Penile Rehabilitation: Progress & Challenges
These stories have been compiled from quotes given with consent during a survey sent to the ‘Touchy Subject’ audience in March 2023 (228 respondents).
Penis ‘feels’ healthier
“I took 5mg Tadalafil daily (morning) until my urologist stopped it at 12 months - he thinks it's not doing anything but hedged his bet saying we can restart it later. I use my vacuum device daily, about a 15-minute session. I started to use Trimix fortnightly, and now every 5 days. Penis "feels" healthier, especially during pump use. I’m finally feeling comfortable with injections and this week was the first time (at twelve months) we tried (and we succeeded!) with vaginal penetration. Very excited. The only challenge I’ve got is waiting for nerve repair. The rest is easy if you're patient.”
(6-12 months of penile rehabilitation)
Orgasmic Waves
“I do a mix of activities, exercises as prescribed by my bladder physio at least twice weekly, Vacurect and hand massage 1-2x weekly, hand massage without aids 1-2x weekly, depending on time available these sessions can last 20 to 30 minutes either during the day or when retiring to bed in the evening. Occasionally I use injection therapy combined with hand relief. Post robotic surgery I have experienced gradual improvement over some 18 months, both flaccid penis and erect penis size have improved significantly over time, returning essentially to preoperative size (length), notably orgasms have returned and experienced more as orgasmic waves followed by a full and deep orgasm (usually accompanied by arousal incontinence, which proves challenging). My challenge is encouraging my partner to support and become involved in the process.”
(1-2 years of penile rehabilitation)
Shrinkage after Surgery
“I take viagra every day and use a Vacuum device daily. After one month, I noticed my penis returning to normal size. It seemed to have suffered some shrinkage immediately after surgery. Also after pumping it’s retaining some fullness and a little firmness. My challenge now is gaining and maintaining a full erection. It has not happened yet.”
(3 months or less of penile rehabilitation)
Struggling with Purpose
“I do kegel exercises daily and use a vacuum pump at least 4 times per week. All done as time permits during the day. Urinary continence is close to 100%. A few dribbles on occasion but not many. I’m starting to get something that resembles an erection. Only about 10% of what would be required for intercourse, but it’s a start. What I struggle with most is Purpose. As an older man, you question the purpose of rehabilitation.”
(3-6 months of penile rehabilitation)
It’s Emotional
“My rehab is ad-hoc, sometimes daily then gaps due to travel etc. Sometimes in the morning sometimes late at night. My penis is much bigger and harder after using the pump regularly, but not as big as before the surgery (perhaps -10%). I’m able to masturbate with the ring on post-pumping but it’s still not possible to penetrate. Having no natural erections is emotional. I was the dominant partner during sex and now this is no longer the case.”
(1-2 years of penile rehabilitation)
Nocturnal Return
“A sequence of sucking the ‘nuts up to the guts’ morning and night. It takes about 10 mins each session. Also using the vacuum pump and Tadalafil 2 to 3 times a week. I’ve noticed nocturnal erections, 4-5 nights in a row at around 4.00 am, I’ve also enjoyed intimacy with my partner, and with them, I’m able to maintain an erection for intercourse. Trying to maintain a good hard erection is my challenge now”
(1-2 years of penile rehabilitation)
Graph: Are men doing penile rehabilitation activities 5+ days every week seeing more signs of progress?
Heart Health is “Hard Health”
“I try to use my pump daily before bedtime. I also occasionally use injections, every two to three weeks. I try to masturbate every second day, sometimes I take Viagra beforehand, maybe once a week. After nine months, I now achieve a solid erection using the pump, almost as good as before surgery. I don’t use the rings, not even the rehab ring, so it's for rehab purposes, not penetration. I am still experimenting with injections at this stage, but unfortunately not erect enough for penetration. I am starting to get small erections spontaneously, nowhere near enough for penetration but it's been promising. I might try using the rings to maintain an erection soon. I'm just worried I won't be able to remove the ring. Exercise has been a challenge. Exercise for heart health is also good for "hard" health, so I’m now using my elliptical trainer every morning and weights every day to give me the best chance at rehab.”
(6-12 months penile rehabilitation)
Early Riser
“I do rehab about 6 mornings a week, between 5:30 and 6:00 am, when no one else is up. My routine includes 1 set of pelvic floor exercises, Vacurect application, and sometimes I use the Manta vibrator. I’m getting some erectile function naturally, but not yet to 50% of desired erection, and sadly there’s not much activity when I’m intimate with my wife. My biggest challenge is a much, much firmer erection!”
