The Unspoken Battle
It is the unspoken
conversation, one I have barely had with myself and definitely not with others,
including my partner, my medical and cancer support teams.
When I was diagnosed
with malignant prostate cancer in June 2024, the first physical urge that left
me was sexual desire, as though someone had just kicked me in the balls. It
wasn't pain, just a numbness of confusion and incapacity.
Preparing for the
Obvious
Even for a man with
African heritage and no need for machismo, I have been open about the bowel and
bladder issues. I was quite read up on them and ready to attend to the matters
concerned. I didn't want a catheter insertion for whatever reason, but incontinence
underwear? I was ready to model it for men of a certain age and body, if
necessary. I do like my underwear, and I have used linings too; the situation
is manageable.
However, on the
sexual part—the big mammoth in the room—I have ignored its presence and viewed
it as part of the weight-bearing structure of that space, insignificant if it
played dead and never moved. But 17 months after radiotherapy, with all things
looking good, the mammoth is awakening from its imposed hibernation.
Weighing the Options
If I wanted sex, and
I enjoyed sex, this diagnosis exacerbated and crystallised the ideas of sexual
dysfunction in my mind.
In choosing the
option for treatment, I first spoke to the consultant surgeon about the radical
prostatectomy procedure. A year before, a men's advocate who had undergone it
explained that the expert surgeon was able to save the nerves necessary to
retain some sexual functions.
The surgeon was quite
candid with me: my prostate gland was so enlarged that he couldn't guarantee
anything could be saved of my nerves until he was in there conducting the
surgery.
Imagining the
Aftermath
As this procedure is
conducted under general anaesthetic, the prospect of waking up to a surgeon
trying to express happiness and sadness in the same facial expression was one I
was not intent on seeing.
His professionalism
and years of experience might have given him the skill as a comic piece, but it
would have been a joke at my expense. “Mr Akintayo, we successfully removed the
prostate gland. However, your sex life is gone; you're impotent. But we can
make some interesting toys for you, to have some sensation and other elements
of pleasure.”
I'd be crying tears
of joy for being free of cancer, catheter inserted as there is no urinary
control for months, finding where my pelvic floor is, and living happily ever
after.
Then I ask, even if
this smacks of medical paternalism: should surgeons be more proactive in
discussing sexual health outcomes?
Learning from Others
Another friend had
undergone the procedure a few years before. He, a straight man, came to me to
seek advice about the kinds of sex I know. Much as I could have helped, I felt
he needed to join a men's support group to appreciate the experiences of men in
similar circumstances before thinking of this, because his views were
explorative to my hearing, rather than developed.
From that surgery
discussion, I knew it was not for me. At the same time, I needed that cancer
excised because, whichever way you look at it, dead men do not have sex.
Another question
arises: how do cultural expectations of manhood affect seeking the essential prostate
health check-ups first, before considering the treatment decisions and recovery?
Radiotherapy and Its
Consequences
As I took
radiotherapy, the immediate and enduring side effects have been bladder
related, with a few bowel issues. My sex drive is depleted by being unsure of
ability and compounded by lacking confidence. It is also not something that can
be addressed with bravado.
As you can read, I am
tackling this issue alone because I do not understand this vulnerability enough
to appreciate the kind of help I need.
The Medication
Dilemma
Yes, I can get
erectile dysfunction medication and pop pills like sweets, but that not only
becomes a prop; it does not address the emotional and mental issues. Rather, it
becomes a legalised version of chemical sex, getting a prescription from a
pharmacist instead of illicit drugs delivered by a dealer.
The question then
becomes, how many highs can I have before drug-induced priapism or severe
hypotension with the risk of death is the danger?
Furthermore, because
it has been offered, is the medical establishment over-reliant on
pharmaceutical solutions rather than psychological support?
Rethinking Intimacy
As men, we are
fixated with erection and penetration as the full expressions of sex; the
absence of either or both feeds a kind of sexual frustration for the person and
their partner. Does sex become a distant memory rather than a present
experience with a hopeful better consummation, or are damaged goods being
repackaged for a partner with different expectations?
For gay men, where
physical intimacy and sexual expression often form central parts of identity
and connection, the loss can feel particularly acute. The dynamics of same-sex
relationships, where both partners understand male sexuality from lived experience,
can create a unique space for empathy and shared problem-solving.
Yet it can also mean
both partners acutely feel the absence of what was, and the uncertainty of what
might be possible. The fear of being seen as “broken” or inadequate in a
community that sometimes prizes sexual vitality can compound the isolation.
For straight men, the
challenge often involves navigating conversations with partners who may not
fully grasp the psychological weight of erectile dysfunction on male identity.
There's the added pressure of traditional gender roles and expectations around
male performance.
Meanwhile, bisexual
men face both sets of pressures, depending on the gender of their partner,
alongside navigating healthcare systems that may not fully recognise or address
their specific concerns.
Regardless of sexual
orientation, the fundamental question remains: how do you maintain intimacy and
connection when the language of physical expression you once spoke fluently
becomes halting and uncertain?
Confronting the Fear
Yes, I have literally
thought through all this with a clear indication that I probably need to
re-engage with a support system that would address many of the pertinent issues
after treatment for prostate cancer. The questions are not abstract; they are real
issues in existing relationships.
You might wonder, if
I have managed the bowel and bladder issues that well, why am I struggling with
the sexual one? Whether we like it or not, it defines, to a certain degree,
manhood, manliness, performance, and self-esteem. Maybe, just maybe, this is part
of the fear that stops us black guys from talking about men's things.
One last question:
are Black men receiving adequate support and information about sex, sexual
health, and sexual expression after cancer treatment?
Moving Forward
Yet we need to talk.
Prostate cancer cannot be the last story, and navigating a way to fulfilled
sexual satisfaction after prostate cancer treatment must not be greeted by the
shock of the experience, but by the hope of new possibilities through therapy,
support, and understanding.
How intimacy changes
in relationships is a journey that has no clear answers for both parties, and
that might not be the prospect a partner desires in what looked amazing before
cancer struck and stole our virility.
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risk in 30 seconds.
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