Day 1242: The new normal after prostate cancer

Honestly, my major concern has been recovering erectile function after prostate cancer. Now, at three and a half years after my radical prostatectomy, I am about ready to celebrate some successes and declare “enough” of struggling to get back what I lost when my prostate was removed.

After all, I am 65 now and can’t go back to being 60, or 40 or 20. And my body is irrevocably different. The challenge is to figure out where the heroic struggle to recover (purple in the diagram) meets the longer arc of aging (green in the diagram). And it would be a suitable topic for conversation between men who do and men who don’t have prostate cancer diagnoses.

And no! Shifting my focus towards fulfilment doesn’t mean I am giving up on curiosity, connection, growth, libido, love, sex or fun. Rather, I want to see my prostate cancer as a round of practice for aging in a good way.

So much to recover after prostate cancer treatment

For most of us, it’s a hero’s journey to recover what we can, after the gland at the very core of our male bodies has been either cut out or blasted with radiation. It is a physical, emotional, mental, social and spiritual journey. Almost all of us have some issues with urine control and erectile function. All of us face either the threat or the reality of cancer recurring for the rest of our lives.

It takes courage and commitment to keep fit and healthy and regain as much quality of life as possible. Those of us with partners can get huge support from them. We also need to recognize that our struggle inevitably impacts our partners and our relationships.

Markers for recovering continence and erectile function after prostate cancer

How I know I am getting towards “as good as it gets”:

• I don’t leak more than a drop or two or urine in three weeks;
• I can experience sexual pleasure;
• My body can respond to my partner with at least some form of recognizable erection – sometimes only from cuddles and without direct stimulation;
• Mentally, spiritually and emotionally I have gotten used to that empty space at the core of my body, my first chakra, and create from that emptiness.

Permanent losses after prostate cancer treatment

But even three years after prostate cancer treatment, it is all a bit wonky and unreliable and confusing. Why I am still wondering if this is as good as it gets:

• I’ll never have the same unconscious confidence about not wetting my pants;
• my sexual parts are less sensitive than they were;
• my erections are a lot less durable and firm;
• orgasms are more elusive.

So what is it like for men who get older without prostate cancer?

Together with my buddies in the Recovering Men support group and other prostate cancer survivors, there is a lot of frank, private discussion about the intimate details I’ve just summarised above. But many men, particularly those who identify as heterosexual, have a reputation for not talking about intimate matters in any detail. Particularly not outside the boundaries of their intimate partnerships. The more so, as the aging process sets in. Men without prostate cancer have an opportunity to cross-calibrate with those who do.

There is a kind of embarrassment for older men that we don’t fit the image of the “always on” insatiable 25 year old hunk. And yet a lot of the value and attractiveness of older men is precisely because we are not so attached to simple virility as we were at 25. I am looking for conversation with those older men who are willing and able to share their experiences.

Acknowledging the arc of aging

My hand gesture in the image is a simple way of sharing ancient wisdom about accepting bodily changes with age, and in particular erections that are no longer so erect or durable. Men over 50 need to master the art of making love with a “soft-on,” sooner or later. This and more I am grateful to have learned from Mordecai Brodie on the remarkable Kadeisha training in sacred sexuality. I took this extraordinarily course 14 years ago and it still happens annually.

When and how does sexual function and urine control begin to fade in men without prostate cancer? Yes, I know that PDE5i drugs like Viagra and Cialis can mask the effects of aging. But the natural “varoom” of sexual energy, and its manifestation in our genitals, clearly changes its nature as we age.

Mind the gap: setting realistic recovery goals after prostate cancer

What is important for the prostate cancer survivor community is not to set unrealistic goals for ourselves. To do that, we need to figure out when we have completed the long struggle of rehabilitating our bodies to their new normal, including erectile function after prostate cancer. And we need to factor in the natural arc of aging, particularly as it affects erectile function. There is something in our stories that can also inform men who don’t have prostate cancer.

I want to enjoy the process of aging, letting my libido broaden and deepen into a love of life as a whole and a sense of flow and fulfilment. I believe I can remain sexually potent, fulfilled and fulfilling my partner, while adapting to the new normal of my body and the longer, inevitable arc of aging. Please let me know if you have your own story to tell about this process.

An edited version of this post also appears on Psychology Today‘s website