(3-6 months of penile rehabilitation)
Masturbation wins (and losses)
“I initially used the pump daily for over 6 months but I rarely do now. I found it not really effective for intercourse. I’ve moved on to trimix injections, which work well, but I’ve not used them much either due to my wife not being too receptive to sex anymore. I’ve been able to get erections of various degrees through masturbation, but it’s hit and miss, same with oral sex and occasionally I’ll notice that my penis is slightly bigger than usual. I guess my biggest challenge is my relationship. My wife has gone off sex, and I now have arm and wrist problems due to masturbation! I’m looking into different masturbators that hopefully will do the “work” for me”
(2-3 years of penile rehabilitation)
Missing Spontaneity
“I try to pump daily, the last thing at night. In reality, it would probably work out to be 4 times per week. I’m noticing a slight firming during the night. The biggest challenge is intimacy. I find it difficult not being spontaneous. I know it’s just in my head but I can’t seem to get past it. Life is different on this side.”
(6-12 months of penile rehabilitation)
Arousal Incontinence
“I do rehab about every other day. Vacurect pump, kegels, and a few pelvic floor exercises. I usually do this in the morning when I have my shower. My progress is that most incontinence is now gone and partial erections are possible, however, I get occasional small leaks and reasonably frequent arousal incontinence (climacturia).”
(1-2 years of penile rehabilitation)
Pump Improvements
“I use a pump daily and try to do kegels daily too. I do a lot of walking and some exercise. I’ve not had sex since January as I’m away from home working and my wife hasn’t been to visit. She’s most likely happy that she doesn’t have to be involved right now since her sex drive has all but disappeared anyway! When using the pump my penis feels and seems fuller and larger. I haven’t tried to pump for intercourse but it seems to be getting bigger than it has been. I still haven’t gotten any erections without pumping. My biggest challenge is that I seem so far off from my old self prior to my surgery.”
(6-12 months of penile rehabilitation)
Progress from the ‘Touchy Demonstrator’
“Every day I use either the Vacurect or a ‘sex shop’ pump for about 10 minutes or so. If I use the Vacurect I pump to full erection. Sometimes I give it a stroke, I think it’s good to give the little fellow a run around the block! I use the ‘sex shop’ pump when I want to just cycle the erection up and down, but I find this challenging to replicate with the Vacurect, due to the lack of a release valve. I always pump before I take a shower because the lube makes a bit of a mess. I take Cialis (20 mg) daily unless I’m going to get lucky, then I take Viagra, not Cialis. I also take Lion's Mane (a mushroom derivative) every day, because it’s supposed to enhance nerve repair. I also add cardamom seeds to my ground coffee before I brew (a doctor of eastern medicine suggested this). It’s supposed to enhance erectile function, but I don't know. I’m seeing some erectile function return over time. It plateaus and then moves forward. I can get kind of chubby with some stimulation, sometimes touch, sometimes porn. I met with my surgeon recently, who was happy that I’m still working at it and gaining some erectile function. He urged me to stay with the rehab and cross my fingers. Well, I'm not crossing my legs!”
(2+ years of rehabilitation)
Slow Progress
“I do 6 sets of 10 pelvic floor exercises daily, most days I take a 1/4 viagra tablet. Once a week I take a whole viagra tablet, and 3 to 4 days a week I use the pump. I can now get a partial erection (40% to 75% size), but I can’t have sex with this. It’s very slow progress so it feels frustrating and sometimes it’s difficult to get motivated”
(6-12 months of penile rehabilitation)
Staying Patient
“I pump once or twice a week (in the evenings). I also take two therapeutic doses of tadalafil (20mg) (with my doctor's permission) regardless of intercourse, which seems to help with overnight erections. As part of my recovery, I also inject and have done two treatments of pulse therapy. After about two and a half to three years of rehab, I was able to maintain an erection for intercourse with the help of tadalafil. It took a long time and a lot of patience to work properly again. I had poor results for two + years. Overcoming the psychological impact was the hardest part - stress, performance anxiety, frustration, anger, etc.”
(3+ years of penile rehabilitation)
Graph: Are men seeing signs of progress at different timeframe stages of rehabilitation?
Almost hard enough
“I started Viagra once a week with masturbation a year ago, then six months ago I added a generic penile pump. I pump usually 5 days a week. Masturbation varies but a least twice a week. I just purchased a Vacurect and I'm in my first week of using it. I’m experiencing progress as I can get an erection without Viagra, but whether I use Viagra or not it's still not firm enough for penetration. So my challenge is getting my erection hard enough for penetration, and I’m still getting the hang of the Vacurect. ”
(1-2 years of penile rehabilitation)
Masturbation for the win!
“I do daily pelvic floor exercises randomly throughout the day and daily masturbation. I get spontaneous erections about half-hard but not hard enough for vaginal penetration, they are good enough for masturbating though, and after a minute or so of self-stimulation, they are hard enough to have sex. My challenge is finding the time to use the pump and masturbate.”
