Surgery or radiation treatment for localized prostate cancer doesn’t mean that your sex life has to be over. But a big part of this may be up to you – and it’s not just that part.  It may be up to you to ask your urologist for extra help. Here are some things Johns Hopkins urologic oncologist Trinity Bivalacqua, M.D., Ph.D., wants you to know.

How Good Is It Right Now? Be honest with yourself.  Take the SHIM survey.  Talk to your partner, too, to make sure you’re not forgetting or sugar-coating anything.  Most urologists will tell you that their patients have “selective amnesia” about ED; they either don’t want to talk about any episodes, or they truly don’t remember it because they repressed it. If you have had any ED before, don’t feel bad about it: they wouldn’t have all those commercials on TV and spend millions of dollars a year advertising drugs to help with ED for an audience of one – you.  It is more common than you might think. Trinity Bivalacqua, M.D., Ph.D., Director of Urologic Oncology at the James Buchanan Brady Urologic Institute at Johns Hopkins, talks to men about this every day.  “A 62-year-old man might say, ‘the erections are pretty good now, and by the way, my primary care doctor gave me Viagra, and when I take it, it really helps.’  This is extremely valuable information for me.  It means that, no matter what his SHIM score says, this man has at least some mild ED.  I can’t give a true assessment if I don’t have the complete picture.” In contrast, “I operated on a 45-year-old man recently, and he scored a 25 out of 25 on his SHIM test.  He told me that his erections were rigid and suitable for intercourse, and I believed him.  But with a man in his sixties, I always ask more questions, because at least 60 percent of all men in their sixties are going to have at least some ED, whether they admit it or not.”  

First, take the SHIM survey. This is really important.  

Second, please understand: A lot of urologists don’t give their patients the most accurate picture of what to expect after prostate cancer treatment. There may be several reasons for this: Maybe they don’t want to admit that their results aren’t that good, or they don’t want to discourage patients from getting their prostate cancer treated by worrying them about their future sex life.  We’ll get to some of that in a minute.

Third: Way too many men suffer in silence. These men – leaders at the office or in the community, respected, take-charge, tough guys – don’t ask for help.  They push  sex over to a quiet corner of their lives, and they’re miserable, because they assume that ED is a done deal.  It’s their fate.  Some things are just not meant to be, they say.

They give up. Maybe they take Viagra or Cialis every day like clockwork, and it doesn’t work.  So they tell themselves that this is how it’s always going to be – partial erection, or no erection, forever.  

Come on, men:  

This is rehab.  

If you had trouble walking after a car accident or a stroke, you would accept that it’s a step-by-step process to get you back on your feet. Maybe you’d start with a wheelchair, but graduate to a walker, and then a cane. You would understand this. It would make sense to you.

It's YOUR Sex Life

It's YOUR Sex Life

Treatment for localized prostate cancer doesn’t mean that your sex life has to be over.

It’s the same thing with your penis. There are steps. You can escalate.  

Don’t give up. This is practical stuff here. If your doctor is not telling you this, print the article and take it in for your next appointment. Ask for help. If you want this to happen, help make it happen. Don’t give up.

And partners:  Give the guy a break.  Have some empathy.  Yes, it’s frustrating for you, and it will take a lot of patience and encouragement on your part, but keep your eye on the prize: long-term success.  This man just beat cancer. With your help, he can get all of his life back.  It’s not going to be this way forever.  Recovery of erections after surgery can take a long time – even years – to return fully. In the meantime, there are many options here. Hang in there, people. You’re not alone.w

How Good Is It Right Now? Be honest with yourself.  Take the SHIM survey.  Talk to your partner, too, to make sure you’re not forgetting or sugar-coating anything.  Most urologists will tell you that their patients have “selective amnesia” about ED; they either don’t want to talk about any episodes, or they truly don’t remember it because they repressed it. If you have had any ED before, don’t feel bad about it: they wouldn’t have all those commercials on TV and spend millions of dollars a year advertising drugs to help with ED for an audience of one – you.  It is more common than you might think. Trinity Bivalacqua, M.D., Ph.D., Director of Urologic Oncology at the James Buchanan Brady Urologic Institute at Johns Hopkins, talks to men about this every day.  “A 62-year-old man might say, ‘the erections are pretty good now, and by the way, my primary care doctor gave me Viagra, and when I take it, it really helps.’  This is extremely valuable information for me.  It means that, no matter what his SHIM score says, this man has at least some mild ED.  I can’t give a true assessment if I don’t have the complete picture.” In contrast, “I operated on a 45-year-old man recently, and he scored a 25 out of 25 on his SHIM test.  He told me that his erections were rigid and suitable for intercourse, and I believed him.  But with a man in his sixties, I always ask more questions, because at least 60 percent of all men in their sixties are going to have at least some ED, whether they admit it or not.”  

Janet Farrar Worthington is an award-winning science writer and has written and edited numerous health publications and contributed to several other medical books.

In addition to writing on medicine, Janet also writes about her family, her former life on a farm in Virginia, her desire to own more chickens, and whichever dog is eyeing the dinner dish.

Learn More