Guest post: ADT and psychosexual therapy

By Tony Collier

Having told me I’d be starting on Androgen Deprivation Therapy (ADT), my oncologist went on to say “Regrettably, once you start on ADT you’ll be unable to gain an erection.  But it may not matter much, as you won’t have a libido either!”

Being told that you have cancer is devastating. Being told that the cancer is incurable is indescribable. Your brain immediately scrambles and you become unable to think rationally at a time when in fact you need utmost clarity to take in what you are being told. It’s at times like this that having your other half or a family member/friend with you is so important. You can then discuss things rationally when you’ve calmed down and unscrambled the brain. Here’s how my wife and I got some help from a specialist nurse through psychosexual therapy.

Watching my manhood fade away

I do wonder whether my oncologist’s dire predictions became a self-fulfilling prophesy and whether a different approach would have led to better outcomes. In addition, I was a sub elite athlete before my diagnosis and I was also emasculated as an athlete and that was nearly as hard to take as losing my manhood. Both affected me mentally very badly at the start. Thankfully I’m much stronger now.

As it was, I just watched my manhood fade away. We kept going as long as possible but the old todger got softer and softer until it was incapable of penetrative sex.

There I was, 60 years of age, being told that my sex life was over. Now, I’d hardly been a stud throughout my earlier years but sex was an important part of our relationship. Clearly this would have an impact on my Wife as well and my way of dealing with it was to push her away which was of course a major mistake. Thankfully, she has been incredibly understanding and supportive. She realised that this was important to both of us.

Without a sex life we’d basically become best friends who lived and slept together. We realised that was intolerable.

Holistic support for men and their partners is so poor here in the UK but even more so in the area of sexual support and therapy. My oncologist didn’t explain what could be done to help until we asked.

Choosing psychosexual therapy as a couple

In the end we decided to be proactive. Back then I had private medical insurance. This gave me access to a first rate Clinical Nurse Specialist (CNS) who became a bit of a shoulder to cry on. So I raised the “unraisable” with her, if you follow my drift. She mentioned that the private clinic offered access to another CNS named Julia with a specialist interest in psychosexual therapy.

I realised that this was very important for our marriage and really had no negative thoughts about it apart from the initial embarrassment of talking to a complete stranger about sex and intimacy. However, that was soon allayed as the therapist was so empathetic and really put our minds at rest so that we could both freely express our feelings and discuss the problem very openly. What also struck me was the offer to my Wife of separate sessions just for her. As it happened she didn’t take up the offer but we were both thankful that the health care professional took into account her needs as well as mine.

What psychosexual therapy was like

My wife and I had some appointments with the specialist psychosexual therapy nurse. We started by talking about feelings before moving on to sensuality and intimacy before we ever got round to mechanical and chemical means of support.

The wonderful Julia explained how loss of testosterone removed my drive. The drive to get out of bed in the morning. The drive to work hard. The drive to run and, most importantly my sex drive. She then went on to explain that, although I no longer had any sex drive I still possessed desire. Desire to do all of those things! Particularly relevant, the desire for my wife who was and still is an attractive woman.

Exploring different pathways to arousal and intimacy

In technical terms we talked about the Model of Sexual Desire (A. Riley) and the Model of Sexual Responding (Basson). The thing that was important to me was to be given a completely blank sheet of paper and the ability to do as much or as little as we chose to. That included the use of sex toys – which we found helpful – and pornography which wasn’t really our thing. Validation that our circumstances are not our fault and therefore anything goes was a relief!

We then talked about intimacy and sensuality. It may not replace sex but it was important to maintain a Husband and Wife relationship so things like holding hands, hugging, touching, kissing, dressing up for each other became very important.

Pleasure without penetration

Julia told me that it was still possible to reach orgasm without an erection but it would need a lot of stimulation which would be enjoyable and we therefore learned how to pleasure each other in different ways that didn’t involve penetrative sex but did involve more use of sex toys as well as oral sex.

Finally, we talked about chemical/mechanical support. Julia arranged for my GP to prescribe a vacuum pump that can be used to draw blood into old floppy and make it erect. Then you slide on a constriction ring to keep the blood in the penis to keep it erect. As we were told, it’s really important to keep exercising the penis and the pump can be used for that as well. Ultimately, the penis is a muscle that becomes bigger when engorged with blood. Without exercising that muscle the penile shrinkage (yes, something else that they don’t tell you about) is much worse.

We never got around to using the pump for sex as it didn’t feel right and took away all sensuality and spontaneity.

Julia also managed to get my GP to prescribe Cialis (Tadalafil) and that was certainly a help.

Letting desire without drive show us the way

We found a way, not perfect by any means but a way nonetheless, of carrying on being a Husband and Wife. We did this by adapting different measures of giving each other pleasure whilst all the time remembering that I still had the desire to do so!

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• More about Androgen Deprivation Therapy (ADT)