July 18, 2024: Over 50% of the nearly three thousand men in the 2022 EUPROMS study reported sexual function to be a big or moderate problem. I think the main part of my erectile nerve recovery is nearly complete 4 and a half years after my treatment for prostate cancer. What I notice now is the subtler part of recovering sexual function after prostate surgery. For me, it seems now to be mainly about relaxing into my new body and its ways of functioning sexually.

Stages of recovery over 4 years since radical prostatectomy

Don’t be too sure of what they tell you about recovery of sexual function taking 6 to 24 months after prostatectomy. It has been a much slower and more complex process for me. The big steps over since my surgery included:

  • Being able to get even a partial erection, with the help of pump and ring and stimulation (year 1)
  • Starting to notice myself swelling up in response to erotic thoughts, or a cuddle with my wife, without direct stimulation (year 2)
  • Spontaneous nocturnal erections that were quite firm (Year 3)
  • Natural erections firm enough for vaginal penetration (on again, off again)

Another step I would like to get to, but may not enjoy again in this lifetime, is really durable erections. Mine come and go in a rather whimsical way. But I realise that my trajectory of recovery might be meeting my arc of aging.

Age related changes coinciding with prostate cancer treatment

5 years ago, before my surgery, my wife and I had developed an ease about my erections sometimes fading during intercourse. It never bothered her, and I got over it quite quickly as I realised that just staying in the moment of lovemaking was more important than worrying about the hardness of my erection.

In the anxiety of ED after my prostatectomy I conveniently forgot that my erections were not always that reliable at age 60, before prostate cancer. Now my ego, mind and body are allowing me to go back there and remember that we learned a freewheeling kind of lovemaking that took periods of limpness as normal.

Brain-genital connections restored

It is wonderful to have my body respond to my wife in a tangible way again. I think she likes it too. It is great to have some erections return in a natural way – in other words from pure love and desire, without tugging or rubbing, without drugs or pumps. Yay!

It often takes a conscious effort not to wonder about whether I am swelling. My wife has also taken to letting me know when I grow, which helps me not focus on trying to “push a piece of rope.” The big thing now is to enjoy the easy flow between us, and not focus on what is NOT happening.

When I relax like this, then actually my body is able to respond to my loving sexual attraction to my wife. A little swelling goes a long way once we both let go of hankering after what it was like when we were young.

Subtler sensations taking over from the big explosions

It’s OK that orgasms from intercourse are now rare for me. Just the connection from penetration is enough for me most days, plus I often have what I describe as mini-peaks. It is a year since I coined that term and I still don’t always accept these subtle climaxes. But when I do, everything goes much better. The whole “blue balls” thing is more of a young man issue, I tell myself.

It’s also OK that erections wax and wane during lovemaking. The more I really accept that, the quicker the erections recover.

This is the weird thing. Erections can’t be willed. They are a gift, and they do better when the penis owner is relaxed and focused on love, not performance.

As Dr Jo Milios so famously said “A watched cock never comes.”