A Fate Worse Than Death?

Sure, we can cure your cancer, the doctor told me. But let me ask you, how attached are you to your sex life?

by Stephan Wilkinson

This article appeared in the March/April 1999 issue of more magazine, published by Ladies Home Journal.

The classic operation to cure localized prostate cancer is removal of the entire walnut-sized organ. Unfortunately, the procedure has one common side effect: Surgery can sever the tiny nerve that sends the crucial "Okay, amigo, time for an erection" signal from brain to penis. Surgeons have developed a nerve-sparing technique, but sometimes prostate tumors grow in ways that make it impossible. Such was my sixty-one-year-old lot in the fall of 1997.

Call me naive, trusting or stupid -- call me all three, in fact -- but the curable cancer didn't much bother me. Indeed, I asked my urologist if I could telephone him for the verdict when the biopsy results came in, since I'd be ninety minutes away on business and saw no reason to make a three-hour round-trip simply to hear a yes or a no. He, of course, made me put in the miles.

But the prospect of impotence... Well, that was a stopper. For four-plus decades, my sexual performance had been nothing out of the ordinary. Routine, predictable, dependable, 100 percent... absolutely ordinary, to me. What would I do without that dependability? "Okay," I said to my Maker, "let's do a deal. How about if I cash it in at age eighty-three instead of eighty-five, but you give me twenty-two more years of sex? No good? Well, how about my living till seventy-five and then checking out, but I get fourteen years of stiffies? What if the disease rears up and kills me at seventy, you say? Hey, can't we find some kind of arithmetic that will work?"

My wife would have none of it. "I want that thing out," she said. "Impotence, schmimpotence. We can work with it." So at least I was going into the deal with the fullest possible support. Which, frankly, is no small matter if you're married to a woman fifteen years younger than yourself. Said one friend, quite seriously, "So what's the big deal? Find her a nice boyfriend." Since he, too, is married to a younger woman, I couldn't help but wonder about their relationship.

Another friend brought up what sounded like a more reliable solution. "If you have to have a prostatectomy, this is the time to do it," he confided. "They're coming out with a sex pill next spring that'll fix any can't-get-it-up problems you might have." It was the first I'd heard of Viagra, though I was too dumb -- or, more likely, too preoccupied -- to snap up some Pfizer stock. But since the "Pfizer Riser" was soon to be approved by the FDA, who cared what else the surgery did, as long as it cured the cancer?

I knew I was going to be a Viagra customer the minute my navel-to-pubis incision healed and I tuned into a porn channel on TV -- and felt not the vaguest stirring of physical interest in the DD-cup babes who poured out of Silicone Valley and into our backyard satellite dish.

"Go see Doctor Felder,"* said my surgeon. "We work with him all the time." Felder's office was filled with elderly men, their faces hidden behind waiting-room magazines. There was a display hawking Felder's book on impotence (just see the receptionist to purchase your copy).

*Name has been changed.

"Viagra often doesn't work in these prostate situations," Felder immediately announced, to my dismay. Little did I know how dismayed I had a right to be. The headline in a New York Times article some months later read, "Enthusiasm of Doctor Can Give Pill Extra Kick." Though they weren't examining Viagra specifically, university studies had shown that an optimistic doctor can help even a placebo to have a positive effect. "One study offered the same drug to patients with identical symptoms, with one difference," the Times said. "Some were told by their physicians, 'This drug has been shown to work, 'while others were told, 'I am not sure if this treatment will work -- let's just try it.' The first group of patients did much better...."

Felder explained that clinical trials had shown a Viagra success rate of only 50 percent when impotence was the result of surgery. In fact, he enthusiastically revealed, he suspected the actual success rate was more like 40 percent, if you took into account newly impotent patients who couldn't bear to admit it even as part of a formal study. "But don't worry, we can definitely fix your problem," he assured me.

