Male Erections and Ejactulation Following Prostate Cancer Treatment – What’s the Real Deal?

I must admit it is a bit unusual when taking on the task of writing a book about a subject that – through personal experience – and now research – I have become a subject matter expert. I have to be honest and say up front, I never really wanted this knowledge – for that matter I didn’t want to find out that I was diagnosed with Prostate Cancer at age 47. But, everything happens for a reason…and I guess that mine role is to be open about the experiences and provide a reality check for men and their families.

Now…some three years later as a Prostate Cancer survivor, I am conducting interviews with men from all around the world about their experience with prostate cancer. My goal…to produce a book and perhaps CD or audio recordings that will explain the realities about Prostate Cancer – what options are available and what you can really expect when it comes to treatment and side effects.

Let me caution – I am not a doctor, not involved in the medical community and don’t represent any drug company that may be trying to persuade you or someone you love to seek a certain option. I am a professional speaker who, just by chance, found out he had prostate cancer.

So, the purpose of this blog is to provide up to date information to men and their partners about Prostate Cancer and the emotional issues that you may face. You may not want to hear what is written, but I promise that it will be practical, useful and accurate. That said…let’s talk about prostate cancer, erections and sex.

Before I began tonights blog I was on the phone with Richard S. – he gave me permission to use his name – although I can’t begin to imagine how many Richard S’s there are in the world. Sorry, I digressed! Anyway, Richard was diagnosed less than a year ago with Prostate Cancer and in May had his treatment of choice – HIFU (High Intensity Focused Ultrasound) a treatment I considered.

Like most of the men I’ve interviewed for this book (I am still conducting interviews if you would like to share your experience contact me), if nerve sparing techniques were used and the prostate cancer was localized, the ability to gain an erection was reasonable. The problem is very few will define for you want an “erection” is after surgery. Now I can hear some folks now saying – “What’s he talking about, I know what an erection is?”

FACT: Not that my research is complete, but thus far no one I’ve talked to has told me that the erection they achieved following treatment was as satisfying of substantial as before their treatment. I ask this question: “On a scale of 1 to 10 with 10 being an erection like you had when you were 17 years old, what number would you assign as erection strength before treatment?” Most men answer between 8 and 10. Then I ask the same question, but this time assign the number after treatment. The answer from Prostate Cancer survivors who have had nerve sparing treatments varies between 3 and 7. Rarely do I find any one who will suggest that they are able to achieve an erection like before.

REALITY CHECK: It is true, an erection can be achieved, but more than likely it will take more stimulation to achieve and maintain or it will take medication or pumps to enhance the erection effort. One does not have to have a #10 erection in order to achieve an orgasm or to achieve penetration during sexual intercourse. However, it is practical to say that while an erection may be possible, do not expect things to be the same – based on my research they generally are not.

SIDE NOTE: As most will tell you the ability to achieve an erection is as much psychological as it is physical. As a Prostate Cancer survivor, if you are stressed about sexual performance, you will find that stress, anxiety, and other emotional strains will hamper your ability to perform and hence challenge your healing. For that reason, I elected to use Hypnotherapy and it worked. If you have questions about that, feel free to contact me – I’ll be happy to share the details.

EJACULATION: Gentlemen – after surgical or, in some cases HIFU, treatment you will not have a ejaculation – you have an orgasm, but nothing generally comes out. Richard S. shared with me that no one told him nor did he find out this fact on the internet. I suppose I was luck as my Doctor prepared me for that fact. He said that orgasm was likely but that it would be a “dry orgasm.” I asked him what that meant…to which he replied nothing would come out. It would feel the same, but there would be no semen released.

Guys…prepare for this. Some men have reported that it was not an issue for them. Other men have shared that they have yet to get over the lack of an ejaculation. I understand that. Now I am quite confident that some will be less than happy with my next comment, but I have made a commitment to be frank and candid in the entries I write. For all our lives since we reached the age of sexual maturity, we have had a ejaculation when orgasm was achieved. Whether that orgasm was released internally (through sexual intercourse) or externally, it was released. Some have said that the release or ejaculation was like “marking one’s territory.” It is quite natural. The inability to continue to “mark the territory” is disconcerting to many and something to prepare for.

