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Severe pain with injection therapy.

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Posted 9/1/2014 6:15 PM (GMT -5)
I have learned a LOT here since being diagnosed with PC recently. After much research, I elected DaVinci surgery as I had a small prostate extension growing into my bladder, and I am in good health.

Now, it looks like I have another big decision shortly: adjuvant radiation or wait, due to the extraprostatic extension. I may have a question or two on that shortly. For now, my focus is on starting ED rehab, which my surgeon encourages after 1 month.

I may be almost unique here, in that I have many years of experience with injection therapy prior to PC. I figured that would be a big help now. However, I am having difficulties. Each injection of a half-normal dose to achieve a partial erection has lead to enormous pain, both from the needle itself and a terrible ache for several hours in the penis. Theoretically, the ache could be from the Prostaglandin in my bi-mix (I know this is not typical bi-mix). However, my doctor felt that if it wasn't a problem in the past, he didn't think it would be now. It seems more likely that this is referred pain from the internal surgical changes. Also, every needle stick seems to hit a major nerve center causing major pain. Previously, this rarely happened.

* Has anyone here had previous experience with injections prior to surgery, and doing them now for rehab? If so, how do your current injections compare with before?

* Could it be too early (1 month) to start injections? Maybe I need more time to let internal healing progress.

* I tried a VED, as another means to get blood circulation, and found I could not pump enough to get close to hard or nearly full erect size. The base of the penis was full of blood, but it tapered to nearly nothing at the head. I have no idea why that would happen. Any ideas?

I am including my signature in this text as it doesn't seem to be happening automatically. Sorry if this appears twice. confused
Age - 71
TURP 1991: obstruction.
Mild ED. Use bi-mix (Prostaglandin, Phentolamine).
1000 injections of bi-mix since 1998.
PSA - 4.65 6/2010 Biopsy negative.
PSA - 8.70 5/2014 Biopsy 5/8/2014 positive 1/12, 5% of total.
Gleason 7 (3+4)
DaVinci Surgery 7/30/2014, nerve sparing both sides.
Pathology: Gleason 7 (3+4), Negative margin, multiple foci extraprostatic extension, right side.
Posted 9/1/2014 6:26 PM (GMT -5)
Jack71
You have put up with a lot of agony to be able to have sex. There's a hell of a lot more to life than an erection! Think about giving it a rest!
Bob
Posted 9/1/2014 6:33 PM (GMT -5)
I just don't want to wait too long to start the therapy and risk permanently losing everything.
Posted 9/1/2014 6:59 PM (GMT -5)
Hello Jack,

Do you by any chance notice that the injection causes a palpable lump that needs to be massaged away? That happens sometimes to me. It's not so much that the needle hurts as that injecting the meds hurts (and the plunger is difficult to depress.) What I think causes that is when you hit an area of scar tissue between the blood chambers in your erectile tissue and instead of injecting into the blood chamber you are injecting between them (forming a pocket) which hurts and doesn't work very well.

I don't inject until I find a spot where the plunger is relatively easy to depress. Usually this only involves pressing the hub of the needle more firmly against the skin so the needle goes a bit deeper, but there have been occasions where I have required a second jab to find a spot.

No idea if this has anything to do with your problem but it seems like it might.
Posted 9/1/2014 8:20 PM (GMT -5)
Jack – my understanding is some men become hypersensitive to prostaglandin after trauma to their cavernous nerves, which definitely happens during RP surgery. Perhaps you should try Trimix, which has a smaller amount of prostaglandin, or the more common form of Bimix containing papaverine and phentolamine. I don’t think 1 month is too early – my doc started me at 6 weeks.
-- Tigerfan
Posted 9/1/2014 10:20 PM (GMT -5)
Peter - No, I don't get any lump from the injection, but in the past (before surgery) about once or twice a year or so, an injection would not go in the right spot, causing a painful swelling and no erection. That is not the case in any of the 3 injections since surgery. The vast majority of past injections only cause a quick pin prick, the needle glides painlessly in, and the plunger offers no resistance. Now the needle seems to hit lots of nerves every time, and hurts like **** all the way in. No pain or resistance when pushing the plunger.

Tigerfan - My ED nurse gave me a sample of her tri-mix to try. I used my bi-mix for the first injection, and her tri-mix for the other 2. Her tri-mix has half the Prostaglandin of my bi-mix, and *might* have caused slightly less aching, but hard to say as both were very painful. I do plan to discuss with her tomorrow the possibility of getting the bi-mix w/o the Prostaglandin.