"Lots of atrophy there," Felder said as he peered at my sad nubbin of a penis, shrunken after the operation even from its former modest proportions. "That happens a lot in prostatectomies, but doctors don't talk about it." Well, that's certainly discerning of them. "Hmmm... You've got a good deal of scar tissue at the base, too." Oh, great. I'm doomed. "No, no," Felder said, "we'll try the Viagra; but if it doesn't work, I can fix you up with a penile implant." An implant? "It's a small, inflatable tube that stiffens and expands the penis at the behest of a finger-pumped bladder hidden away down in the scrotum," Felder explained. "I'm a master at doing them, and it's a guaranteed solution. Why, I've had patients whose wives don't even know they've had an implant." (Uh-huh, more relationships to wonder about.)

Felder was right: The Viagra didn't work. Two tries -- the second with double the first's dosage -- left me with nothing more than the indefinable, slightly woozy feeling that something as strange, powerful and foreign as an Iraqi terrorist was coursing through my veins. At least through all the veins except the ones in the targeted member.

I hadn't really expected the pills to work. It all seemed too magical -- take pill, get woodie, have sex, smoke cigarette -- and my reaction was not so much disappointment as resignation. I felt anger at the continuing, indiscriminate, don't-bother-me-with-the-facts media promotion of the miracle pill by TV's talking pinheads and news magazine pseudo-journalists who had all the medical expertise of my local Dodge mechanic. Still, I'd performed a necessary step in the anti-impotence process, and now it was time to move on.

The rest of the expensive blue pills didn't go to waste. There was a line at the door awaiting donations like bridesmaids at the bouquet-toss. A gay friend was intrigued by the thought of trying Viagra. A friend of my sister-in-law's, who had a considerably older husband, had put in her order. But I mailed the pills (with all the side-effects warnings I'd been given, I hasten to add) to my dear buddy Arthur, a depressive who had been overjoyed to discover Prozac but had lamented its effect on his sex life. "Did I thank you for sending the Viagra?" he later faxed me. "I mean, did I THANK you? REALLY, REALLY THANK YOU?" So in the end, my little bottle of Viagra did do the trick.

Dismayed by my dealings with the impotence doc who seemed all too interested in selling his books and his surgery, I turned to my urologist, a gentle man who had initially discovered the cancer. "Never heard of him," Ajit said when I explained that I'd seen the great Dr. Felder. "But anybody who recommends an implant before you've waited to see if there's nerve regeneration..." He shook his head.

Ajit, ever the teacher, explained in detail my options, accompanied by a flurry of sketches and diagrams: injections directly into the penis, suppositories inserted into the urethra or the use of a vacuum pump. A friend who'd tried the injections had already dissuaded me -- not because of the pain, but because of the not-worth-it hassle involved in the procedure. And, having been catheterized a couple of times during my medical adventures, I couldn't imagine voluntarily inserting anything into my urethra. Simply typing the words makes my groin clench.

Okay, the pump it is. Ajit wrote me a one-word prescription that even I could read: ErecAid. The druggist's assistant, however, couldn't. "Whuzzis?" she said, squinting at the slip. Feeling like a teenager buying his first rubber, I said, "It's a penile pump. Something you use for erectile dysfunction." She gave me a funny look and huddled with the druggist, who consulted a fat volume and then peered at me over the top of his reading glasses as though I were that teenager. "Before I order it," he said, "do you understand this is going to cost four-hundred-something dollars?"

Four-hundred-something dollars, it turns out, buys an assemblage of plastic, rubber and "personal lubricant" looking like a cross between a kitchen tool and a toy from a marital-aids catalogue. Using it makes putting on a condom seem heedlessly romantic. The hand-operated pump evacuates the air from a big plastic tube which is held tightly over the penis, sealed against the groin. (And I do mean big. Long Dong Silver must have been measured as a potential customer. Most discouraging, however, is the fact that the company offers an optional extension.) As the vacuum grows, so does the penis, albeit a bit painfully. Worse still is the bear-trap "snap" of the fat rubber ring which slides off the groin end of the plastic tube and onto the base of the penis, supposedly sealing off and maintaining the erection.

Are we having fun yet?

