25 May 2020:  At last I am able to take practical action on penile rehabilitation. Medically, it directly addresses the biggest danger to long term erectile function arising from my prostate cancer surgery.

Penile rehabilitation exercises also promise to help with sexual function. Some practice and  open communication is needed to get over the awkwardness. It feels weird to apply mechanical exercise around an intimate activity which we expected to be spontaneous.

It helps me to think of this as “yoga for the penis” in that it is a stretching and exercise routine for long term health. I don’t intend to imply that it has a direct link to the distinguished lineage of established forms of yoga practice.

The missing link in pre- and post-operative care

I should have been properly briefed about penile rehabilitation before my surgery, and started rehab months ago. Instead, I have been stuck with the dilemma of being told to “use it or lose it.” Yet with the impact of neuropraxia (nerves recoiling from the heat and light and something like bruising during laparoscopic surgery) I was completely unable to find the elusive erection I’d been told to use.

There was an alarming missing link in the information I received from my urologist and surgeon. And embarrassment makes it harder to ask questions. My doctors seem almost more afraid to talk about matters of sexual function than I am.

Medical basis for “use it or lose it”

Here’s what I now know after a lot of research: My ED condition leaves my previously dependable old friend down below subject to “reduced oxygenation and subsequent structural changes in penile tissue.” Without the blood flow that comes with erections, basically my penis will permanently atrophy. Also, without penile rehabilitation, more men experience significant loss in penile length and girth after prostate cancer treatment.

Men lose 2000 spontaneous nocturnal erections a year after prostate surgery

“My” kind of surgically induced erectile dysfunction is more deadly for the erectile tissue than ED from other natural causes. This is because the nerve damage also breaks the natural cycle of spontaneous nocturnal erections.

Spontaneous nocturnal erections occur several times a night regardless of whether we are sexually active in our conscious daytime lives. Women also have spontaneous nocturnal clitoral erections as part of their body’s natural housekeeping function for erectile tissue. We typically aren’t aware of what is happening down there while we are sleeping – except that men’s “morning wood” tends to be more obvious.

The erections we don’t know about, in the depths of sleep time, are not about erotic events. They are essential natural housekeeping for erectile tissues. Without this form of regular oxygenation, erectile function is permanently lost.

I was alarmed to learn that after prostate cancer surgery, men lose 2000 of these unconscious tissue-regenerating erections a year. Those who opt for radiation treatment are usually better off for the first few years, but tend to end up with similar problems within 5 years.

Drug independent penile rehabilitation treatment

There is strong evidence for the value of Vacuum Erectile Devices (VEDs) in penile rehabilitation (in a field with very limited conclusive research data). I purchased a Vacurect device to enable me to stretch out and oxygenate these precious erectile tissues.  My third month since radical prostatectomy has been by far the worst from an erectile dysfunction (ED) point of view, and my ongoing daily dose of Cialis isn’t helping in any way I can detect.

I got the VED recommendation on the very practical Australian website ATouchySubject.com. Amazing information to get from half way round the world: The Vacurect device turns out to have been designed, developed and manufactured about 60 kilometres from my home in South Africa. For the background, please read a remarkable personal and business story of innovation and recovery from all kinds of adversity.

Immediate positive results

From a medical perspective, I am thrilled at the new life the Vacurect brings to my flaccid member. Right out of the box, I am able to use this medical grade device to literally pump up my erection, flushing the tissues with life-giving blood and allaying my fears of penile atrophy, shrinkage and even the radical bending that comes with Peyronie’s Disease.

Penis owners with these issues, please see my Resources section for the low-down guide to using the Vacurect in practice.

Pathway towards regaining sexual function

From a sexual perspective my first attempts with the Vacuum Erectile Device (VED) are not exactly thrilling. I mention my latest purchase to my wife and she is encouraging – from a bit of a distance. I am also shy about it.

It’s a long way from the fantasy of spontaneous uncomplicated sex. The device feels awkward and the first time I bring it into the bedroom the results are underwhelming. With so much focus on the mechanics, all erotic thoughts disappear and even the pump can’t revive my flagging erection.

[Editor’s note: see Awkwardness and love intertwining (Day 115) for more about this aspect.]

Taking myself in hand without shame

The GP who saved my life with my cancer diagnosis gave me this down to earth advice the week after my surgery: “masturbate at least twice a week.” Since surgery that has been physically difficult, but not impossible, without an erection.

The Vacurect makes it all a whole lot easier. Solo play emerges as my first step back towards regaining sexual function. Perhaps my cancer recovery will finally banish whatever vestiges of masturbation shame that still dance around my psyche.

I am scared that solo play will usurp the joy of marital intimacy. My wife and I commit to exploring new forms of intimacy that don’t depend on erectile function. Before my cancer, we already believed we were good at this.  With ED, it has proved more difficult than we expected. More about our laughs, fumbles and learning in a future post.

A new form of yoga

Our daily routine: yoga on the lawn | Photo credit @lunchtimecontinuum

My wife and I have been doing daily yoga for our whole bodies and spirits for more than ten years. The stretching and exercise is deeply sustaining of our lives.

Now, with penile rehabilitation, I have a new yoga-like therapy for stretching and exercise of my penis to help with recovery from nerve damage.

This practice, as described above, is awkward – but then I found the other more ancient form of yoga (illustrated here) pretty awkward when we started.

Practice makes perfect.

[See also Yoga for the penis Part 2: real time biofeedback]


An edited version of this post also appears on PsychologyToday.com