In other words guy – you won’t need one of these (unless you are using it for other purposes).

CAUTION: I have reported in other blog entries that some men experience the release of urine during sex. This may occur before or during orgasm. It seems, from my research, to be limited in scope – most men are not reporting this issue. But there are some of us, myself included, that have experienced this – and I am told from the Doctors that it is not that unusual. Interestingly enough, most women that I have interviewed were not put off by that – the issue with urine release was more a problem for the man. If this is a problem, one practical thing is to avoid heavy drinking immediately before sex and certainly empty one’s bladder before sex is practical.

As always…these entries are intended to stimulate discussion. Please feel free to comment as your comments will certainly help others.

Prostate Cancer and Sexual Function – It’s More Than Physical!

Over the course of this past year, as I have been conducting research on Prostate Cancer for my new book, I discovered what might seem obvious to some, but is news to others. Assuming that physically a man can achieve an erection following treatment for prostate cancer (i.e., the nerves were spared) the quality of recovery is, in large part, a function of issues other than physical.

An article written by Leslie R. Schover, Ph.D. states the following:

A narrow focus on erectile rigidity overlooks the role of the partner in successful sexual recovery after prostate cancer. In our survey (MD Anderson), 66% of men noted that their partner had a problem that interfered with sex, most commonly a loss of desire. Not surprisingly, men whose partners enjoyed sex were themselves more satisfied.

As I read those words now I better understand them. After surgery for prostate cancer anticipating restoration of sexual function, I didn’t quite get it as, like most men, I was preoccupied with an erection and didn’t completely connect the dots.

In fact before surgery my doctor and I had a frank talk. I recall my surgeon telling me that after a time of healing I would likely achieve an erection (of some sort) and have an orgasm, but that nothing would come out…in other words there would be no ejaculation. I suppose I had a stunned look on my face. He then went on to say that an orgasm occurred in the center part of your brain near your forehead. It was all mental. At the time I thought he was thinking with the wrong “head”…sorry, but I write it as I think it and that was an honest thought.

After surgery (which successfully spared the nerves) I did find that I was able to achieve some sort of an erection and that with some stimulation an orgasm was possible. Sure enough the sensation was in my head…I just had never notices that before. Perhaps I was too preoccupied with the wrong “head.”

For those who have read my former blog entries I will not restate the actions leading to healing. If you have not and are interested click here. Suffice it to say, as time went on I discovered that frustration lead to anxiety and stress – the combination of which meant loss of sexual function.

Toward the end of my eleventh month I had tried many things to return to what I thought should be normal. I did not have an unrealistic sense of what normal was, but I did think that I should be able to engage in sexual activity without having to have performance anxiety.

LADIES: As your man’s partner (I am aware it could be a man as well – I am not concerned with sexual preference here), if you are not aware – performance anxiety is huge for a man. A man’s identity is in large part tied to his sexual function. Not to be crass – that certainly is not my intent – but loss of sexual function for a man is similar to the loss of a woman’s breast. A breast is part of a woman’s identity. Sexual function is a part of a man’s and critically important when dealing with the emotional healing that must take place from cancer recovery.

BACK TO ELEVEN MONTHS…at that time I elected to have a hypnotherapy session. While that was not normal for me, I was aware that the subconscious mind is powerful. My negative self talk – “I can’t sexually perform,” “Wonder how my wife thinks about all this,” “Wonder if she’ll be patient,” “Am I still attractive,” “How can I be attractive if I can’t perform in bed,” – and the talk went on and on. I felt that anything was worth a shot.

SPEAKING OF SHOTS: Yes, I did attempt the injection into the penis therapy. For me it did not work. I am deathly afraid of needles and soon after the doctor did the injection – directing me to “go and enjoy a fabulous erection” – I nearly passed out. Seems that the psychological block to needles was much stronger than the medicine administered. Conclusion – I was not a candidate for that treatment.

HYPNOTHERAPY: In my case, hypnotherapy worked. It did not change me physically in any way, rather, it was effective in tapping into my subconscious mind allowing the mental blocks I had placed to be removed. That was huge. After the session, I walked away with a CD that I listened to each night as I fell asleep. Within two weeks I was amazed at the normality of my sexual responsiveness. Somehow I felt less anxiety.

