Looking for "Normal"

While recovering from radiation therapy and hormone therapy (also known as androgen deprivation therapy, or ADT) for prostate cancer, I had no clear memory of my health before treatment. I had no way to judge my progress back to “normal.” I regretted not having an assessment by both physical therapists and pelvic therapists for a baseline of my “normal” health for comparison.

Having surgery or radiation of the pelvic area can cause problems with sexual function, bladder control, and bowels.³ Pelvic therapists work with the muscles that control erections and ejaculation, bladder control, and bowel function. Knowing what is and is not working before treatment can potentially make it easier to monitor recovery after treatment.

Dealing with treatment side effects

In addition to sexual issues, men can have balance issues after ADT and be at risk for falling.² I've been in exercise programs meant to help men recover muscle mass and work on balance. Recently a physical therapist pointed out that I'm not keeping my right knee pointed forward, resulting in balance problems not related to cancer treatment. Knowing this before treatment would have let me know why recovery seemed to be slow.

I'd had experience with physical therapy and psychologists, but there is truthfully no way I would have gone to a pelvic therapist before prostate cancer treatment. I have an overwhelming sense of modesty. To be honest, I'm very uncomfortable (terrified) that I might have an erection during treatment.

I was diagnosed with Stage 2b prostate cancer about one month before my 74th birthday (happy birthday) and decided to go with radiation and six months of ADT. ADT reduces testosterone production in an attempt to slow cancer growth. It can cause andropause (male menopause) and erectile dysfunction.^4,5

Trying to produce erections

I decided to produce at least one good erection every day while I was on ADT to help maintain healthy erectile tissue. Producing an erection with no libido can feel like a bit of a chore even with the support of a loved one, so I looked forward to being off ADT and back to letting Mother Nature take care of producing the erections.

Three years after the end of treatment, I still did not feel complete. There was still no sign of nocturnal erections, and other erections felt too much like those I had while on ADT. I realized that I was probably in natural andropause with low testosterone and would continue to have the same symptoms as being on ADT.

Still having issues

A testosterone check showed that my free and bio available testosterone actually were below normal. I decided to go on testosterone replacement therapy (TRT) in the hope it would bring back nocturnal erections. I also hoped to stop the fatigue, wild emotions, loss of muscle mass, and osteoporosis that had come with ADT.

I found a doctor who was willing to prescribe testosterone to a prostate cancer survivor and began using transdermal testosterone gel. TRT brought my free and bio available testosterone up into the normal range, but I still had some of the ADT symptoms and no sign of nocturnal erections.

My thought was that the reasons for this could be psychological, depression, or physical fatigue. I decided to check off all the boxes by working with a mental health professional for the depression and a physician for the fatigue.

Making a discovery

Then I discovered a video by one of our team members, Becca Ironside, about the part pelvic muscles play in achieving erections. After viewing videos by Becca and Dr. Susan Gronski, I decided to make an appointment for pelvic health assessment as well.

Going in for a pelvic health assessment turned out to be a good move. The therapist found that I was not relaxing the muscles that control blood flow to the erection. After three therapy sessions and some home exercises, I had spontaneous nighttime erections, but not full erections.

This led to learning that I had minor erectile dysfunction (ED), probably either from aging blood vessels or damage done by the radiation beam to the blood vessels. I had always thought of ED being all or nothing, but this was subtle enough to take 4 years to sort out. I'm now taking Tadalafil and seem to be back to pre-cancer “normal,” as of my writing this.

I'm very impressed with my experience with pelvic health therapy. It helped me find my way to “norm” in more ways than one.