Sex, Sexuality, and Masculinity

I was 60 years of age when I was diagnosed with stage 4 incurable prostate cancer. I started lifelong androgen deprivation therapy, also known as chemical castration, which has been the cornerstone of advanced prostate cancer for many years.

My very attractive wife was only 58 years of age, so the last thing on our minds was our sex life ending just yet. At my first oncology appointment my oncologist told my wife and I that once I started on ADT, I wouldn’t be able to get erections any more. But it probably wouldn’t matter, because I won’t have a libido either.

Watching my manhood fade away

Chemical castration involves removal of male hormone, testosterone that we need to drive everything we do from muscle growth to sex drive. It defines our masculinity, and it was horrendous to hear that I would lose that as the price to pay to keep me alive.

The first few months were incredibly difficult, as I literally watched my manhood fade away until not long after, the oncologists’ words became our reality.

At this stage the whole situation was very frustrating for both of us, and no offer of help was forthcoming. Unfortunately support in this area is basically awful here in the UK, but I was fortunate enough to have private medical insurance. So I asked for help, and the cancer center where I’m treated had a clinical nurse specialist (CNS) who had a special interest in psychosexual therapy. We were fortunate that my insurers funded some sessions with her.

Seeking help for my sex life

The first thing to stress is that I think this support won’t work for a couple unless both partners attend the sessions. It’s really important that both partners buy in to the process and are prepared to be very open. This was something that neither of us was comfortable with, as we had rarely spoken about sex in our near 40-year marriage prior to my diagnosis. However, we both embraced it and have reaped the benefits.

The clinical nurse specialist spoke to us about the difference between sexual drive and sexual desire, and her words have stuck with me ever since: “you may have lost your drive, but you haven’t lost your desire.”

From a technical viewpoint, the specialist took us through the Model of Desire (Riley 1997) and the Model of Sexual Responding (Basson 2002) with great emphasis on the importance of intimacy, touch, and stimulation. She spent a long time persuading me that it was possible to reach orgasm without an erection. We talked a lot about different ways of mutual stimulation, as the reality is that, without a libido, stimulation is vitally important.

Finding new ways to pleasure each other

Stimulation included lots of different ways of pleasuring each other without penetrative sex, including oral stimulation and the use of sex toys.

Inevitably we talked about ways to try to gain erections mechanically, including a vacuum pump that I used at the start but primarily as an aid to maintain penile health. The penis is a muscle and needs exercising, and that for me was the pump’s purpose. Although others use it in conjunction with constriction rings in order to maintain an erection, that wasn’t for me and I gave up on the pump completely after 6 months because I found it messy and unenjoyable.

Some men use injections into the penis to generate an erection but, again, this wasn’t for me. I was able to get PDE5 inhibitors prescribed and take Tadalafil (Cialis) daily. It’s vaguely effective in that I can get semi-erect with lots of stimulus but couldn’t without the mechanical support.

I’ve lost my drive, but not my desire

In summary, losing your masculinity and manhood is incredibly frustrating, but there are lots of ways that men can be helped. The most important things for us have been intimacy (holding hands, kissing, and cuddling), mutual stimulation, and sex toys. But most importantly, remembering that while I’ve lost my drive, I haven’t lost my desire!