Side note: I have contacted the Hypnotherapist that I used (as there are few who work in this arena) to see if she might offer a generic CD for men who have undergone Prostate Cancer surgery (with the nerve sparing technique utilized). If you are interested…please contact me at chuck@chuckgallagher.com.

ANOTHER DISCOVERY: While I certainly cannot speak for all men, I have found through my research that a more satisfying sexual relationship can be had if you go back to how your started. Let me explain. For most of us, when we were young men we flirted, we strutted, we did everything we could think of to attract that woman or girl to (first) go out with us, and (then) perhaps to make love to us. Rarely, did we look at the female – say, “want to have sex,” and then get it on. In fact, had we done that we would likely have been slapped.

Hum…well, after years of marriage the question is – how many of us put that same amount of effort into the relationship? Since I have elected for my life to be a bit of an open book…I’ll be completely candid here. Sex had become less passionate, less playful and more a function, and if that is the way I saw it, I’m sure it was much less fulfilling for my wife. Needless to say, there is no wonder that it was difficult to move through sexual healing following surgery.

TWO THINGS I FOUND: (1) Physically it took more time, effort and stimulation in order to achieve a satisfying sexual experience; and (2) that was easier achieved if I were relaxed and did not feel stress to perform.

The first issue was something that I had to discuss (not easy) with my spouse. Men rarely tell women what works, they (we guys) are too macho. Now, I never considered myself macho, but I did find it difficult to truly be willing to open up and tell my wife exactly what I needed from her to make sex satisfying. Regarding # 2, I did find the hypnotherapy effective. Exactly how it worked, I can’t say, but the effect was profound. The way I looked at it was it cost me the equivalent of 10 Viagra pills and could potentially have a long lasting benefit. When I put it into perspective, it was worth a try and a heck of a lot more comfortable than a shot to the penis.

CONCLUSION: Dr. Schover is right – successful sexual activity following prostate cancer treatment is not just physical. It is a joint venture – yours and your partner’s. Over the span of three and one-half years, we have come to understand the joys of a mutually satisfying relationship while understanding that I am not 17 and have undergone life altering surgery in order to live. As I talked with many in the course of my book research…I have come to know that those who have reported the best results are those who also have a willing, resourceful and patient partner whose love speeds along health.

AS ALWAYS…YOUR COMMENTS ARE WELCOME.

Sex Following Prostate Cancer – The Real Truth from a Prostate Cancer Survivor!

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 December 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.

First, if you are reading this you, like I, have had the unpleasant experience of being diagnosed with Prostate Cancer. Just like a diagnosis of breast cancer to a woman, prostate cancer to a man is devastating to hear and begins a long physical and emotional road to a life changing phase of life.

Allow me to make certain assumptions:

(1) You are alive and have survived. If you have just been diagnosed then this article, while informative, will be a bit premature. Yes, I know the issue of sex following successful treatment for prostate cancer is on your mind, but your priorities must first be – what is the best treatment that will cure this cancer and eliminate the issue of mortality from my mind.

(2) The therapy you chose allowed for the physical nerves to be spared and hence allow for the potential resumption of sexual function. All the research for years has shown that removing or substantially damaging the nerves eliminates the ability to achieve an erection and hence resume a “normal” sex life.

(3) Lastly, you recognize that you have undergone a substantial change in your body and accept that sexual function may never be quite the same. That does not mean that sexual function can’t be quite good, approaching normal, but more than likely by the time you’re diagnosed and have gone through treatment, you are middle aged. Face it, middle aged men aren’t quite as viral as they were when, say they were seventeen.

In an earlier blog entry I wrote about my experience with sexual function following a highly successful prostate cancer surgery. The article is referenced here. For clarity and convenience, allow me to restate a portion of that article here:

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

There is a reality for us all. For now all I can speak for is myself. (I am conducting research into this area – see the tab “Prostate Cancer” if you are willing to help). There are three areas that I feel need to be exposed as men and those who love them deal with the very real and significant issue of sexual function after prostate cancer. There is no order to the issues listed below – each are important in their own way.

