I’ll never forget the day when my primary care physician said, “You’re PSA a bit high. I’m sending you to a Urologist.” My first question – “What’s a PSA?” Needless to say, I quickly learned. In the two weeks following I found that my trips to the Urologist brought the news that no man wants to hear. “You’ve got Prostate Cancer.”
Cancer – that’s a word that no one wants to hear about themselves or those they love. Yet, like over 200,000 men each year in the US I was faced with the issue of treatment choices and the consequences that followed. My diagnosis age – 47. My treatment age 48. My age today…soon to be 53. My motive for writing this blog…to offer practical information and hope.
Beyond surviving prostate cancer – which detected early – is quite survivable, the main question that I hear from men – either after diagnosis or soon after treatment – relates to the return of sexual function. Frankly, that question is often a matter of concern to their partner as well. Since I have been open and quite transparent about my experiences, I often get calls from partners and prostate cancer survivors asking for help in know what to expect and when. And, frankly, in just about every case I’ll pose a few questions and now, I’ve come to expect, a routine set of predictable answers. So, I’m taking the time to deviate from my normal blog entries to address some practical answers to questions related to sex following prostate cancer – is there hope for a normal life.
So we don’t rehash old news I am providing links to prior posts that are still relevant today.
LET’S BE PRACTICAL…
First, I’m not a doctor, so please understand that my approach here is to help from a layman’s perspective and one who has personally been through want many are experiencing and/or asking today.
Assuming we are NOT dealing with advanced prostate cancer, the likelihood of survival is good and the treatment options aren’t bad. I elected to use the DaVinci Surgical Method and am very pleased with the results. But, immediately following surgery and for sometime thereafter I have to admit (as you can read in the blog entries above) I was less that pleased with my sexual function – or lack thereof. So let’s look at what is realistic first.
Think of your prostate as a small balloon and the nerves that allow for an erection to take place as silly string that has been squirted on the balloon. Get that picture in your mind clearly and then (I’ll use my case) understand that for 47 years (in my case) my body has had that little balloon inflated inside of me with the nerves (silly strong) laying on top of the balloon for all that time. That (to our bodies) is normal.
OOPS…then someone comes along and says “You’ve got cancer.” In other words the air inside your balloon is defective and needs to be removed – after all you don’t need it anyway. Then…the surgeon (assuming that’s the treatment route you take – but my example is not limited to that treatment) pops the balloon (removes the air) and all that is left is a thin shell of what the balloon used to be. In effect, that’s what’s left of your prostate following surgery (assuming the use of the nerve sparing technique). Ah…and those (formerly comfortable nerves) and now completely disturbed – crushed if you will – on the shell of the balloon that for so long was nicely inflated.
Put yourself in the nerves place… For 47 years they existed in the comfort of your body doing just what they were supposed to do – provide a signal that allowed for an erection. Then…one day, their world changes and no longer are they comfortable. Their world has been substantially destroyed and, frankly, they don’t know what to do. For those who find this too simplistic…sorry, the example here is practical, understandable and it works. Anything that is changed that much fails to function normally. It’s no different that if you experienced the loss of your home in a hurricane. Life dramatically changed and you can’t go back to your old routines with any ease. That, my friends, is where your body is following prostate cancer treatment.
SO WHERE FROM HERE…?
Now, let me be quite candid, I’m speaking to men and their partners from here forward in an honest and forthright way. The remainder is an adult conversation so understand that as you read. If you do not wish to talk about sexual function in a direct way…STOP READING. Go do something else, this blog is not for you. Otherwise, I will hold nothing back and do my best to provide honest practical advice that can help the reader in the long run.
MEN…it’s time for rehabilitation. Before you or your partner laugh, ask yourself this question. If you had a knee replaced or a hip replaced, after the surgery would you participate in extensive rehabilitation or would you sit on the couch and assume that with time it would just get better? I can’t speak for all folks, but those that I know who have had either – hip or knee replacement have said that rehabilitation (no matter how initially uncomfortable) was worth it in the end. Why? They regained primary function of their legs, etc. if they relearned how to use their body following the trauma of surgery.
Guys…the same is true with your nerves and penis. STOP…THINK ABOUT IT… You must take the time and put forth the effort to relearn to use your dramatically disturbed nerves and relearn how to regain sexual function. It isn’t easy, but it can be done…I’m living proof.
I recall a physician at Johns Hopkins sitting with me and having a frank conversation regarding sexual function following prostate cancer surgery. He stated (and this isn’t verbatim) the following:
- Your nerves have been damaged. They were saved, but the no longer rest comfortably on your prostate…
- Any time your body suffers trauma it takes time for it to recover. You’ll feel better on the outside and, likely in fact, find that most functions return to good working order sooner – much sooner – than your sexual function…
- Expect it to take 18 months before you can expect to have a normal sexual function…
- The more you put your sexual function into “rehab” the greater the likelihood that you’ll re-gain normal function…
The “Rehab” was a new concept to me. But, as he explained it, it really all made sense. So…STEP ONE: Recognize your age and understand that sexual function for me tends to decrease with a natural decrease in testosterone as we age. We aren’t 17 so quit thinking we are and accept that there is a natural decline in erectile function with age.
