180 Increased Orgasmic Intensity After Radical Prostatectomy: Prevalence And Predictors

Abstract

Little exploration has occurred on orgasm quality after radical prostatectomy (RP). It is well recognized that some men report increased orgasmic intensity (IOI) after RP. Only survey data exist on its prevalence, of approximately 5% but no analysis of predictors or chronology of this entity has been conducted. Men who underwent RP, who were sexually active within the first 12 months (mo) of RP, who had orgasm data recorded and were followed for 24 mo after their operation were studied. Demographic, comorbidity, RP and sexual function data were recorded. Patients were followed serially with the international index of erectile function (IIEF) questionnaire. Multivariable analysis was performed to look for possible predictors of IOI after RP with the following factors being entered into the model: patient age, partner status, partner age, RP nerve sparing status, presence of dysorgasmia, erectile function. 1963 men were analyzed. 137 (7%) reported IOI at any time point after RP. Those reporting IOI were compared to those who did not report such a change in orgasm. Mean age of the entire cohort was 62±13 years; 81% were partnered; 69% married; 79% had bilateral nerve sparing RP (no difference between the two groups in any of these factors). Median time to the first orgasm after RP was different between groups 2mo (IOI) vs 4 mo (p<0.01). Reporting dysorgasmia within the first 6mo after RP: 19% (IOI) vs. 6% (p<0.01). The mean IIEF erectile function domain scores (using any erectile aid) at 24mo were different: IOI 21±6 vs. 16±9 (p<0.01). 67% of patients with IOI were capable of sexual intercourse at 24mo (with or without aids) vs. 49%. Over 24mo, of those men with IOI: 12% had reduction in orgasmic intensity back to preoperative levels; 8% had reduction to lower than preoperative levels; 80% maintained their IOI level. The only predictor of IOI occurrence was ability to participate in penetrative sexual relations: odds ratio 2.3, 95% confidence interval 1.4-.4.4 (p<0.01).