Prostate Cancer and Sex, part 3

December 11,2008

The amazing thing about living with someone for forty plus years is the depth and breadth of the relationship. Life becomes a kind of endless dance where we anticipate each other’s moves and swirl gracefully into them. And that dance includes finishing each other’s sentences, knowing what scene in our past this current scene makes us think of, even getting up at the same time in the night to go to the bathroom (thank the lord for houses with two bathrooms). Of course that dance extends to sex. A certain look (yes, there actually is THAT look), a certain phrase, a certain wiggle or giggle, and the deal is on. This much time on dishes, that much time on email or tv or phone calls, or wine drinking, and then up to the bed and the, ah, consummation. If that look happens at breakfast, there is an entire day of something akin to squirming, waiting, anticipating. The drive home is sweeter, the meal tastier, the book less interesting. And if it doesn’t happen today—the day was rotten at work, a cold or headache started (for real), exhaustion kicks in—that is ok, because there is tomorrow. There is a basis, a bed rock, to life together, an understanding, an understanding that this important union is always possible, always there, always part of yesterday, today, and tomorrow. It is the air we like birds fly through, the water like fish we swim in, always there. And now it is gone.

As I said in an earlier post, really gone. Images, situations, fantasies that used to work, not only don’t, they seem remote, even silly. So there I am, full of lupron, the testosterone done, the psa down, the desire not down, gone. And what of that dance, that air, that water? Gone?

For some people it is gone, and their marriage is over. Ours didn’t happen that way. Instead, I discovered--I think I always knew it, but was never tested—that we had woven a strong cloth and the sex was just one of the threads. The cloth didn’t unravel. All those years of traveling together, acting together—the kids, the book, the family crises, the parental deaths and worse the run up to those deaths, the laughter, the meals, the sense that we, together could accomplish anything, could get through anything, all of that kicked in. The rug got pulled out from under me but I landed in her arms. Her smile still there, her eyes like they sparkled on our wedding day (and among other days those when they were conceived), like they sparkled when we strode into Siyeh pass the first time, or the time we touched Emerald Glacier. Or the time she got off the train in Raleigh, just back from Europe, her hair short, wearing the scarf and coat it took me years to let her give away, that moment when the deal went down.

At any rate our history, alive as it is in the moment, and in the forecast for the future, sprung alive in a way that surprised me. Those moments, glances, dropped code words, gone, but not the support not the joining, the joining of a different type than sex, but, it turns out, as powerful. And so we can make fun of ourselves in situations that would have led to ‘intimacy,’ now passing at best with a smart crack and at worst unnoticed. I have had to learn to be sure to touch, to soothe, to run fingers through hair, to, with all the thrill of a 14-year old, cop a feel, accidentally run my hand over her ass, give a kiss. What can I say? I have been blessed with an incredible gift from cancer—an awareness of a depth that I not only did not know I had but didn’t know existed. I trust that the lupron and its effects will pass (at the end of May) and that at least some of the old way, old dance will return, but it will be so much richer for what I have found and can live now. Cancer gives strange gifts.

Prostate Cancer and Sex, part 2

December 8, 2008

Anyway on to sex. There are two issues—emotional/relational and physical. Let’s talk about physical first. The deal is, Can you get a hard on? Well, sorry, erection. My answer is yes, with difficulty, and nowhere near as hard as before. Let’s talk about that. The basic rule is Use it or lose it. But the physical reality is that those nerves were severed, even though laproscopy, which I had, is more precise than the previous method of the incision from the belly button to just above the penis. The result is that what used to happen, well, more or less with a thought (remember the 5th grade joke? What’s the lightest thing in the world? A cock, because it can be raised with a thought.), doesn’t. Thoughts won’t do it. So the usual fantasies, whatever yours are—you don’t think I’m going to tell you mine, I hope, not on a free blog—won’t do it. I couldn’t/can’t get into much of a ‘state.’ I tried looking at porn, reading some porn, and, while I understood the attraction of certain scenes, even words, and poses, not much happened. By that I mean that I could get to a state emotionally where I wanted to have sex, but no matter how I went about it, the erection was never the, well, rod it used to be. Talk about the spirit willing but the flesh weak.

Now an interesting thing—during this period, from roughly 8 weeks after the operation until about one week after I received the lupron injection, from March till October, though the erection was weak, the orgasm was not. The orgasms were fantastic, among the best I have ever had. They went on for a longer time and the intensity, the way they grabbed me inside, in my chest and head, was more powerful than nearly any I had ever had. I wondered before the first one what it would be like without an ejaculation. I was surprised. It was exactly the same, same buildup, same quivering, same peak, same screaming climax, same feeling of let down and being over. Now the one thing I will reveal. Since these accompanied an erection that was not particularly erect, they took place in my wife’s hand. There was no, well, mess, another surprising thing, and I found I didn’t miss it.