Issue One: Psychological ramifications of sexual function after prostate cancer surgery. Following my earlier articles and blogs I received a number of e-mails and calls from men and women who appreciated the candid discussion and insight. As time has moved on I have come to understand that sexual function, especially following prostate cancer, is as much (if not more) about the mind than it is about the body.

Women/Partners - I am not yet sure that you know just how much a man’s identity is tied up in his sexual function. Now, I can hear two responses as this is being read: (1) you think I didn’t know that? and (2) it can’t be that important. At the risk of sounding preachy – ladies – No you don’t really know that and, yes it is more important you’ll ever conceive.

While a man is far more than his sexual ability, the lizard brain in us all sends messages that we cannot control – to a man it is to procreate. So to eliminate that possibility means that the subconscious mind diminishes the worth and value of the being. On the outside he may seem invincible, but on the inside he is crumbling, but rarely will he be emotionally connected enough to show it or willing to show it. Showing that pain (emotional pain) is a form of weakness to most men and revealing that would only slide him further into a downward spiral.

What to do? The less pressure there is to sexually perform the easier it is to perform. Now, by that statement, I do not mean reduce the frequency of sexual attempts. First, create an environment that will allow for play, fun and all the joy that comes from being sexually with your partner.

Secondly, be willing to become more active in order to help the recovery process. I have been told by several physicians that muscles grow if they are used. Basically they were telling me to use my penis (sexually of course) and do so whether through masterbation or with a partner. I will be blunt here. I have found that masterbation produces a more consistent result. For a while I wondered why, then it hit me – I can take all the time I want to with myself. There is no pressure and I can image that where ever my thoughts may take me, the person I imagine myself with is patient, willing and engaged.

Let me be clear, I am married and my wife has encouraged me to continue this writing knowing that others may, very well, be feeling the same thing or experiencing the same issues. That said, while sex with my wife is very pleasing, I find that while I can gain an erection, often the sexual experience does not result in an orgasm. As we have spent time discussing this, it has become clear that my inability to achieve a satisfactory sexual result was psychologically connected to my wife’s attitude and engagement in the process. It takes more effort to achieve what used to be easy. Hence, in order for the experience to be satisfying to me – my wife has to, bluntly put, work harder. Not only is that a substantial change for her, but it puts pressure on me and the more pressure the less performance.

Issue Two: Bodily Function. As I mentioned in the first article, it took me time to recognize that my body was different. While sex was more difficult following surgery, it became clear that there was a greater than likely chance that urine would be released sometime during the act of sex. Hence, I have discovered three things: (1) the less you drink before attempting sex the less chance of leakage; (2) urination immediately before sexual intercourse (or whatever method of sex is selected) reduces the chance for any substantial leakage; and (3) since urine is sterile and effectively harmless, allow it to be used as a form of lubricant or play. I can hear many scoffing at the third suggestion, but going back to Issue One – if a man is concerned about what might happen (urine leak) during sex, he will be constrained physically (because of that mental state) and hence have a much more significant problem with achieving an erection or achieving a sexually satisfying experience.

Issue Three: Practice…Practice…Practice. Now, as I write those words, it occurs to me that some may interpret this as applying pressure and increasing the sexual anxiety associated with prostate cancer. I don’t mean “practice” in that sense. Rather, it means either love yourself or love your partner (that will depend on who is reading this – you or your partner) enough to provide any and all outlets necessary to heal. I would suggest that you consider spicing up your sex life so that the stimulation (whether visual, auditory or by feeling) is enhanced. Having talked with others I know that sexual healing can take place, but it does come with a cost – and in most cases that cost is increased effort.

Question: If your dog broke his or her leg in an accident and the vet told you that he had to walk at least two mile each day and do other physical activities in order to heal – would you do what was necessary to help your dog heal? If you answer no – “I’d put him to sleep,” please quit reading this article – it’s hopeless. But, I think most would agree that we’d all say, “I love my pet and would do what ever.” Strange example, but we need to do whatever is necessary to heal, both physically and emotionally. No one said it would be easy – physical therapy is hard.

Simply put, sexual healing from prostate cancer is physical therapy that heals on both a physical and emotional plain. If sex is still a struggle…hang on and keep trying. It may never be what it was, but in most cases you can sexually recover from prostate cancer. I did and so have countless others.