Viagra "not a sack of cement installer"

I'm writing the chapter about cancer and sexuality for my new book, Naked at Our Age: Talking Out Loud about Senior Sex. The stories people sent me about reclaiming their sexuality after cancer treatment fill me with admiration. I looked back at some older posts on this blog that deal with sex & cancer, and decided to bring back this one from 2006. With the prevalence of Viagra use, I think BillyBob's experience and his thoughts about it are important. - Joan

BillyBob, age 62, has told some of his story previously as a comment here. He recently sent me an email detailing an experience that he wants to share -- and he makes an important point:

I started dating a lady I have known for a year, mostly through phone conversations. I knew that she likes sex. Last weekend we went for dinner. After dinner she wanted to go back to my place for a while.

Well, as it turned out, it was the most embarrassing time I have ever had, all because of a misconception some woman have about impotency.

I took a Viagra after we got back to the motel hoping it worked fast! It did its normal thing and got me sexually aroused but not 100%. She knew I had to take it because of the prostate cancer killing my prostate.

Here is where the misconception comes in. It seems that women who do not know about Viagra seem to think if you take it you just get ramrodding hard, and they do not need to do any stimulation. Well that’s just plain wrong. Men still need stimulation along with the Viagra. The drug is not a sack of cement installer.

And I was not about to masturbate myself in order to get it hard. Not in the presence of a woman.

So as it turned out she turned me off instead of on. What a bummer. It was so disappointing. I had looked forward to our meeting for some time. And the possibility of finally enjoying good sex with some one that likes sex.

All a woman needs to know about the drug is that you do things as normally, using stimulation together. So please tell your readers what my experience was.

BillyBob, thank you for sharing this experience. Viagra helps when there's a physical cause for lack of erection, as you know, but it doesn't increase libido, or substitute for all those other crucial components of good sex that you (and I, and probably everyone reading this) crave -- touching, kissing, bonding, stimulating each other physically and emotionally, enjoying each other's pleasure as well as our own.

It sounds like most of this experience was missing for you. What a bummer, I agree. I'm sorry you didn't feel you could communicate your needs and desires to your partner -- I don't know, maybe she would have been happy to help you get aroused if she had understood. It's hard to understand why she didn't seem interested in stimulating you just as part of the sex play (with or without Viagra), since that's a good part of the fun of sex.

I know you were too embarrassed to masturbate in front of her when she didn't help arouse you, but as a woman, I find it very pleasurable and exciting to watch a man stimulate himself. I don't know if your partner would have reacted this way, but I'll bet she would have.

If you see a future or at least a repeat date with this woman, I hope you'll communicate candidly with her before you get to "the act." And please continue to write.

Thank you again, BillyBob.

-- Joan

Sex after prostate surgery? Anne Katz answers reader's question

Cancer -- not a sexy topic, and not what you'd expect me to write about on Christmas Eve. But cancer knows no seasons and respects no holidays. Maggie, age 62, wrote to me:

Recently, I met a nice guy who after dating for a while, told me that he had surgery for prostate cancer 7 months ago. He went on to tell me all the bad news that the Dr. had told him about side effects. My question is, do you know any where that I can get some straight answers on what we are looking at, possibility wise? The information I have found online so far has been very negative, almost always putting the pressure on the woman if things were going to work or not. He advised me that he would never be able to have an ejaculation & that sex for him would never be the same. I got the idea that he would never feel the pleasure of having a climax again. My fear is that if this is true, what would be the point of him having sex? I am a very sexual woman & would just like to know if there is any chance that there can be a sexual relationship? Any guidance that you could offer would be greatly appreciated.

I sent Maggie's question to cancer and sexuality specialist, Anne Katz, RN, PhD. Here is her response:

There are a number of possibilities in this situation, some of them good and some of them not so good. Here are the facts:

1. Having surgery for prostate cancer (a radical prostatectomy or complete removal of the prostate gland) will result in significant changes in a man's ability to have an erection. Depending on what his erections were like before the surgery and the amount of damage done to the nerves responsible for erections during the surgery, the man may be able to have erections after the surgery but he is most likely always going to need some help (from medication like Viagra, Cialis or Levitra). These medications only help about 50% of the time but there are other erectile aids (the vacuum pump or penile injections) that can help too. Some men are able to have an erection but it may not last very long. Some men can only achieve a thickening of the penis and this may not be sufficient for penetration. Progress in regaining erections may continue for up to two years after surgery but what he has at that point is usually as good as it is going to get.

