Men's things XXXI: Can Intimacy Be Reclaimed After Prostate Cancer?

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.

Check your Prostate Cancer risk in 30 seconds.

Blog - Men's things XXX: Let's talk Prostate Cancer

Blog – Photons on the Prostate - A year from starting radiotherapy

Blog - A prostate cancer diagnosis, one year on

Blog - Men's things - Prostate Cancer blogs

A Google NotebookLM AI Audio Overview Discussion of this blog

The toys have been delayed

Bitter to sweet

In other news, Evergreen’s Ever Given, the super container ship that blocked the Suez Canal for 6 days was dislodged and re-floated this afternoon. It heads for the Great Bitter Lake for inspection before it is sent on its way to Rotterdam, all things being equal. [BBC News: Suez Canal reopens after giant stranded ship is freed]

There is cause for great sweet celebration for moving the ship out of the way would soon address a pressing need that the pandemic and lockdowns placed on us. As without partners and companionship for intimacy, some people have sought alternative avenues to fulfil human expression, even pleasure for self or with some company.

Escape your inhibitions with toys

Wending its way to The Netherlands, a shipment of 20 containers contain toys of a titillating and excitable variety which on usage, application, and play can or could bring orgasmic heights or spasmodic climaxes, or some feverish expression of body, soul, and escape that is currently absent from my vocabulary. [iNews: The Suez Canal crisis is now blocking a huge shipment of erotic toys from reaching the Netherlands]

Where people absent themselves from a Puritanical view of sensual pleasure, they might find a fuller experience of the essence of their being human and humanity, for which the Dutch, the Belgians, and the Germans might be considered quite ahead of those of whom it is known, No sex please, We’re British. Any wonder that consignment is not bound for Liverpool.

Beautiful Romantic Intimacy Attractive Nascent - V

A love nest in Jo’burg

The opportunity to meet in February was one I could not pass up. I arrived a day earlier than him and was at the airport to pick him up the next day with a sign, ‘Brian with an I’. It is likely our hearts were pounding unsure of what to expect of each other. Our only other meeting was at the bar and then for lunch. We had a lot of learning to do about each other.

This was a holiday of moments and experiences, fully laden with activity, mainly touristic. Then dinner at night. It afforded many ways of getting to know who we were, the pictures we took together began to look like this couple were made for each other. How that South Africa constitutionally recognises same-sex relationships meant we had liberties to be expressive and we used every opportunity to revel in it.

Much more than it seemed

It is likely that the 10 nights went so fast, but I never cancelled the plans for Easter, we had that pencilled in and an agenda that was filling up that little did I know that some of the arrangements he had in visiting Johannesburg at my behest were in fact, first-time experiences.

I commandeered the moments and activities, yet found in both the company and the companionship, someone I could converse with and relate to. We were becoming friends and lovers at the same time. Maybe I was thinking ahead of myself, but I felt there was a lot going on between him and me, not just platonic but quite involved. We were not going to make an apology for having become lovers.

It was 46 days to our next meet up in Johannesburg for Cape Town, whether I was counting down the months, the weeks, the days, the hours, or the minutes, there was no doubt in my heart and mind, I could not wait to see him again.

The unsweetened experience of taste

For each, a pleasure

A friend shared a profile of his with me which made for intriguing reading until I happened upon a phrase, I was unfamiliar with. With more information at my fingertips than I could care to absorb in a microsecond, I tapped in the ‘girlfriend experience’ and a new world of knowledge without prejudice was opened to me.

Not one to moralise about vices as I cannot say I have that many virtues, even as one strives to be more virtuous, the offer of intimacy with emotional accoutrements for an agreed transactional value satisfies a universe of purveyors and patrons that cannot be ignored, if consent rather than duress initiates the purpose of the rendezvous. Invariably, there should be no shame in having the talent to share and seeking the talent to explore rather than exploit.

On the matter of ‘girlfriend experience’ of which it is an expression, a film, and a television series, even for the limited period in which that experience exists with one patron before another seeks it, it can only be hoped that the value of it which for my friend would be as cerebral as it is physical and rewarding will be repeated with more generosity than before.

Much as there can be a gender specification like ‘boyfriend experience’, it would appear the ‘girlfriend experience’ applies to all manner of companionship of that genre, it evokes a more fulfilling expectation than can be said for the less salubrious male determined version.

Stirring up the wrong sugar

Then to my long-running polemic about Frankenstein sugars. These are artificial sweeteners not derived from sugar cane or beetroot. I had decades ago taken to reading the labels on drinks and foods to ensure these sweeteners did not become part of my diet. Anything that suggests diet, no sugar, or low calorie, almost definitely has a different kind of known sugar in it.

Blog - The rise of the Frankenstein Sugars

In my ‘The rise of the Frankenstein Sugars’ blog of 2007, I wrote of the many sweeteners I have avoid whilst failing to wean myself off sugar. I had discovered through the process of elimination that some sweeteners trigger severe migraines, though accidental ingestion may not be a direct cause, new knowledge guides my adjustments.

The other day, I walked into a shop for a bottle of cranberry juice which is supposed to be ameliorative for the water infection I recently had. There was one with Stevia, a sweetener and sugar substitute derived from plants.

Peradventure a mistake indeed

Plants would have suggested its natural providence, but on tasting the juice, I did not have more than a glass, before I emptied the bottle down the sink after a week of it squatting with mendicancy in my fridge. Indeed, I have worked on eradicating the use of sugar in my beverages, I rarely have it in coffee which should be milky and not in tea when served in a restaurant or in a café.

I need to work on the guilty pleasures at home, honey replacing sugar is an indulgence and agave syrup doing the same is probably a cry for help where you’re marooned far away from civilisation. Evaporated milk in tea or coffee is a sin I indulged with the use of coffee milk when I lived in the Netherlands. I can only wonder how many pounds I might shed if I made sugar haram.

Stevia is sweet, but that is where the praise ends, the aftertaste is bland and forgettable, just a few degrees from sickly, you cannot have a tongue with taste buds and think Stevia is the future of sweetness. If I were to close the chapter on Stevia, Yuck, will be the last word of the three same words I repeat at the end. Each with their own exclamation mark. I regret that foolish adventure each day I remember my tongue was assaulted by it.