We need to talk about sex.

That’s never easy, but this is an emergency:

A professor and long-time PC patient I’ve spoken to who is familiar with research about sex and prostate cancer told me that *50% of the time* couples will incur serious damage to their marriag after the man has had treatment for PC. I have to caution you that this statistic may apply only to hormone therapy, but either way, it looks bad.

So I hope we can have a prolonged conversation about sex after PC. I’d like to discuss it from a woman’s point of view. And I’m going to start at the very beginning: How does sex work?

My new maxim is:

*Behind every successful man with PC is a woman who does the research.*

I know some guy won’t like that, but too bad. In our case, my first job after dear husband’s surgery was to figure out what caused ED. And that nearly drove me crazy.

As an urban woman who has no car, no lawnmower, sprinkler or garden hose, and no knowledge of plumbing or hydraulics, I felt lost. Because this is the way men talk about their bodies.

Scardino was my first read. He declares in “The Prostate Book”:

“The penis is a marvel of mechanical engineering.”

Too bad for me. I’m not mechanical. Nor visual. I’m a left-brainer with two left hands. Just so you know I have finished college, law school and passed the bar, but learning the mechanics of the lower half of the male body was the most difficult intellectual challenge I’d every faced

I remember sitting in Barnes & Noble for a couple of hours staring at the male genitalia in the “Atlas of the Human Body.” I couldn’t even tell whether the page was right-side up! And everybody around me thought I must be some kind of pervert.

Then there was the diagram in “The Prostate Book” of how an erection works. I looked blankly at the page for what seemed like an eternity. Then Ted came to the rescue.

Scardino explained that an erection is a sort of “valve.” Of course, I knew a valve is a pipe, but I didn’t know it’s a pipe with a stopper at one end. I had to look it up in the dictionary. That was the key to understanding the whole thing. And most embarrassing of all, DH had to explain to me the difference between a vein and an artery.

Then it got even better: Scardino wrote:

“The same hydraulic principle [as an erection] applies when you inflate a bicycle tire. To make the tire rigid, you have to force in sufficient air and then keep it contained under pressure. A leaky valve would make it impossible to maintain rigidity, and the tire would go completely flat.”

Wow. My husband had a flat tire. A leak in his penis. But something just didn’t sound right. I had read plenty about ED, but I’d never heard of a guy complaining of a leaky organ.

Then there was my favorite Scardino quote:

“Erectile nerves run along the outside of the prostate like strings along a package.”

Duh? I imagined the prostate tied with ribbons — blue, of course. But dear husband translated: “I think he just means the nerves are on the outer surface of the prostate.”

One of my favorite people in the PC community, Curtis P., never seems to have met a machine he didn’t like or understand. That’s why the guys love the way he describes things: You might call his lingo “Man-go.” “Man-go” is very technical. Not for me, but I’m learning.

But I have to say Curtis has taught me a lot, not just about auto mechanics but physiology as well. For example, Curtis wrote this about the process of getting an erection, and it sounds pretty accurate (remember, this is not medical advice):

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“Part One – The Nerve Process”

This [the erectile nerves] can be viewed as the electrical wires to run the piece of equipment. Take for example – a motor. If the wires are broke or in any way damaged to where it can’t get the signal to the motor, the motor will not run — even though the motor itself is in perfect running order.

“Part Two – The Actual Mechanical Unit Itself”

If it is working and there are no problems with it, such as leaking [in the veins, possibly as a result of damage from surgery], then erections will take place. [A little simplified. You need to get the smooth muscles of the penis to relax to allow blood to flow in, etc.]

So, this is where the different theories start at:

(1) Does one take Vitamin V (Viagra), in order to help reduce the shutdown process [give a boost to the “wires,” the erectile nerves]? Or:

(2) Does one “hotwire” the unit with a shot of postaglandin [ingredient in injections for ED]?

Let’s dive into this situation even more. In the RP itself, if the nerves were NEVER disturbed, then, the patient would have the same erections post op as they did going into the surgery. So, this is the joker in the deck. One knows that when you pull on the nerves, stretching them, or have to strip the pca off of the nerve, you are going to cause damage.

The skill of the surgeon is a very big factor in this — can he remove the prostate without disturbing the nerves? Some don’t and some do. And what about the unknown factors? The size of the prostate? Where the prostate cancer is located? Is it in more in the front of the body or is it deeper inside? This has a direct impact on erectile function afterwards.

So, what’s the best method to regain erections post op?

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This is where Curtis and I parted company. He went on to recommend the VED for “penile rehab.”:

“Yes, it is all about simple hydraulics. The penis gets hard for the same reason you can use one hand to lift your car with a hydraulic jack.”

??? I don’t know how to use a jack, certainly not with one hand.

My suggestion at the time was to “hotwire” the engine, i.e., to use injections as ED therapy or rehabilitation.

Then there was the guy who wrote me comparing an erection to using a sprinkler. I think I got his point. Sort of.

Anyway, eventually I went on to do a lot of research on ED on behalf of my husband and others, and it was a slog. Difficult, but worth it.

So my next job is to learn how to use a computer.

More on sex. What exactly is sex? And do people need it, or is it just a luxury? What do women want?

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One Comment

  1. Teresia January 29, 2013 at 1:34 pm

    Ok, so I got online today to research whether or not there have been any cases of medical negligence due to lack of patient counseling and the insuing mental anguish following prostatectomy in the U.S. I burst into tears reading Leah’s success story! My husband was 48 and I was 40 when he lost his ‘getter-upper’. His was due to a rare case of bladder cancer. We are now in the midst of divorce proceedings. There was absolutely no counseling or preparation for life post op. The anger and feelings of neglect are so tremendous. It has destroyed our lives. I was 40 YEARS OLD FOR GOD’S SAKE! It has gone on so long now that my husband refuses to get help. He’s alive, that should be good enough for me, right? Well it’s not. Kudos to you, Leah, you were lucky enough to have an open minded partner.

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