2. Orgasms are still possible, even with a flaccid penis. The orgasm will not be accompanied by ejaculation however (the prostate gland makes the fluid portion of the ejaculate and so when it is gone, so is the emission). Some men report more intense orgasms after this surgery; some say they are much less intense.

3. Libido (or sexual desire) is not affected by removal of the prostate but the mind is a very important part of a man's sexuality. Repeated failure to have an erection sufficient for penetration may cause him to lose some interest. Although some men just keep on trying and trying and trying - the human spirit is a powerful force and many men retain hope for many years despite little success.

4. Many couples find a way around these difficulties. There are more ways than just penetration for both the man and the woman to achieve orgasm and satisfaction and some creativity goes a long way. This may be challenging for a new relationship. But the lust and attraction in a new relationship may also provide more impetus than a 30 year relationship! There is no right way or wrong way in this; a lot depends on how you want to look at the situation.

5. If you read anything that you feel puts the onus on the woman (or male partner) to fix things, then stop reading! This is a couple's issue and both partners have to work on finding a solution. Communication is a very important part of sexuality. You should be able to talk openly about what works for him and what doesn't. You should be able to talk about what you want and what creativity you can both bring to sexual activity. In your letter you state that you "got the idea" - you will have to ask questions and not rely on innuendo to help you understand what is possible and what is not.

New relationships are challenging and exciting and inspiring and joyful. When illness or injury have occurred it puts a lot of pressure on this new partnership. Good luck!

Anne Katz, RN, PhD, is the author of the award-winning text book Breaking the Silence on Cancer and Sexuality: A Handbook for Health Care Providers . Dr Katz has also written three books for consumers: Sex When You're Sick: Reclaiming Sexual Health after Illness or Injury; Woman Cancer Sex, and Man Cancer Sex. She is the sexuality counselor at CancerCare Manitoba in Winnipeg, Manitoba, where she provides counseling to men and women experiencing sexual difficulties as a consequence of cancer and its treatments. Visit her website at http://www.drannekatz.com/.

Aggressive prostate cancer treatment saved his life

Neil, age 74, who wrote his Personal View of Prostate Surgery and Sex here, wants to add this:

I hope I did not leave the impression that I am anti-physician. I do not want to imply that my caregivers were incompetent or uncaring. I certainly don't think anyone lied to me. I am blessed with a caring and extremely competent urologist who has given me nine years free of prostate cancer.

The urologist was aggressive in treatment. Tests were conducted well before my PSA even reached critical numbers. Normal range is 1 to 4 -- mine was a little over 2. The disease was caught early because of a very dedicated doctor.

My urologist routinely spends 12 to 14 hour days in the battle against cancer and has very little personal time. I am grateful for what was done for me. My physician, by the way, was not the person who gave the word that sex didn't matter after 55. That was a second opinion guy at another medical center.

I suppose the myths and lack of information come from two areas:
(1) The work load of dedicated health care professionals is unbelievable. When faced with a choice of saving life or providing sexuality education, I would want my doctor to first go after the cancer. I was very grateful my urologist did just that. I am here today because of this priority.
(2) While some counseling was given, my physician candidly stated that not much training was given in matters of sexuality. There simply was not enough time for everything. I believe that. As I have talked to other urologists, the story is the same. There is just not enough time to get everything into the program of study.

I am sure that we, as sex educators, have some responsibility to assist in making things better. Perhaps more of us will somehow find our way into relationships with medical school faculties. Hopefully, we can also raise awareness that would provide support to local medical groups as well. I would hope that we could be of assistance to the medical profession without getting in the way of their very important clinical work. I am sure that your book will also provide more information that can be placed in the hands of the health care community.

Above all, I want to leave the message for men to find a competent urologist and stay with their professional judgment. This stuff is nothing to mess with or take lightly. I prefer that we work hand in hand with health care professionals in the battle against cancer as well as the enhancement of sexuality.

