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Thread: Orgasmic Pain, does anyone have such problem?

  1. #1
    Experienced User wolfgang's Avatar
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    Orgasmic Pain, does anyone have such problem?

    After my radical prostatectomy (it's been 5 years now) I have different problem that nobody here shared or at least I couldn't find. I am not that much concerned about my ED because different help exists but I have orgasmic pain that becomes unbearable. I feel excruciating pain in my lower abdomen when having orgasm, it's like someone is stubbing me with a sharp knife. It is so painful that beats the purpose of having orgasm and sex in general. I didn't have the pain at the beginning, having a dry orgasm was strange but still nice. As the time went by the pain became stronger and stronger and now on the scale 1 to 10 it feels like 20 (LOL). Because of that I lost interest in sex although I enjoyed it previously a lot. My wife is OK with that but I am not. I read online that I am not alone in this and some 15 to 25% men have it after radical prostatectomy. I also read that it is because the seminal vesicles have been saved in order to spare the nerve bundles. I have a feeling like the sperm wants to get out from my testicles but there is no way out. I wish there was some kind of remedy for this excluding another surgery. Thanks for reading this.
    Age 63 in 2014
    10/2009 - PSA 3.6 Mild BPH symptoms
    04/2010 - PSA 4.5 First TRUS biopsy, negative
    10/2010 - PSA 5.6 Second TRUS biopsy, negative,
    12/2013 - PSA 10.7 Mild symptoms, no nocturia
    04/2014 - Saturated biopsy, 7/52 , Gleason 4+5
    05/2014 - Retropubic Radical Prostatectomy w/ Hernia repair
    Post-Op - Pathology negative, PCa Stage pT2b, N0, Mx
    06/2014 - Incontinence, ED still present
    06/2014 - PSA Total Ultra-sensitive <0.01
    07/2019 - PSA Total Ultra-sensitive <0.01

  2. #2
    Top User
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    Blue balls.

  3. #3
    Moderator Top User HighlanderCFH's Avatar
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    As far as I know, the seminal vesicles are always removed along with the prostate, even when the nerves are being spared.

    I would consult with your urologist about the pain, though, and see if it can be helped.
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Eight annual post-op exams 2012 through 2019: PSA <0.1
    Semi-firm erections without "training wheels," usable erections with 100mg Sildenafil.
    NOTE: ED caused by BPH, not the surgery.

  4. #4
    Senior User
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    Yes my doctor at Mayo said they always take the seminal vessels.
    DOB 1955
    63 at dx
    3/2018 PSA 4.05 DRE normal refer to URO small town
    10/2018 PSA 6.28 DRE normal
    Bx 11/2018 12 cores 3 pos 1 - 5% left mid 2 - 50% left base
    GS 3+4=7 T1c
    Appt Mayo Clinic Phoenix Az 1/4/2019
    Dr. Paul Andrews recommend
    MRI 2/27/2019 Mayo AZ
    RALP 2/28/2019 Mayo AZ Dr. Paul Andrews
    Path: GS 3+4=7, Tertiary Gleason Pattern none, Grade Group 2
    Tumor presents moderate to extensive volume mainly posterior
    portion of prostate. Largest tumor nodule measures 8 mm
    Prostate: 21g 3.5 x 3 x 3 cm
    EPE: Neg
    Bladder Neck Invasion: Neg
    Seminal Vesicle Invasion: Pos (left seminal vesicle)
    Margins: Pos left lateral base & central base 2mm focus each
    Lymph Nodes involved: 0
    Lymph Nodes Ex: 16
    Nerves spared right side only
    Path Staging (AJCC 8th Edition)
    Primary Tumor pT3b
    Regional lymph nodes: pNO
    Distant Metastasis: Mx
    Continence 99% 9 wks
    ED Present
    PSA 4/17/2019 <.10
    PSA 5/2/2019 <.007
    PSA 6/10/2019 <.10
    PSA 8/1/2019 <.007
    PSA 9/16/2019 <.10

  5. #5
    What has your uro said about this? Surely you haven't kept this to yourself all this time? Intense pain with orgasm is not normal and needs to be investigated. It can result from abdominal surgery and from RP.

    Good luck,

    Djin
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg., then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional
    SM EPE BNI LVI SVI LNI(16): negative, PNI+, nerves spared
    pT2c pN0 pMX acinar adenocarcinoma G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    11-10-17 Decipher 0.37 Low Risk: 5-yr met risk 2.4%, 10-yr PCa-specific mortality 3.3%
    Dry; ED OK with sildenafil
    9-16-17 (5 wk) PSA <0.1
    LabCorp uPSA, Roche ECLIA:
    11-28-17 (3 m ) 0.010
    02-26-18 (6 m ) 0.009
    05-30-18 (9 m ) 0.007
    08-27-18 (1 yr.) 0.018 (?)
    09-26-18 (13 m) 0.013 (30-day check)
    11-26-18 (15 m) 0.012
    02-25-19 (18 m) 0.015
    05-22-19 (21 m) 0.015
    08-28-19 (2 yr. ) 0.016
    Avg. = 0.013