My Doc preceded to share some practical wisdom. He said, something to the effect, that when (prior to surgery) you and your wife had sex – you were making love. It was an experience of pleasure between two people. It was not clinical. Now, however, the Doc proceeded to share – you need clinical help – rehab of sorts. No…you don’t need an “escort clinician” to rehab your penis. Rather, you need to understand that the more you exercise the entire sexual function, including your penis, the greater the chance of a complete recovery.
Therefore, he warned, don’t assume that your wife’s function is to do your rehab for you. In fact, he shared, that if you expect your wife to be active in your sexual rehab, you’ll run the risk of changing the experience for her and potentially damage your relationship. Love making is love making. Rehab is rehab…and the two don’t mix well together. You, the Doc stated, are responsible for your own health…don’t place that burden on your partner.
My boy. (I thought it was funny that my Doc call me “My Boy” when I was almost old enough to be his dad) In order to have effective rehab you need to know some things.
- Sex starts and ends in the brain…
- Sexual stimulation begins from some sort of sensory stimulation – visual, auditory, feeling, etc.
- Once stimulated the message travels through the nerves ACROSS the nerves that have been damaged (that’s where the problem lies) and to the penis…
- Once the message is properly sent the penis begins the erection process (which for men is the clear indication that sex has the potential for taking place)…
He proceeded to tell me – what you’ve got to do is find sexual stimulation frequently enough to reteach those damaged nerves to carry the signal to your penis so that an erection can take place. Then he said, (this is verbatim) “I’d suggest you take matters into your own hands.” And with those comments he shared some practical advice that I know rubs (no pun intended) many folks the wrong way. Basically, he said, excluding one’s religious belief, etc. that masturbation is an effective method of sexual rehabilitation following prostate cancer treatment. Keep in mind, the objective is to reteach the nerves to carry the signal from the brain to the penis. You are rehabbing your body.
There is a difference between sexual stimulation for rehab and intimacy and loving making with your partner. However, the most important factor is open and honest communication between you both. Your partner needs to know that your body has changed and that the actions she once took to stimulate you may not work now. Does that mean you love her any less? No. What it does mean is – stimulation is more work now than it was. Likewise, you both need to know that it will likely take more effort to achieve an orgasm than it once did and that, again, changes the interaction between the two of you and needs (if not requires) honest and open communication. For example, my wife understands that today sexual stimulation, for me, requires greater tactile touch – which, candidly, is more work on her part. Further, we have found that my internal thermometer is a bit out of whack…cause if I get the least bit hot, my ability to maintain an erection is diminished greatly.
Honest communication also requires a frank discussion about how one might be stimulated (for rehab) and the frequency of rehab activities. WARNING…IF YOU DON’T LIKE FRANK…QUIT READING!
I was told that I should work to obtain an erection approximately 4 to 5 times per week. Now, let’s be honest…most folks don’t make love 4 to 5 times per week (not if your 50 – and I didn’t when I was 25 – so there…the cats out of the bag). Further, it is unreasonable to assume that your partner (wife, spouse, partner, whatever) should be expected to be there when you feel its time to rehab. That said, where do you get your stimulation? Hum…here’s the problem. You might find it best to dismiss modern misconceptions about sex and sexual stimulation if you truly wish to regain sexual function without injections, pills, or pumps. Where do you find stimulation? Pick it – the Victoria Secret catalog – the internet porn sites (free ones) – magazines – sexually oriented videos – whatever. Just understand that the use of sexual aids doesn’t make you a perv…but rather is – for this purpose – part of the healing process.
As I close this long blog out…I just realized that I am now 5 years cancer free. I have to be honest… for the first year or so I was less than satisfied with my lack of sexual function. Then I realized that I was expecting too much too soon and the pressure I was placing on myself was a contributing factor in my lack of performance. Now, looking back, it was just as my doctor had suggested. It does take time. And, yes, I followed his orders to participate in sexual rehabilitation and it paid off. While I have a prescription for Viagra I rarely use it (maybe one pill in the past 18 months). Does every sexual encounter end with orgasmic ecstasy – no, but then I am fortunate in that my wife and I understand that – that too – is part of life. We love each other and our time together.
There is hope for a normal life – or shall I say – a normal sex life following prostate cancer.
As a prostate cancer survivor I am writing a book on the subject and including in that a substantial part for the partners of those diagnosed with prostate cancer. As part of that, I, from time to time counsel with folks (at no charge) to help them open the realities of rehabilitation and communication. If you feel that a phone conversation (individually or as a couple) would be of benefit…send me an email at firstname.lastname@example.org and we’ll schedule a time. Meanwhile, I hope this helps.