Weekly blog: Let's talk about sex, Baby

26 July 2022

By Tim Baker

Let's talk about sex, Baby*

*(may contain puns and awkward euphemisms to protect my male fragility)

In the grand, time-honoured tradition of “those that don’t do, teach,” please allow me to impart what I know about maintaining sexual function during prostate cancer treatment, a mission I have failed at spectacularly myself.

When you are first diagnosed with prostate cancer, overwhelmed with information about treatment options and side effects, your deepest mortal fears abruptly aroused, a different form of arousal is probably the last thing on your mind.       

This is a common scenario. In the months and even years after diagnosis, navigating an often-baffling medical system, maintaining sexual function often never makes it to the top of the to-do list. Hormone therapy, surgery, chemo and radiation can all take a toll on libido and sexual function, which might not feel like your highest priority when fixated on mere survival. And in all the various forums or support groups I explored, there was precious little discussion of this issue. Men, it hardly needs saying, are not always great at discussing this kind of thing.

So, allow me to be your cautionary tale. It took me four years to take the advice of my GP and make an appointment with a men’s sexual health specialist, by which time the damage had essentially been done. During early chemotherapy (in conjunction with hormone therapy) I was told even my bodily fluids were considered toxic, that I should always flush the toilet twice with the lid down and avoid allowing my semen to come into contact with anyone’s skin. Thus, even before hormone therapy had laid waste to my libido it had taken some serious hits.

The sexual health specialist I saw was enthusiastic and upbeat about the array of options available to me to try and salvage some vestige of sexual function. In a nutshell, you need to maintain the necessary blood flow to the penis and there are essentially four key treatment options, generally prescribed in an escalating order of invasiveness.

POPPING A PILL

First stop is the famous blue pill, our old friend Viagra, or other similar oral medications. Known collectively as Phosphodiesterase Type 5 Inhibitors (PDEi5), these are tablets that relax the smooth muscle cells lining the blood vessels and allow blood flow to the penis more easily. These include Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil) and Spedra (Avanafil). They don’t work for every man and their effectiveness depends on the type of damage that is causing the erectile dysfunction.

My specialist recommended I treat my efforts to achieve an erection like going to the gym – the more diligent and frequent my practice, the better results I’d achieve. With no libido, this proved a greater challenge than I could, er, rise to and the benefits of the blue pill for me were marginal at best.

Pros: Quick, cheap and convenient.

Cons: Have to wait 90 minutes for it to work, which requires some forward planning. Not effective for all men.

NO PRESSURE

The next suggestion was a vacuum pump which helps draw blood into the penis by creating negative pressure, but, honestly, I could never quite come to, um, grips with the concept or the other more dramatic interventions. But if I had my time over again, I think I’d try harder to overcome my squeamishness. The idea of having to pump up my appendage prior to sexual congress seemed to lack spontaneity, but many men report good results and a satisfying sex life with its use. A rubber ring can be used around the base of the penis to trap blood in it to help maintain an erection.

Pros: More or less instant results, minimal invasiveness.

Cons: Might feel awkward at first introducing this to your sexy time.

A LITTLE PRICK

(Sorry, I’ll see myself out)

If the pump fails to, ah, float your boat, or feels too awkward or clumsy there is a simple injection and, yes, that injection goes directly into the relevant organ. Which might make the idea of that vacuum pump suddenly seem a whole lot less awkward or clumsy. But, again, many men find “intracavenosal injections” (to use the technical term) highly effective and convenient. Alprostadil is one of the drugs used for such injections and increases blood flow to the penis by expanding the blood vessels within it. It does come with some side effects so you should consult a doctor before use.

Pros: Again, quick, and convenient.

Cons: Some might baulk at the idea of self-injecting. Some potential side effects.

PUMP IT UP

Which leads us to our fourth and final erectile dysfunction strategy and that is a surgical implant. It may take you a while to wrap your head around the concept (as it did me), but essentially two silicon balloons are placed in the shaft of the penis, connected to a simple pump implanted in the scrotum. With a few squeezes of the pump, you can inflate your own boner to the desired pressure. Many satisfied customers attest to the ease and efficiency of this arrangement, but sadly your correspondent isn’t one of them. I haven’t ruled it out altogether but sense that perhaps this particular horse has long bolted.

Pros: Quick and lasting efficacy

Cons: Surgical implants might be seen as invasive and, like any surgical procedure, are not without risks.

Which, I suppose, leads to a fifth option. Adaptation. They say you can get used to anything, but I tell you, this experience tests that old adage. I got as far as the pill option and when that didn’t yield the desired result I more or less racked the cue, so to speak. Not an ideal option in hindsight, not great for my marriage and if I had my time over I’d attend to the matter much sooner. A referral to a suitable specialist should be standard care at diagnosis, with a 12-month reminder if it hasn’t been actioned.

It’s all a pretty delicate topic for me to publicly ventilate like this but as blokes we need to get a whole lot better at talking about this kind of stuff, to look after our own health, our intimate relationships and the health of other men we care about.

More information and an excellent online resource here: https://www.atouchysubject.com/

This August, Tim will launch his latest book, Patting the Shark. This candid story documents his journey learning to live well with prostate cancer. To launch Patting the Shark, Tim will join Professor Suzanne Chambers at Brisbane Library on August 21, 2022 from 11am to 12pm to talk about his journey. To attend, click here.

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