Many men experience a reduction or 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 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 of energy and interest in previously enjoyed hobbies and activities. Depression often leads to a noticeable reduction in desire 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 greatly impact a man’s desire for sex.
4. Climacturia: This is a medical term describing orgasm-associated incontinence. Few, if any, men are told it’s possible they will leak or urinate during their orgasm. For some men and women, urinating during an orgasm is either highly embarrassing or a complete sexual turn-off, so a couple may avoid sex due to climacturia.
5. 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 of orgasms, or painful orgasms: Some men have orgasms of significantly reduced intensity, and pleasure also is reduced. This could become a turn-off. Some men also experience painful orgasms after surgery, and we have a built-in desire to avoid pain.
7. A reduction in penis size: Some men report a noticeable reduction in the size of their penises. This may cause some degree of shame that will greatly impact a man’s interest in sex.
8. Erectile dysfunction: The majority of men will lose the 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 anywhere else, but the following seems obvious to me. Before surgery, men had a number of triggers that could result in an erection. Here are six lost sexual triggers for erections:

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 these six 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 sexually exciting triggers leaves couples confused about their sexuality and sexual relationship. I suspect it takes a compete rewiring 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, and many couples lose their way.

To reclaim your sexuality post-surgery takes time, effort, experimentation, and new experiences to reprogram your mind and body to experience arousal in completely different ways than you did before 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 essential to reclaiming and renewing sexuality post-surgery. For some men, this is a temporary challenge. For others, it’s permanent.

For most of the four years I lived with erectile dysfunction, I never lost my desire to reclaim what I had lost after surgery — my erectile functioning.

After four years of failure with pills, pumps, and injections, I decided to have penile implant surgery. That decision gave me back what cancer took away.

My desire for sex never returned to my pre-surgery levels, but I’m enjoying our sexual relationship now more than ever before.

I have good news and bad news:

The bad news: Time doesn’t heal all wounds. You can get stuck in depression, withdrawal, and self-loathing. You can remain stuck for decades.

The good news: With or without implant surgery, you can discover new and creative ways to enjoy sex. It will take time, effort, intent, persistence, a teachable spirit, and a willingness to finish grieving what you’ve lost. Last, but certainly not least, you’ll need to change your definition of manhood. You’ll need to believe it’s possible to be a desirable man without the ability to achieve an erection.

Once you’ve redefined your manhood, you’re able to move forward living and loving with erectile dysfunction.

Portions of this blog were taken from the award-winning book my wife and I wrote titled, “Everything You Never Wanted to Know About Erectile Dysfunction and Penile Implants.” 

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Note: Prostate Cancer News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Prostate Cancer News Today, or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to prostate cancer.