Sex after Prostate Cancer Surgery – What Can You Expect? Comments by Motivational Speaker and Cancer Survivor Chuck Gallagher

Before reading this post…if you have been diagnosed with Prostate Cancer or are a Prostate Cancer survivor, I would appreciate your help.  I am writing a book, from a layman’s perspective, about Prostate Cancer and how to find solutions to improve our lives.  I am conducting interviews during the months of October 2008 through November 2008.  The interviews are confidential and your name will not be revealed.  If you are willing to discuss your experience…please contact me at chuck@chuckgallagher.com.  From there we can set up a time for a phone interview.  Likewise, this disease no only affects the man diagnosed but also his family, so I am interviewing spouses and/or significant others.  Thank you in advance for your help.  Now I hope this article is of some benefit to you.

Let me begin by saying, this is written with the intent to help those men who have dealt with or are dealing with the issues surrounding prostate cancer. I am not a physician. My perspective is my own and born from my personal experience with prostate cancer at a “relatively” young age.

Background: I was diagnosed with prostate cancer at age 47. There were no warning signs. To all around me I was the picture of health and as far as I was concerned they were right. I had no symptoms. In fact, I felt great.

I went to my family doctor in order to get a prescription for Propecia (a pill to keep your hair from falling out). My hair line was beginning to recede and I wanted to stop its progress. My physician (who in retrospect saved my life) required that I have a blood test before she would prescribe the hair loss drug. As I recall, she said that the drug would artificially lower my PSA and I needed to have it checked first.

Honestly, at the time I didn’t know what a PSA was – the only thing I did know was – I hated needles and the thoughts of giving blood repulsed me. But vanity won and I had the test. Frankly, the rest was history, as the tests revealed an elevated PSA which ultimately lead to the prostate cancer diagnosis.

Treatment Method: While considering many methods, ultimate I selected surgery using the da Vinci method. I could not have been more pleased. The skill of the surgeon from Johns Hopkins and the method used were both outstanding. I highly recommend that men considering surgery consider this method. The recovery time following surgery was substantially reduced and the side effects were non-existent.

Following surgery there were several issues that were of immediate concern:

1. What was in the pathology report (if that was good then the other issues were important)?
2. Were the nerve bundles saved around the prostate (if not, no erection)?
3. How difficult would it be to recover – move, walk, have a bowel movement, etc.?
4. How long would the catheter stay in and would it cause problems?
5. What would the reported incontinence be like (really) and would it last a long time?
6. When could I expect some normalcy in sexual performance?

#1 = great pathology report (whew…that was a relief!)

#2 = nerves were saved; however, the doctor cautioned about expecting too much too soon.

#3 = no great surprise, the hospital got me moving quickly. It was not comfortable, but in the end they were right. Suck it up and get on with it they told me. You’ll appreciate how quickly you’ll recover when you get out of bed and get on with life. They were right. Within three days, I was prepared (moving a bit slowly I might add) to get on a plane and fly back home from Baltimore to North Carolina.

#4 = That was (at the outset) the biggest challenge. While most catheters stay in a week or maybe two, mine was in for three weeks. The physician stated that he wanted to make sure due to my psychology that it healed well, so I got the pleasure (NOT) of an extra week. Frankly, that was annoying and one of the happiest days of my life was when it was removed. Frankly, it was somewhat painful, unpleasant, difficult to keep comfortable, and all around a real pain (both figuratively and literally).

#5 = Considering I took a good six months from diagnosis to surgery, I had time to work with Kegel exercises. Kegel exercises may be beneficial in treating urinary incontinence in both men and women. Having received wise advice from the folks at Johns Hopkins, I was told that men would be wise to exercise those pubococcygenus muscles in advance of surgery so that they have “muscle memory” after surgery. I was told issues with incontinence would be dramatically reduced and they were right. Within 5 – 6 weeks I was 99% continent.

#6 Sexual Function: Candidly, that returned much slower than I expected.

• Within three weeks of the catheter being removed I wanted to test sexual function. To my pleasant surprise with physical and visual stimulation I was able to achieve a marginal erection and orgasm. I was elated. However, I soon found out that my first experience was not sustainable on a regular basis.
• Like most men, I was given prescriptions for Viagra and informed about other alternatives.
• Within three to six months, I found that achieving an erection was difficult and that any mental distraction would prove to be an impairment.
• Viagra would provide some help, but the side effects were bothersome – especially the flushed feeling I felt in my chest and nasal cavity. Even with Viagra or the other alternatives, I did not feel that the result was successful.
• By the seventh month I was concerned about the lack of consistence in sexual function. That took it’s toll emotionally. While women may not completely understand, men will get it. We are sexual beings and, while we don’t define ourselves by sex, we certainly understand the important role sexual function has in our lives. Inability to perform can have direct effects in other areas of ones life.
• I was told there would be no ejaculate. That was true and false. There was no ejaculate as men generally know it. However, I did leak a fair amount of urine. I think the urine leakage surprises and disturbed me more than it did my partner She understood that urine is harmless. I soon learned that I should empty my bladder before sex otherwise, there would generally be urine leak when orgasm was reached.
• By the ninth month I woke to a nocturnal erection. I must admit I was surprised and elated. However, the natural erection was still missing.
• There had been no significant change from the sixth month through the tenth month, so I was becoming a bit concerned. I sought help in an unusual way, I sought Hypnotherapy as a possible solution. Wow…now that was worth it.

Hypnotherapy: Perhaps for the skeptics I had just healed enough to experience a change, but when I sought help I had the same results. Not knowing what to expect, I was open to anything that would provide some normalcy. I had come to know that things would never be the same. For one thing, I wasn’t 17 years old any more. I had to know that with age sexual performance will change. Likewise, I knew that without a prostate (the old plumbing if you will) I would never have an ejaculation – although an orgasm is quite normal without ejaculation. In any event, I elected this alternative form of therapy. What did I have to lose?

I went through the process feeling quite relaxed. The female hypnotherapist wasn’t sure that it would be comfortable for a man. Frankly, in my mind, if I got the result I didn’t care who provided the service. The process lasted and hour to and hour and one-half.

Within three days it was time to test the program. To my great surprise, I had an erection with less effort than it took over the prior 10 months and the orgasm was powerful. Since that point, there has been a marked difference in sexual function. Why? I’m not sure I know. I feel that two things converged at the same point. One – I had taken time to heal physically and with practice one can achieve a return to normalcy. Two, I feel the hypnotherapy allowed me to by pass my conscious emotional fears and empower my subconscious to know that I was fine and fully functional (within the physical confines of surgery). Either way…the process worked.

Three Years Later: Sexual function is normal – for a 50 year old prostate cancer survivor.

1. I understand that sex will never be the same as before. I accept that knowing that I am living as a result of early detection and appropriate treatment.
2. With the prostate gone, there will not be normal ejaculate during sex. Strange, but as a man I miss that – but I must say, my wife doesn’t.
3. As time goes on natural erections (unassisted) are possible. They are not as frequent as they used to be, but from time to time I will have a nocturnal erection.
4. Orgasm is quite natural, with or without ejaculate. However, expect some urine leakage during sex. Especially early on one might want to keep a towel handy.
5. Libido did not change even right after surgery.

As a motivational speaker, I have become accustom to sharing personal experiences in order to share more universal truths. This entry, however unusual, is not about personal sexual performance, but rather written in order to help other men understand from a first hand perspective what to expect and perhaps to provide hope that sexual performance, so important to most men, can return after experiencing surgery.

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