Personal View of Prostate Surgery and Sex

Neil, age 74, offers this startling information about sex after prostate cancer surgery. I'm grateful to Neil for his willingness to share his personal story:

A diagnosis of cancer is very frightening. For me the journey was scary enough without the myths and misinformation I was told about cancer of the prostate. I share my experience in the hope that this information will be of help to others.

Myth # 1: “After Age 55, Sex Doesn’t Matter That Much Anyway.”
I heard these words from a physician who specializes in the treatment of prostate cancer. A very nice person, considered extremely competent, he believed his words would be comforting. They weren’t!

Sex does matter after 55. I promised the doctor that I would look him up on his 55th birthday and tell him to “cut that out.” He sheepishly smiled and said, “Oh my. I think I said something wrong.”

Myth # 2: “What You Have At The End Of A Year Is What You Get.”
Although many men are told that any rehab after prostate cancer treatment will peak in twelve months, every case is different. Some methods of prostate cancer treatment can result in serious damage to sexual performance. On the other hand, robotic surgery and nerve sparing have greatly improved sexual potential. Whatever the case, don’t give up! There are options for almost every case of sexual impairment.

But I must warn about some of the product advertisements that flood the market about penile enhancement, instant erections, and so on. Some of these products can be harmful to a cancer survivor. Some are loaded with testosterone which can cause further growth of prostate cancer. Check with your physician before trying any of these medications.

At all times, keep your partner involved in the options you’re considering. They can be our most precious friends and supporters. They deserve to be part of the solution to our new life experiences.

What We Are Often Not Told:

The penis will be about an inch shorter after surgery. Because the urethra passes through the prostate, when the prostate is removed, that portion of the urethra is removed as well. Then, when the urethra is resectioned, the penis is drawn in towards the abdomen. Secure circumcised males seem able weather this storm but uncircumcised males have an additional problem. The surgery leaves more foreskin than before. This additional tissue traps urine and produces odor. Baby Wipes do a very fine job of solving this problem. They are easy to carry and save a lot of embarrassment.

The “Missionary” position usually is no longer successful after prostate surgery. Because the prostate stabilizes the penis and prevents it from receding into the abdominal cavity, removal of the prostate decreases penile stability. The angle of the vagina, coupled with a shortened penis with no internal stability means vaginal intercourse may not work. However, “Doggie Style” and “Woman on Top” work just fine.

I welcome feedback about the experience of others regarding sex and prostate surgery!

9/22/2009: Neil added these comments about how his urologist saved his life.

Intimacy after prostate surgery

Several readers have posted and emailed me about sex and intimacy after prostate surgery. I asked Anne Katz , RN PhD, author of Breaking the Silence on Cancer and Sexuality: A Handbook for Health Care Providers and sexuality counselor at CancerCare Manitoba in Winnipeg, Manitoba, to respond to a common question:

Ever since my husband had his prostate removed because of prostate cancer, he has been reluctant to touch me. This is so upsetting. I love him very much and don’t know what to do.

It is common for men to be unable to have an erection after this surgery. Depending on the type of surgery (nerve sparing or not), his ability to have erections may or may not return. Many men are deeply distressed by this and may avoid all physical contact with their partner so as not to “lead them on” or disappoint them. This leads to a very unhappy partner who wants to express his/her love and support but feels cut off and cut out.

What is important is for the couple to TALK. It is often really difficult to talk about a sensitive topic when emotions are running high. But talking goes a long way to healing and connecting. Start with an “I” statement: “I miss touching you and being touched by you. How can we reconnect again?” Or perhaps: “I love you so much and want our relationship to be the way it was before the surgery. What can WE do to help this happen?”

While there are medications and treatments that may help, further treatment should be a couple’s decision and the man should always include his partner in medical appointments so that both people can express themselves and have their questions answered. Because communication is so important, the couple may need professional help to start the communication flowing. But seeking help is the first step.

For more posts about cancer and sexuality, please click "cancer" in the "labels" list in the right-hand column.

Is this helpful? Let me know what questions you'd like me to explore as we age and encounter physical and emotional challenges to our sexuality.

