PART 16 of My PC Adventure (read full story HERE>)
Freud said that in the end everything comes down to one thing – sex.
He was right, if you look at the way this story is ending up. To be more precise – at the Erectile Dysfunction or Impotence Clinic (I prefer the first – sounds more optimistic).
So far, my recovery has been orderly, on target and highly encouraging, but there remains this question about erections.
The question is more in my mind than that of the people treating me, who are strongly urging an early course of rehab treatment.
That’s because the sooner it’s started, the better the likely results. Put another way: “If you don’t use it, you’ll lose it.”
However, the signs are actually good.
I don’t appear to have suffered permanent damage, there’s no blood anywhere, I’m getting the occasional nocturnal/early morning spontaneous erection, and with a bit of mental effort and careful massage, the same result – with about 90% function – can be achieved.
So, a month after the radical prostatectomy, off I go to the clinic to find out more.
The nurse/manager is someone I knew 40 years ago when we were youngsters growing up in the same town, so a bit of time is spent catching up.
That eases any tension or embarrassment, not that I actually feel any, to my surprise.
Right. Down to business. It consists of the nurse taking me through the various options, which begin with prescription drugs.
The one the clinic prefers is tadalafil (Cialis), mainly because its effects last longer.
Here’s what the clinic website says:
Oral phosphodiesterase type-5 inhibitors (PDE5 inhibitors) such as Viagra, Cialis and Levitra are first line therapy for ED.
The efficacy of sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are very similar. Because efficacy is very similar amongst the three agents, side effects and time-to-onset will be the main distinguishing factors.
Viagra and Levitra feature rapid-onset of action, whereas Cialis has a long window of opportunity for use.
Maximum levels in the bloodstream are reached within 45 minutes with Levitra, an hour and 10 minutes with Viagra, and 2 hours with Cialis. Conversely, the half-life of Viagra is 4 hours, for vardenafil 4 to 5 hours, and for Cialis 17 to 21 hours.
Apparently, the oral drugs aren’t particularly effective in prostatectomy rehab.
But since the other options look far more challenging, I guess we all want to start with something as simple as popping a pill.
I’m given a couple of samples to try at the appropriate time.
By the way, when is that? Is intercourse okay? Yes, absolutely.
Oh. I’d read a comment on a US discussion group in which a surgery patient was told to encourage erections by all means, but not to touch for about three months.
The nurse is surprised. Hasn’t heard that. I think I’ll go with her advice, and make a note to treat the comments of fellow travellers, well-meaning though they be, with some caution.
Next, we talk about something that makes the boys cringe just at the mere mention: injections. And not just injections, but self-administered ones.
However, it’s not as bad as I imagined, I think, as we go through it (although that judgement will be made if/when I try it).
The needles are very tiny and they are meant to go into the flesh on either side of the member, not blood vessels (so we steer away from the top or bottom).
The drugs recommended by the clinic are Papaverine and Phentolamine. A third, prostaglandin, apparently causes a bit of temporary pain after it’s injected, so we don’t go there in my case.
I’m given what is informally dubbed a starter pack, two week’s supply of Papaverine/Regitine - three pre-filled syringes to inject each week.
The nurse takes me through the injection procedure, including warnings. For instance, if blood appears in the head of the syringe I’ll know I’ve hit a blood vessel and should withdraw and try again.
The needle goes in either side, between the base and half way along (I won’t say “up”, because we’re not there yet). That way, stiffness is induced near the base, which is where you need it, obviously.
You need to vary your target so as not to cause scar tissue.
The biggest thing that can go wrong, it seems, is that old adolescent affliction I referred to earlier, clumsily, as “lover’s balls” – priapism.
This is the erection staying up there for four hours or more, instead of the hour or two that’s intended.
The nurse has had only one such case in years, so that’s encouraging. But if it happens, you need to head for A and E and get them to give an antidote, as well as drain off the “old” blood. Gulp.
Okay, what else?
There’s the vacuum pump, which is used to literally suck the penis into shape.
The clinic has a couple and it can lend one to me, if I want to try, or I can head for an adult shop and buy one.
I daren’t ask why they sell them, but I suppose I can guess.
Ones in the sex shops are as cheap as $80, while the top of the range ones like the clinic owns cost nearly $700.
I’m far too squeamish to think about them.
So what do I want to do?
I pick up the pills and syringes and promise to go home and consult, and think about it.
From what I’ve described about my current condition, she says it’s possible I won’t need anything.
But I need to think carefully about it: if it becomes apparent I need more help and the pills aren’t enough, I will have to seriously consider the injections. If I decide against them now, it might be too late a year down the track.
How long would I need to use them? A year to 18 months. Hmmm.
I have read in my web-searches that spontaneous nocturnal erections are important for penile health. So that alone, from a purely selfish perspective, means I need to take this aspect of my recovery seriously.
Hanging up my boots may not be an option.
I’m not sure if I’m going to let you know how I get on. Perhaps there is, after all, a limit to my self-inflicted privacy intrusion, and it’s not just my privacy that’s involved from here on.
NEXT: My prognosis.