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Let's Talk About Erectile Dysfunction

How my prostate cancer experience is helping make ED more discussable for me.

Key points

  • Erectile dysfunction impacts about half of all men aged 60, and many much younger.
  • Prostate cancer is known as "the couple's disease" because treatment has a major impact on intimacy.
  • Good starting points for men and their partners facing ED: We can still make love without erections and there is no shame in body changes.

It is very awkward talking about erectile dysfunction (ED). Hardly anybody does, except in derisive jokes. Yet it is extremely common after prostate cancer treatment, and some level of ED affects about half of all men by age 60 .

Surprisingly large numbers of men under 40 are also affected . It's a big deal, especially when you factor in the impact of ED on partners and intimate relationships. Yet it remains mostly undiscussable.

My prostate cancer journey makes it easier for me to talk about erectile dysfunction. Somehow for me as a man, it is much easier to say "I can't get it up because of cancer surgery," than to just say I can't get it up.

I'm 63 now, fit and healthy in every other way, but I was diagnosed with prostate cancer in November 2019. I felt no symptoms at all. I had my prostate surgically removed just over a year ago, by which time the cancer was at Stage 3a. Right after surgery, I thought I was one of the lucky ones who escaped without ED, but my erections faded progressively in the following two months.

Breakfasts with Cialis

Photo by Mish Middelmann
Source: Photo by Mish Middelmann

It's pretty weird sitting down to breakfast with medication for erectile dysfunction. I mean, I am not an ED type of guy. Right? I am a fit, strong married man enjoying a healthy sex life and a strong libido. That's certainly how I saw myself until my surgery.

Before surgery, my urologist and surgeon warned me that post-treatment erectile dysfunction has a similar prevalence regardless of the type of prostate cancer treatment . Apparently, the difference is that with radiotherapy the onset is slower. With radical prostatectomy surgery, the onset is quicker but the graphs converge after five years. Routine first-line post-operative treatment is regular doses of PDE5 inhibitors, most commonly known as Viagra or Cialis. These drugs have recently emerged in generic form as sildenafil and tadalafil respectively.

My prescription is 5 mg of Cialis every morning for the next six months. Not just for date nights. The doctor's intention is not so much for sexual performance but to improve blood flow to the area. And he has said something about "use it or lose it." What? Apparently, the erectile tissue will permanently atrophy if deprived of activity for extended periods. My hands creep to my groin in a protective gesture: That outlook really scares me.

Talking about erectile dysfunction and manhood

Actually, this is not the first time I have experienced erectile dysfunction. The first time was about 10 years ago after a rather traumatic conflict at work. I was shocked when my erection simply vanished in the middle of lovemaking with my wife, and I felt absolutely mortified. I certainly didn't tell anybody about it.

What I am deeply grateful about is that my wife's immediate response at the time my erection turned to jelly was "don't worry, we can still make love even if we can't have penetration." I cried, and I am not a crying kind of man. Cried for the humiliation that I was expecting. Cried with relief that she made the choice not to shame me. Cried as I realised how deeply I expected erectile dysfunction to be my most shameful moment ever.

I'm also very grateful that I recovered within a week or two back then, no doubt largely thanks to my wife's wonderfully supportive, flexible, and non-shaming response.

Now the ED is coming back, and this time as a (hopefully temporary) response to the inevitable nerve trauma during an otherwise highly successful robotic-assisted radical prostatectomy. It really helps to start from these two places:

  • We can still make love even if I don't have an erection; and
  • I don't have to be ashamed about changes in my body. It is normal to change.

Beyond talking about ED: Questioning my manhood

Through all this, I wonder what makes me a man. I am missing my favourite part of manhood (sex) but I do realise there is much more to manhood than just sex, and much more to libido and sex than just erections and penetrative sex.

I can already feel how much joy there is in simply being alive after having cancer, and also the simple physical pleasure of going for a run out in the hills. I am sure there is a lot more for me to learn and a lot to explore about widening my sense of manhood. And figuring out how to talk about all this with my wife.

In the coming weeks and months, I will keep you posted on what emerges in all aspects of recovering from prostate cancer and rediscovering what it means for me to be a man.

If you are wondering whether erectile dysfunction issues might be relevant to you or your male partner, check out this data:

JB McKinlay in International Journal of Impotence Research, 2000 (12) Suppl 4
Source: JB McKinlay in International Journal of Impotence Research, 2000 (12) Suppl 4

This post also appears at recoveringman.net along with more of my personal and medical backstory.

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