It seems to me that all the internal trauma of the surgery may be referred to the penis, but it is difficult to see how that would make the needle insertion so painful. I could have her watch my technique to see what I'm doing wrong, except that I've been successfully doing this myself for 16 years now! I thought this part of the recovery process would be a piece of cake!
Posted 9/1/2014 11:19 PM (GMT -5)
Jack -- sorry you're having these problems. I can't imagine why the needle insertion would now be causing so much pain. Let us know what your doc says.
Posted 9/29/2014 6:43 PM (GMT -5)
Sorry for the very late reply!
It appears that the problem is scar tissue on both sides of the penis from many years of injections. Before surgery, the scar tissue was apparently pretty flexible, letting me get good erections without pain. The needle did sometimes cause some pain on injection before surgery, but I thought my technique was getting a little careless.
Add the RRP and a month of NO erections (even in the middle of the night), and the scar tissue is less flexible than before. An injection now forces an erection, but the scar tissue fights back, leading to hours of pain. I was told to do the injections below the scar tissue (around 8 o'clock, rather than 9 to 10 o'clock). This works well. No pain when injecting. However, the resulting erection pain is so severe, it makes me never want another erection again!
The prescription is therapy to help break up the scar tissue: Use a penile stretching device every day, and also a VED to induce several partial erections. No injections for a month, then try again.
What a mess!
Posted 9/29/2014 8:32 PM (GMT -5)
Jack,

Getting an erection at 70 is indeed a blessing; but at 71 is even better and if you can use it then it so much better for a little discomfort. I trust that you do get some "crumpet" after all the injections and whatnot.

Life is also about enjoyment too and if this is your thing, ENJOY - mate ENJOY!!
.
Posted 9/29/2014 10:35 PM (GMT -5)
Jack,

At least you know what you are dealing with and have a plan to make it better. On balance it sounds like things are getting better for you.
Posted 9/29/2014 11:17 PM (GMT -5)
Actually, at 71 I was functioning very well before RRP. Injections gave me even harder/better erections than when I was much younger. They helped me feel young, energetic, and healthy. I definitely didn't want them ripped away suddenly by surgery. I didn't expect this complication. I thought I had an advantage over others, since I had lots of experience with injections. Hopefully, I can get back to comfortable full erections in time.

In the mean time, that leaves orgasm w/o erection. And that doesn't work either, so I am a little bonkers.

The only good news is that my first post-surgery PSA is too low to measure! Yea!
Posted 9/30/2014 9:44 AM (GMT -5)
Jack,

Are you by any chance on Prozac or some similar SSRI antidepressant? Anorgasmia is a common side effect with them. Sometimes it helps to switch to a different drug or a different dose or add an additional drug to offset the effect. We've talked about several drugs that help some guys. Buproprion or Modafinil are sometimes used to offset the sexual side effects of SSRI drugs and Cabergoline, which works via a different mechanism appears to do wonders for some men (but not all).

Obviously, all stuff to discuss with your doctor.

Good luck. Hope you can get something going.
Posted 9/30/2014 12:43 PM (GMT -5)
One afterthought: a friend who is into things herbal mentioned that supplements with Mucuna Puriens (velvet beans ) may have some of the same action as the Cabergoline in reducing prolactin levels which, when elevated, can interfere with orgasms.

I Googled to find research and it seems a little thin on the ground. But, I did find this (for what it's worth):

Aphrodisiac activity of polyherbal formulation in experimental models on male rats.
Posted 9/30/2014 4:37 PM (GMT -5)
Peter,
No, I am not taking any drugs at all. I know that SSRI's can be a serious problem wrt orgasms.
The only change between now and last July before surgery is the surgery itself. My understanding is that only the erection nerves are disturbed during surgery. The nerves responsible for orgasm don't run near the prostate, so it is supposed to be unaffected. However, reading the forums shows that many (most?) guys do experience a difference, mostly negative, but not a zero.

I have already tried Oxytocin and it didn't make any difference. I'd like to try Cabergoline, but my doc wants me to wait for a few more months before trying that. Perhaps it is time to try the herbal route. Note that my "desire" is still there. Erections are not there yet, even with nerve sparing. Stimulation w/o erection feels just a little bit good, but nothing like before, and reaching orgasm is like trying to reach the moon. Virtually impossible. Herbals are unlikely to help me at this point with erections, but maybe there is one that helps to reach orgasm. Time for a little more research. Thanks for the suggestions!
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