Well, no. Mister Pump did little more than convert my flaccid cocktail weiner to a spongy frankfurter. I know it works for some people. My wife and I have an acquaintance, a charming Los Angeles-based public-relations executive who -- despite the fact that our relationship is superficial and casual -- can't resist trying to help. Gary extols in vivid detail his pump-assisted bedroom performance every time he and I (or, indeed, he and my wife) talk. "Three or four times a night" he boasts. "Better than it ever was. Marybeth loves the thing. Lemme tell you how we use it." Gee, no thanks.

Still, it fascinated me that Gary -- and others -- constituted a network of entirely voluntary advisors, neatly refuting the image of the grunting, towel-snapping locker-room male whose curiosity extends no further than wondering whether size actually does matter. Today, I'm convinced that any man who even hints at impotence problems at the health club will find himself the recipient of more bad, yet entirely well-meaning, advice than he can handle.

Having been given for example, the name of a casual acquaintance who shared my situation, I approached the man with some awkwardness at a cocktail party and politely said I'd heard from a mutual friend that he'd tried penile injections after his prostate surgery. "Oh, no," he laughed heartily, "I didn't have an operation. I just couldn't get it up anymore. That's why I tried the needle."

The pump's manufacturer claims satisfactory results among nine out of ten users, so I called their, uh, hot line for professional advice. "This is Brenda, how may ah he'p you?" purred the Southern-accented voice. Had I dialed a different kind of phone-sex number by mistake? Apparently not, for Brenda dealt professionally with my stumbling explanations of tumescence and insertion, size and stroke -- though I couldn't help but think it odd that Mister Pump's makers should assign a woman to the task of discussing penises with a clientele composed virtually entirely of embarrassed, middle-aged men.

Brenda gave me the classic "How do I get to Carnegie Hall?" answer: Practice, practice, practice. Had I been mastering the violin it might have worked, but daily pumping did little more than give my member hickeys. "You have to use two rings," one helpful friend advised. "Here's what you do. Pump as much as you can bear, snap one ring on, then pump some more and put a second ring on. When you're actually having intercourse, you won't notice the pain a bit." Wait a minute, what is this: sex or punishment?

To their credit, the pump makers offer a ninety-day money-back guarantee, of which I finally, reluctantly, took advantage. It was the morning after the night when, pumping futilely, trying to make lubricant-smeared rubber rings with the strength of weasel traps do my bidding, I burst into tears and smashed the miserable pump again and again against the hard stone of our bathroom counter. My wife came in and comforted me. It didn't matter, she said. It's not important. And that lifted a great weight that I'd been toting.

The pump? It remained utterly unmarked from the pounding. Hey, four-hundred-something-dollar plastic is one tough mother.

So our life has settled down to one without sex in the classic sense. Though those words might seem a death sentence, they are, to my wife and me, surprisingly inconsequential. Sure, I'm discouraged after sex that gratifies her but does little for me, and I continue to do deals in my head. "Okay, what if I'd skipped the operation, died five years sooner but had ten extra years of sex? Would I have taken it?"

Maybe if my wife were sexier, more physically appealing, you're thinking? Well, Cindy Crawford's mole may be cuter than my wife's lack of one, but she remains the loveliest and most physically desirable woman who has ever allowed me into her heart. When I first heard Paul McCartney's simple explanation of the utter depth of his feeling for his late wife, Linda, I knew exactly what he meant. "I not only love her," he said, "I like her."

Perhaps the nerve will regenerate, for I'm only a year out of surgery. At times, I sense a stirring. Am I imagining it? There, look, it's moving. No, I sadly conclude, it isn't. Yet, ultimately, we have our options. The great Felder is right. He and his scalpel can build me a penis that will do my bidding, virtually guaranteed. And even before trying that, the injections might work -- if I can accept tiny stainless-steel needles and carefully apportioned chemicals as components of foreplay.

To me, the most reassuring thing is that it doesn't matter. Desire can be assuaged by friendship as well as by friction, and for my wife and me simply to be together and to share our lives totally is infinitely more than enough.