--Joan

Gerald Haslam talks about prostate cancer and sex

Gerald Haslam, author of Grace Period, is living with prostate cancer. He wrote a stunning summary of his views of the importance of sexuality while living with cancer for my upcoming book. I know I have many readers who are looking for information on sexuality and cancer, so I'm giving you an advanced look at some of the insights he shared:

A seventyish man who was recovering from a prostatectomy asked fellow members of a prostate-cancer support group how they could have sex if they were leaking urine. He ended with a timeless observation--"My wife is willing to be pissed off but not pissed on."

Despite the laughter that followed, his was a serious problem, but the first response solved it: "Put a band on your penis --a cock ring. A lot of older guys who aren't incontinent use them to maintain erections, but if you're leaking they're a good answer, especially if you use a pump."

The first man was honest enough to admit, "I hadn't thought of that. We've never used any...devices. Of course, I've never had prostate cancer before, either." In fact, the prostate cancer world introduces many guys to devices and positions and concepts previously unimagined.

A physician pal said to me shortly after I was rendered impotent by prostate surgery and radiation, "You'd better start pumping up your penis every day, whether you're going to use it right away or not, or it'll shrivel into a Vienna sausage. As soon as you lose spontaneous erections you lose penile tone. No tone, and there'll be nothing to pump when you do want to use it."

In fact, sex seems to be the second most common topic--after cancer therapies--in discussions at most prostate cancer support groups, and I learned that many men, rendered impotent and perhaps stripped of libido by hormonal ablation, simply but not happily accepted the verdict that their sex lives were over, a defining activity lost. A dread frequently mentioned to me by my fellow prostate-cancer survivors has been not only the sudden absence of sex but of sexuality itself. This is especially grave since sex and sexuality can represent the life force's most powerful affirmation in the face of death.

Unfortunately, many of us men grow up believing that our sexuality dwells almost exclusively in our genitals, so a damaged penis may lead to a damaged personality. As one wife admitted at a session for couples, "There's not much fun in our lives anymore, and I don't just mean sex. He's just so sad." A penile fixation may also lead one to forget how much sexual satisfaction can be achieved by giving pleasure to a partner you love.

Please read my review of Gerald Haslam's Grace Period. Click here to view or order Grace Period on Amazon.

Changes after Prostate Surgery: Tina Tessina

Many of you have been reading and asking about prostate cancer, how it affects sexuality, how spouses/lovers can communicate and keep their love strong while living with it. Some of the most widely read posts on this blog have been those dealing with prostate cancer, such as "A man asks about sex after prostate cancer" and "Grace Period: a novel about living with prostate cancer."

In response to your interest, I've asked Tina Tessina, Ph.D. to comment on this subject. Besides being a psychotherapist and author, Tina writes from experience: her husband is living with prostate cancer. Here are her comments:

The changes that come after prostate surgery are, like all changes, not easy. We don't like to have to deal with changes, especially those that confront us with our mortality. But, I can happily report, with some encouragement and enthusiasm from me, my wonderful husband is quite functional sexually. His surgery was in 2002, he just got another 'undetectable' PSA test, so we are blessed.

For us, the blessing is in how heightened our love and appreciation (which was pretty good before) has been by the threat of terminal illness. Richard is lucky -- they got it early, it has not spread, the surgery went well. His second surgery to have an artificial sphincter put on his urethra, also went well.

Others, I know, have a more difficult time. But, as Gerald Haslam wrote in Grace Period, "Live for the moment, since that may be all you have." Richard and I decided to do that in 2002, and we've been making the most of our moments ever since. Every day is a gift, another cup of sweetness, and we drain it to the last drop. One of our joke lines is "I'd like another one of them there drinks," from Scrooge, referring to the Cup of Human Kindness given to him by the Ghost of Christmas Present.

For some couples, the tension of serious illness creates crabbiness and bickering. Richard and I have never wanted to waste time arguing, and we haven't for a long time. I don't believe it helps anything that's going on. In my newest book, Money, Sex and Kids: Stop Squabbling About the Three Things That Can Destroy Your Marriage out from Adams Media spring 2007, I help couples who are fighting learn new methods of getting along so they can enjoy their time together.

