumped to increase blood flow. When the penis is erect the pump is removed and a tight band placed around the base of the penis prevents the blood from flowing back out. The erection lasts about 30 minutes, but it is only hard above the band, which, because it is tight, can prevent ejaculation.
Last but not least is the inflatable penile prosthesis, as rudimentary as it sounds. This surgical implant is generally considered as a last resort but 90 per cent of men who have it are satisfied with the result. The outpatient procedure is about as invasive as a hernia operation and most men can have sex within six to eight weeks.
Whatever treatment you choose, make sure that you give it ample time to take effect and try everything between five and ten times before giving up. Keep track of new treatments; there are tablets, creams, gels, medications that are inhaled, and gene therapies all in development now.
OVER TO YOU
Do you have a sexual dilemma for Suzi Godson and Dr Thomas Stuttaford? Send your e-mails to body&soul@thetimes.co.uk or write to Body&Soul, The Times, 1 Pennington Street, London E98 1TT. The authors regret that, although your letters are much appreciated, they cannot respond personally.
