By Michael Ward

Prostate cancer. Its mere mention provoked dread and fear for me. At first it was the cancer’s threat to my life, then afterwards erectile dysfunction (ED) threatened aspects of my identity. I am so aware of others losing much more to cancer – I feel a heart connection with theirs. And I want to contribute my part to the dialogue. Here is my story of prostate cancer for the first year after treatment – with a focus on those aspects where I was able to actively contribute to my own recovery. I am convinced that persistence in my penile rehabilitation helped.

When I mildly boasted before my surgery that I had never had difficulty getting an erection, my surgeon just smiled and replied “Oh, you will now!”

On the cancer, I knew I had to rely mainly on the surgeon and my own body. Recovering erectile function and urine control – this was where I had an active role to play. I decided “this ED thing – I am going to beat it.” I took a hands-on approach and dove in.

They call it impotence

My penis has always been happily up to any opportunity whenever I desired. It was the same, even in those awkward situations (especially in adolescence) when I didn’t expect or want it to get hard.

The ready ability to enjoy the joyful freedom of simple fucking or slow sensual sexual episodes had always been something that I expected of myself. It so often reaffirmed my feelings of being human and a full participant in life itself.

As one of my medical doctors who also specializes in male sexuality described, having erections and sex are at the core of our shared identity as men. Sexual impairment can leave us feeling, well—impotent. That terrible word is so loaded with meanings that include powerlessness, ineffectuality, inability, all qualities that extend beyond sexuality.

For me it’s not so out there, public for the world, but sexual function is part of who I am. It sits around my root chakra and feels as if it is where my creativity comes from. It’s beyond masculine energy – it’s where a part of my creative soul resides. The inability for it to work makes me feel cut off from a part of myself.

How important sex is to me

In many ways sex seems to be at the very core of my being, serving as a kind of energy and a driving force of action and creativity and spirituality. Facing prostate cancer and a prostatectomy, my sexual functioning felt just as important as getting the disease out and retaining urinary function.

Once I dismissed my trepidations and decided (with my primary urologist’s encouragement) to take it as an adventure, I committed to robotic-assisted radical prostatectomy surgery.  At least that was better than dreading the outcomes! A few weeks later, the surgery went very well, and during my one-night stay in the hospital, my traumatized reproductive system still tried to raise its usual nighttime erections at a rate that I estimated were about 20% of full pre-surgery hardness. The next morning my surgeon seemed happy at that report, telling me that was what we wanted to see and to “keep it up.” I was determined to do so.

Penile rehabilitation requires patience and persistence

I soon found that penile rehabilitation was the surest way to resolve what for me was a temporary bit of urinary incontinence and less-than-hard erections. Early after surgery my doctors prescribed “Kegel” exercises to strengthen my pelvic floor muscles. They placed me on a daily 10 mg dose of Tadalafil (Cialis) to oxygenate the tissues and help re-awaken the neurovascular network that is responsible for erections. With the old “use it or lose it” maxim, they encouraged me to have sex and/ or masturbate as often as possible, and at least three times each week. They enthusiastically approved of the use of a vacuum erection device (VED) to produce erections.

Erections after the catheter was removed were generally weak for many weeks. But using the VED in conjunction with Tadalafil produced erections equal to 95% to 100% of pre-surgery hardness.

More delightful to me, I found that orgasms were as strong as ever. After weeks of continuing this penile rehab regime, it sometimes became a bit of a cumbersome chore however, requiring a conscious decision to keep with pumping, Kegels, drugs and all.

Data dashboard pays off with penile rehab persistence

According to a number of medical studies, this is where we men sometimes run into trouble. Many of us give up at this point, especially if expected results fail to appear. Patience with our bodies and our individual pace of recovery is a must. Maintaining the rehab program, I was able to improve to the point where I stopped using the VED eight months after my prostatectomy.

In a separate post, I’ve described how I tracked recovery of my natural physical erectile function by recording the degree of involuntary nocturnal tumescence my body generated while I was sleeping. This was hugely helpful in keeping my hopes up and supporting my flagging rehab efforts.

At the one-year anniversary of my prostatectomy surgery, night-time erections have returned to normal. One of my doctors proclaimed that we hit the “trifecta” and eliminated the cancer, restored urinary function, and brought erectile functioning back to what it was before the surgery (albeit with the help of Tadalafil).

… and physical recovery is not all it takes

The “big joke” of it all, as my psychotherapist wife Ann reminds me, is that my cancer arrived and my recovery process began just as we endured the trials of the near-complete breakdown of our marriage and the rigors of couples’ therapy to deal with our marital issues. For a time, I felt quite alone with my cancer.

That being said, Ann has been ever nurturing and supportive, and is quick to add, “This is how life is,” to which I reply, “I can think of a million other pleasant ways I would rather have it!”

She is right, of course. When cancer arrives it is never welcome, and when it appeared in me, affecting our home, it gave us another focus around which Ann and I found each other and pulled together.

In retrospect, it has all been a gift born out of pain and fear. I found a new post-cancer me, and Ann and I have found each other anew in ways we couldn’t have otherwise, after thirty-one years of being together.

What makes me a man?

I know that I’ve been very fortunate in my recovery, while many of our brothers take much longer to recover or don’t at all. For example, a late friend of mine never regained erectile or urinary functioning for the more-than fifteen years following his prostatectomy, till complications of Covid-19 ended his life a few months ago. But, even without erections, we can remain fully and completely male.

Do erections make me a man? Does my ability to remain urinarily continent make me a man? Of course not, but the feelings and fear are real. With persistent attention to one’s own recovery process, there is no need to fear the loss of sex in order to remove the threat of prostate cancer.

As many of our brothers and those who support us have pointed out, there are solutions or adaptations to every man’s situation. Keeping hope and a positive outlook with it all can go far. It helps to stick to a rehabilitation regime with as much determination—and stimulation – as can be handled, remembering that erections and genital penetration are not the only benchmarks of success.