For more, see Tina Tessina's Dr. Romance Blog. Dr. Tessina is a psychotherapist, author of several books including It Ends With You: Grow Up and Out of Dysfunction, How To Be a Couple and Still Be Free, and The Unofficial Guide to Dating Again. She writes the "Dating Dr." column on www.CouplesCompany.com and "Dr. Romance" on Yahoo! Personals.

Grace Period: a novel about living with prostate cancer

Grace Period is a novel about living with prostate cancer by Gerald Haslam. Although fiction, the author does indeed have prostate cancer. Though the details of his protagonist's life don't match his own, Haslam gives solid medical information about treatments for the disease, and what it's like to go through daily life living with this cancer.

Grace Period's progagonist falls in love with a breast cancer survivor, and many of the highlights of this engrossing novel deal with the relationship between Marty and Miranda. Although the book's plot does not revolve around sex, Haslam treats his characters' sexual relationship with directness and sensitivity. Marty uses a pump because he cannot get "natural" erections, and his doctor encourages him to explore alternatives: "Guys tend to overestimate hard-ons. You've got a tongue, toes, fingers, and ingenuity."

Marty learns that he can have "dry orgasms": "It hadn't felt quite as good as the old fuild ejaculation -- or at least I didn't think it had -- but it sure felt better than anything else I could think of."

"Once you're in the cancer world, everything's iffy," Miranda tells Marty. "Live for the moment, since that may be all you have."

That sounds like good advice whether we're living "in the cancer world" or not. It's up to us to make the most of the cards life deals us. Near the end of the book, Marty grins and tells Miranda, "I'm standing here wearing a damp diaper; I haven't had a natural erection in years; my body is drooping and my face is sagging; I'm driving the wrong way on one-way streets. And I'm a happy guy."

Many thanks to Gerald Haslam for a novel full of truths, centered around a relationship that touched me deeply.

Update: I just heard from Gerald Haslam, who wants to contribute this to our discussion:

Joan:

Thanks for your kind words about "Grace Period."

Like Marty in the novel, I think that making love as long as one can and as well as one can represents life refusing give in to death or infirmity.

There is no proper age for it, there is only the desire, the need, the ability (along with, one hopes, a little creativity). Although my own life is rather different than his, my cancer isn't and neither is my attitude or my good fortune at enjoying the comfort of a loving relationship. I'm delighted to learn that you do, too.

All the best, Gerry

A man asks about sex after prostate cancer

Billybob, 62, has written several times, always willing to share his thoughts and experiences to help both men and women talk more freely about the special challenges of sex after 60. In his case, these challenges include recovering from divorce, re-entering the dating scene, and living with prostate cancer. I just received this question from him:

Since my cancer treatments I still want sex but I have an erection problem that Viagra seems not to work to well. What would a lady think of me if I chose to use a strap on device? Or do you know of alternatives? And If I were to use a strap on how would I break or tell such an idea to a lady?

I wrote this to Billybob:

If you read the chapter of Better Than I Ever Expected titled "When You or Your Partner Can't," you'll see that women are very happy with fingers, tongue, vibrator, and cuddling when their partner can't have an erection. I don't think many women would appreciate a strap-on device, though I suggest you talk about it ahead and let her know you're willing if she'd like it. My suggestion: level with her about your situation as soon as the intimacy gets past kissing, and see what she'd like and -- please! -- also tell her what would make you feel satisfied. Let me know how this works for you.

What do the rest of you think?

I read two good books on this topic, which I mentioned in Better Than I Ever Expected and which you can order from Amazon by clicking on the links:

Intimacy with Impotence: the Couple's Guide to Better Sex after Prostate Disease by Ralph & Barbara Alterowitz (Da Capo/ Lifelong Books, 2004). A frank, practical guidebook to satisfying, sensual intimacy whether or not the male partner can have erections. An array of self-help strategies, from communication and creativity to medical therapies.

Making Love Again: Hope for Couples Facing Loss of Sexual Intimacy by Virginia and Keith Laken (Ant Hill Press, 2002). Candid personal narrative by Keith Laken, prostate cancer survivor facing impotence, and his wife, including fears, arguments, resolutions, setbacks, and a new definition of intimacy.

-- Joan