  6. #6
    Experienced User wolfgang's Avatar
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    It seems nobody here has such pain, I am here the lucky one to have, incontinence, ED and horrible orgasms. This RP really screwed me up but as my wife says I should be luck to be alive. Anyway, I spoke to my urologist but all he said it's lots of nerves in question. The relation to the semen vesicles is something I read about online so they may be or may have not been removed in my case. However, I am not the only one having this pain, it is common occurrence after RP, some 20% have this type of pain. Thanks to all for your input.
    Age 63 in 2014
    10/2009 - PSA 3.6 Mild BPH symptoms
    04/2010 - PSA 4.5 First TRUS biopsy, negative
    10/2010 - PSA 5.6 Second TRUS biopsy, negative,
    12/2013 - PSA 10.7 Mild symptoms, no nocturia
    04/2014 - Saturated biopsy, 7/52 , Gleason 4+5
    05/2014 - Retropubic Radical Prostatectomy w/ Hernia repair
    Post-Op - Pathology negative, PCa Stage pT2b, N0, Mx
    06/2014 - Incontinence, ED still present
    06/2014 - PSA Total Ultra-sensitive <0.01
    07/2019 - PSA Total Ultra-sensitive <0.01

  7. #7
    With a G9 on biopsy, I highly doubt you have SVs intact. If you read your pathology report it should clearly indicate if they were examined post RALP.
    YOB 1957

    DX 12/18, GS 8, 4+4 6/12 cores, LL Apex 100%, LM Apex 60%, LL Mid 50%, LMM 40%, LL Base 5%, LM <5%, Right side negative.

    3/6/19. Pathology - Grade Group 4 with Intraductal Carcinoma
    T3aNO, 1 mm EPE, GS8, 21 mm uni-focal tumor involved 10% of prostate.

    7 Nodes, SV, SM, PNI, and BNI were negative.

    LVI and Cribriform pattern present.

    Decipher .86 High Risk.

    Post Surgery PSA
    3/25/19 .03. (28 days)
    4/25/19 <.03. (58 days)
    5/25/19 <.02. (88 days)
    9/10/2019. <.02. (198 days)

    3 Part Modality Treatment

    2/25/19 Robotic Laparoendoscopic Single Site Surgery outpatient Cleveland Clinic,

    ADT - started 6/19, end date 6/21.

    ART - Completed 9/26/19. (78 Gy, yes, I glow in the dark)

  8. #8
    Wolfgang, having not gone through a RP I don't have any advice for you unfortunately. But I want to offer sympathy and hope for better days.
    Born 1953. All care at Kaiser in LA.

    10/11/18: 2 positive low volume (5-20%) G6 cores out of 12. Prostate vol 33g.
    Jan-June 2019: saw several uros, only initial one recommends treatment: all others AS.
    7/15/19: Dr. Leonard Marks at UCLA: AS. UCLA radiologist finds nothing abnormal in MRI.
    Currently on AS.
    Urolift for BPH 10/21/19

    PSA
    8/2/18: 1.2
    3/26/19: 1.8
    6/14/19: 2.2
    10/18/19: 2.0

    Head and neck cancer 2009: Surgery and 31 days IMRT. NED for 10 years and counting.

  9. #9
    I don't have pelvic pain, but I do get a burning sensation in the urethra within the penis. It subsides in a couple minutes. I figure it is from muscle tissue contracting and since there is no fluid there, the urethra is being squeezed and irritated.
    There is no right or wrong decision for treatment. Make the decision you are comfortable with and can live with and not second guess if all does not go optimally.

    6/2016 PSA 5.1, negative DRE
    6/2016 Urologist PSA 6.0, %free = <10% chance cancer, negative DRE
    12/2016 PSA 7.7, %free = 50% chance cancer, negative DRE
    2/2017 biopsy Bostwick 5/12 3+3, perineural invasion. Hopkins 5/12, 4 3+3, 1 3+4 (5% 4), perineural invasion
    5/17/2017 Open RP by Dr Alan Partin - Hopkins (5500+ prostate cancer surgeries, open & robotic)
    5/2017 Pathology 3+4, T2x, +margin (6mm, 3+3), organ contained except unevaluable at +margin, moderate tumor extent
    seminal vesicles, lymph nodes all neg
    Age: 62 @ surgery
    8/2017 PSA < .1
    11/2017 PSA <.1
    5/2018 uPSA .06, standard .1
    8/2018 uPSA .07, standard .1
    11/2018 uPSA .10, standard .1
    12/29/2018 6 month Lupron shot
    1/22/2019 start SRT, 39 treatments, 5 days per week
    3/15/19 ended SRT with no significant side effects

  10. #10
    Regular User
    Join Date
    Jul 2017
    Posts
    27
    I too have occasional orgasmic pain. It seems to me that the stronger the orgasm, the worse the pain is. My Oncologist thinks it is muscle spasms pulling adhesions in the tissue that has grown together. I don't have this problem every time, but it is a real mood killer.
    PSA 1/2013 was 3.6, DRE normal.
    PSA 8/2014 was 5.5, DRE normal.
    Open RP 11/20/2014. Age 55.
    Pathology from surgery:
    Gleason 3+4=7, Tertiary Pattern 5 (15%)
    Tumor size: 30x 24x 12 mm
    Extraprostatic extension present nonfocal (established, extensive) right and left posterior
    Seminal vesicles, bilateral +
    Positive margins, multifocal, Apical, Postero-lateral
    Perineural invasion +
    19 Lymph nodes, Negative, Tumor t3b
    Adjuvant RT, 1/16
    PSA 7/19, <0.01

 

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