The evolution of orgasmic pain (dysorgasmia) following radical prostatectomy

It is recognized that some patients experience painful orgasms known as dysorgasmia after radical prostatectomy (RP). This problem poses a barrier to satisfactory sexual relations for some couples. However, the natural history of this condition remains unknown.

To assess the evolution of dysorgasmia in patients who underwent RP.

The study population included men who had been seen initially within 6 months after RP and complained of postoperative dysorgasmia and opted for no medical therapy with postoperative follow-up at least 24 months, and were seen at least twice over 2 years.

A proprietary dysorgasmia frequency scale and visual analog scale (VAS) for pain were used at each visit.

Data from 702 patients who had RP and presented for sexual function evaluation between 2002 and 2008 were prospectively collected and analyzed at Memorial Sloan-Kettering Cancer Center. Of the 702 patients, 84 (12%) complained of dysorgasmia. Mean patient age was 64 ± 16 years. Mean time interval since RP to initial sexual medicine interview was 2.2 ± 3.2 months. Mean number of visits was 4 ± 1.4. For the 84 patients who had dysorgasmia, mean dysorgasmia frequency and VAS score for pain at initial interview were 3.9 and 4.1, respectively. At 24 months, a statistically significant decrease in symptoms occurred, with 72%, 26%, and 7% of patients still complaining of pain at 12, 18, and 24 months, respectively. At 6 months, 26% of patients had a VAS score ≥6/10 and at 24 months this figure was 16%.

Our data provide evidence that dysorgasmia decreases in frequency and degree over time after RP. These data are in support of a surveillance strategy for all but the most bothered patients with dysorgasmia after RP.