January 29, 2021 4 min read

Many men suffer with partial or full erectile dysfunction post prostatectomy.  Did you know that you can still have orgasms even if you cannot have erections?

JUMPING THE RIVER conjures up an image of a short cut. With some simple, but clever interventions men can use their capacity to rehabilitate their own erection function. This will hugely help with the excitation and neuro-muscular repair of all structures involved in the erection process.

Jumping the river, instead of taking the long way around, can sound a bit scary, but it can also be a lot of fun!

What to expect from erections after a prostatectomy?

The level of erectile dysfunction after a prostatectomy is dependent on the advancement of the cancer and the subsequent nerve sparring results. Where both nerves are spared, it is realistic to encourage the patient to regain an active sex life which will include erection capability. If a man has had a  non nerve sparring procedure he will be unable to obtain an erection with out external help. Where one nerve is sparred, full erection capacity can be obtained with medication, patience and lots of jumping the river..

The four phases of a man's sexual experience:

One can think of a man's sexual experience in terms of  four phases: foreplay, erection, orgasm and ejaculation/climax. (Ejaculation  is not possible post prostatectomy but a man can still experience an orgasm - it is actually to different things, which usually happens at the same time. Did you know that?)

These four phases work separately but intertwine to create the whole sexual experience. I often challenge men to consider how much thought, words, jokes and anxiety go into erections, (and later in life, ejaculation), yet minimal thought and mindfulness go into the orgamic phase... (and often even less into the fourplay, which is where the true art of lovemaking resides.)

Hardly any men are aware that an erection is not needed for an orgasm. The erection is needed for penetration and procreation. The orgasm is attainable with a flaccid penis. It is also a huge part of the pleasurable aspect of sexual activity. 

It is very important to know that you can have a very pleasurable sexual experience, when only two or three of these phases are present! If you have lost the ability to experience one or two of the phases, you do not have to miss out on the rest of them!

What is outercourse?

”Well my darling - it’s all that stuff we did before the ring was on the finger.”

                                                                    - my 74 year old patient said, turning to his 72 year old wife

It is hand work, oral sex, positional sex and any other sensual experience you would like to include. Combing two ore more of these, obviously work better than trying to use only one approach.


What is handwork?

Handwork is done with self stimulation or partner stimulation. Yes, it can be done on a flaccid penis – with lots of lube or in the shower or combined with oral sex. Gentle gliding movements over the looser skin works well and is effective. A U shaped vibrator can be used up and down the penis with the gentle end used on the glans. The man may experience arousal leakage of urine, which can go on to become climaturia  (leaking with climax ). As the external sphincter strengthens, this leakage diminishes.


How about oral sex post prostatectomy?

This is known to be the most successful partner stimulation.  Stimulation around the glans of the penis and just under the penis work extremely well. Oral sex can also be done on the scrotum. This is known as T-Balling.  Like the anus, the nerves to the scrotum are not affected by prostate surgery, and this area is therefore a useful tool for enhancing excitation to a weaker area. It is further stimulated by cold and if the partner has touched or sucked on an ice cube, sensation is enhanced. Each testicle can in turn be given it’s own oral sex . As one famous woman said “you just kiss it until it gets well”.


What is positional sex?

Genitalia against genitalia. Here the couple can “play” with a non or partial erection, trying to use gravity to their advantage. The penetrating partner stands or kneels at the edge of the bed or the missionary position. The most successful position is the “hot dog sausage in the hot dog roll.”  While spooning the partner, the flaccid penis is moved in a well lubricated vulva. The female partner can gently touch the glans, thus combining hand work and positional sex.


In short about post prostatectomy erections and orgasms:

Dealing with erectile dysfunction after prostatectomy requires communication, knowledge, love, trust and respect. Powerful gold dust to be put in the cauldron. Here is a chance for couples to rediscover and reinvigorate their relationship. For the couple that may not be able to experience penetrative sex again, this is an alternate way of having an intimate relationship.


Helen Shaw

MSH Team Member and Physiotherapist

Wynberg, Cape Town


If you need any help with Sexual Rehabilitation post prostatectomy, we have a whole team of people who can be of assistance!  Find a highly qualified and experienced clinician to reach out to here.

You might also be interested in the blog about Sexual Problems after Prostate Cancer.

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