Sex and Prostate cancer, part 1

November 30, 2008

IT is time to talk about sex and prostate cancer. Just so you know, there is no way to do this without being graphic, at least in my opinion. So if this is a concern to you, all you need to know is this. Erections are difficult to achieve, orgasm is possible, ejaculation after surgery is not possible. Lupron, an estrogen, dramatically reduces your libido.

To help you understand what I will eventually discuss, you need to know that in my 30s I got terrible migraines, all on the right side of my head, often so strong that I was in bed for three days. They went on for years until I had my teeth straightened when they basically ended. I don’t know if that is a cause/effect relationship. They were so disabling that then, and now, I would/will do about anything to avoid them. Since my surgery I have had them again, though no where near as serious, and that fact colors the story I am about to tell.

When I was talking to doctors and a sex therapist prior to my surgery, I discovered anatomical facts that I never knew. The three experiences of erection, ejaculation and orgasm are independent. Erections are caused by nerves along and throughout the penis region. They get cut during the surgery. As a result it is harder to get an erection after the surgery. The nerves can be retrained but as you will see it is a laborious project. Ejaculation is caused by sperm moving up from the testicles and moving out the penis mixed with the fluid that the prostate produces. Not only is the prostate gone, so is the connection of the testicles to the penis (by means of the vas deferens). Orgasm is caused by stimulation; it is a whole body experience (or so I have learned). Orgasm without ejaculation is as pleasant as it is with ejaculation. I will try to check my facts. So separate are these three that the sex therapist told me that it would be possible to have an orgasm as you rolled out of prostatectomy surgery. Brr. The general outline of what I say here is true; I am not entirely clear on the anatomy.

One more fact for you. The prostate surrounds the urethra. It is in between the bladder and the penis. The prostate is about an inch in diameter. After it is removed, there is a one-inch break in the urethra. The urologist sews the two loose ends together, rejoining the urethra into a workable tube for your urine. That inch has to come from somewhere. There is only one place. The bladder doesn’t move. Your penis is shorter. If and when you achieve an erection it is not as long as it was. If the size of your ‘manliness’ is an issue, it is one that you have to face when you decide to have surgery.

For the first weeks after surgery the mantra is first get healed, then get dry, then get hard. The healing for me was uneventful. The catheter was in for 10 days—I can’t remember now if I have its removal and use covered in other parts of this blog. It was hard to sit on a hard seat because that plastic thing was sticking up past the incision, but otherwise I quickly adjusted. You carry the bag for pee around. They have two sizes, a small one to put under your pants if you go out and a large one for night use. I used the large one all the time. I didn’t go out. It wasn’t pretty and I covered it if I had visitors but otherwise I just hauled it around. The incontinence for me was also uneventful. Not everyone’s is and I am thankful for that. I did the Kegel exercises, squeezing my rectum and penis muscles to get control. I wore depends—usually two a day—for about 6 weeks (I think).

During the time I was incontinent I only lost control once, and that was at night in bed. Amazingly since the operation I have had any number of dreams where I had to go to the bathroom, or was in the dream actually peeing, only to wake to realize I needed to go, but I have never wet the bed since. And now as I approach a year since the surgery I have incontinence drips sometimes during a sneeze or if I sit or bend wrong, but not enough to worry about.

Sex is another matter.