(3-6 months of penile rehabilitation)
Happy Pumping
“Upon waking up I conduct pelvic floor exercises in bed. Then use the low-speed on a miniature bullet vibrator on my penis. Every 2-3 days I exercise with my Vacurect using the largest ring, I do 5 sets of pumping and hold for approx 2 minutes at the top. By this time, ‘Old Mate’ is reaching the 7 to 8-inch mark and 5.2 cm diameter. Quite pleased with that outcome to date. I’ve managed intercourse successfully with the pump, it works well on me at the moment and my spouse definitely has a smile on her face. I’m continuing to work on reaching an erection without the pump.”
(less than 3 months of penile rehabilitation)
Injection Success
“I use a vacuum pump every couple of days, Tadalafil 5 mg each night, and at times I use 20mg to try for an erection. I’m now also using injections for penetrative sex and I go to the gym twice a week. I get semi-erect using the pump and tadalafil together, but it’s not good enough for penetrative sex. Starting to use injections has made a big difference, and at times I can hold my own without the injection. I feel the injection has helped my progress with erections. My challenge now is getting my continence back and the work required with using a pump.”
(6-12 months of penile rehabilitation)
Pumping Positivity
”I do my rehabilitation daily. I did it both morning and night at the start, but now it’s mostly at night. I’m now able to achieve an erection for periods of time with the use of a tight Vacurect ring. I’ve started to notice spontaneous engorgement at times and I’m feeling more positive since I started using the Vacurect pump. My incontinence is also well under control, which I am very happy about. My challenge now is to achieve an erection without the pump.”
(less than 3 months of penile rehabilitation)
Good Vibrations
“I pump daily, use a vibrator, and masturbate ad-hoc. I’m able to achieve a hard erection with vibration. Manual stimulation alone allows for penetrative sex, although I don’t get completely hard. Fear about the possible outcomes is the main challenge I’m facing.”
(6-12 months of penile rehabilitation)
Losing hope
“I guess you could say my rehab is just sporadic. Definitely not daily. If I'm lucky once a week. I use the pump and don’t know about anything outside of that for rehab. Sometimes I feel an overnight erection or firmness coming on. My challenge is just not getting erections anymore. Sometimes I lose hope and just accept that I'm not going to get them.”
(2-3 years of penile rehabilitation)
Spontaneous Erections
“I use the Vacurect and Trimix 1-2 times/week, I use the Viberect (vibration device) occasionally. I’m now experiencing spontaneous full erections, and nearly full erections in the morning, although when I want penetrative anal intercourse (I’m a gay man), I pump with the Vacurect and have to have a band at the base to get enough firmness. I don’t rely on the Vacurect bands, I use another product that works better for me. I’d say lack of spontaneity is the biggest challenge.”
(6-12 months of penile rehabilitation)
One Year Recovery
“I used a vacuum pump multiple times per week shortly after catheter removal and began daily use of sildenafil at 3 months. I slowed the daily use of sildenafil at 6 months to check progress and found that spontaneous erections were returning. By the 6 month mark, unassisted erections were sufficient for penetration although sildenafil definitely helped. By the 9-month mark, unassisted spontaneous erections had improved more. As I now approach a year, unassisted spontaneous erections are nearly the same as before surgery. I am delighted by the progress gained via saving one nerve, the use of a vacuum pump, and sildenafil. This approach worked very well for me. The time it took for recovery was challenging. For three months there was zero ability to experience an erection.”
(6-12 months of penile rehabilitation)
Size Restored
“I do rehab with my Vacurect pump about 2-3 times per week, and recently I’ve tried using a ring to maintain the erection after pumping. I usually do my rehab in the evening. My penis has lengthened now (as it had shrunk after my operation). I notice that if I don’t do exercises for a few days it shrinks back and takes some time to regain its full length again. When I use the ring (size 5) needed to hold the erection up, it’s very difficult to remove the ring over the head of the penis as the skin bunches up behind the head (I am circumcised), I use lube but it hurts quite a bit trying to expand the ring hole. I’m hoping to achieve a reasonable erection and maintain it long enough to achieve orgasm without it going down.”
(6-12 months of penile rehabilitation)
Ethical Porn & Communication
“I use a vacuum erection device each morning before I shower. I will also masturbate (usually to orgasm) most mornings after using the pump. Usually, this will include viewing pornography to stimulate my mind. I now view only ethical pornography on sites such as Lustery and MakeLoveNotPorn. I take 5 mg of tadalafil each night before bed. I'm finding myself with random erections on an infrequent basis. I've even woken to a nocturnal erection. None of these are adequate for penetration but I like the progress. I doubt that I'll ever get back to the firm erection I had before my surgery but I'm fine with that mentally. The challenge is discussing what I'm doing/experiencing with my wife. We have never been good communicators about sex. I'm trying to work on that.”
(3 years+ of penile rehabilitation)