During this period, I was supposed to use two aids to erection—a vacuum pump and one of the erection pills, Viagra or Cialis. The vacuum pump is exactly that, a pump. It has a long tube that fits over the penis and a pump handle on the end. A person, me, lubricates the end of the penis, so it will slide in the tube, and also lubricates the front edge of the tube so that the tube fits against the body with an air tight seal, thus allowing the vacuum to work. The pump creates a vacuum and the vacuum makes the penis extend from its limp state into the cylinder in a semi-erection. The idea is to pump the handle and enlarge the penis, then push a button which releases the pressure, and the penis shrinks back to its original state, then pump again. During each cycle the penis gets longer and more engorged. For me it never got to a consistency that amounted to what I would think of as a ‘usable’ erection. The company supplied some rubber band-type objects that could be applied to the base of the erection, preventing the blood from draining out, and the result could be used in sex. According to the literature that came with the pump, this erection should work, leading to fun and excitement. For me it never did. Frankly I got as far with the porn as with the pump. I still use it but it is boring. Each daily session is 15 minutes, so I drop my pants, turn on a TV, one of the ones that are out of the way, and do the ‘exercise.’ I call it, not very reverently, a vacwhack, but I suppose that merely serves to cover my frustration that it has not worked particularly well for me. I keep at it. The literature, and the sex therapist, say it eventually will work, and that as a result of using it, I will not lose it.

The other strategy is the erection-aid drug. You have no doubt seen those ads of a gray-haired guy, usually with a woman young enough to be his daughter, dancing off the floor to the elevator which they take to an upper, secret floor and a night of wild bashing, lashing and crashing. I doesn’t happen like that, at least not for me. Remember I mentioned headaches? I got them. Over and over I would take one of these pills—note that they don’t make you horny, they only get you an erection; you have to make yourself horny, though what guy my age wouldn’t be so at the thought of a sweet young thing not only choosing him, but expecting that she could get physically from him what she couldn’t get from some 25-year old? Ah, well, what bull. The headaches. The next day after taking one of these my head would pound, and pound. Just like the bad old days, it felt like a nail driven through my right eye into my brain. I spent a number of next days dragging through the rituals of the day. And to combat the headache effect, I began to drink a lot of water, 4 liters a day. That helps some, I have to admit, but of course if you drink that much you pee that much. So then I was like the guys in the ad who kept missing the big event (and being not so much laughed at as tsked) because I was constantly running off to the bathroom.

These pills come in various sizes, 40, 20, 10, and 2.5. I kept lowering my size intake, hoping to get to the therapist’s recommended intake of three times a week. I couldn’t. No way could I do that and go to work or have any kind of day on the days after I took the pills. I have to admit there was a certain licentious thrill to taking them at first. I was one of those guys who could chemically overcome the body and perform for my woman, satisfying her just like I did 40 years ago. No doubt there are many men who have very satisfying experiences with these drugs. I didn’t. As I said I got as far with the porn and that was not all that far. I will keep at this of course, but the failure of it to work has led to some other emotional realizations.

I suppose that the medication that bounced me into another realm was lupron, an estrogen. Lupron reduces testosterone on which prostate cancer feeds. Less testosterone, less cancer. It is admisnistered in a shot (in the butt) that lasts for four months. I got the shot. It worked. My psa was cut by more than half. The upshot though is a total loss of libido. I mean total. I have to admit; I have seen many sexy women and pictures of sexy women. It used to be that I would look and think ‘nice.’ My wife and I had a kind of dance, you know what I mean, that could go on for two days, extended foreplay, thrilling, fun, compelling, satisfactory beyond belief, never boring, never something to take or leave. Now I don’t notice, hardly look, and never think ‘nice.’ At most I look and think, I used to think nice, now I just look. In other words I exist in the world sexlessly. There is no desire and no action. I had to learn that I had to still fondle and kiss and touch and caress and make jokes. I did, and I feel good about that.

So let’s go on to the emotional/relational side of this. I have already done quite a bit of explanation of the emotional. In the early months the emotional desire was there and could be acted upon. We could do the dance and hop into bed and, though the mechanics were a bit different, have a satisfactory, thrilling event. (Sorry, in spite of saying earlier that I would be candid, I can’t. A) it really isn’t your business and B) use your imagination.) But the point is that the physical and emotional changed, but remained at least similar to previous.

With the lupron that is over. No hopping into bed, no thrilling, and, in that sense, no satisfactory. If that were the basis of our marriage—no thrills, no satisfaction, no relationship—ours would end. And so I have had to take on the relational task of having my best friend and the only sexual partner I want, and have ever had, be just my best friend. What to do? I feel like the answer is one that I can’t joke about, even though I find that laughing is probably the best way to handle the condition I have, we have, and the cards we have been dealt. So I need to end here and begin again another night when I can focus just on the relational and the amazing power I have found in this new state.