While it is not within our scope to discuss all of these in detail, we need to touch upon a few other cancers that can affect sexual functioning of your trouser serpent.

Cancer of the prostate is the second most common non-skin cancer in men. There are many books and websites devoted to this topic, and you can seek them out for more in-depth information—see Appendix 3. Surgical removal of the prostate may be recommended for early cancer, especially in younger men, and is done as an open surgery through the area just north of the pubic bone. (The approach to the prostate gland through the urethra—the ‘trans-urethral resection’, abbreviated as TUR or TURP, depending on where you live—may be used for diagnosis or to relieve obstruction if the bladder is blocked by the cancer.) The surgeon is always particularly careful not to damage the nerve plexus around the prostate but, even with all the good will in the world, this does happen—especially when the cancer is extensive and a wide excision needs to be done. If this happens, problems with getting Dick up may result. The best figures we’ve found show 30–40 per cent of men are affected by erectile dysfunction after open prostatectomy. This is not likely to be improved by Viagra, but prostheses (penile implants) or pumps may be useful.

Also, as we mentioned previously, a sequel of prostate surgery through the urethra may be that the bladder no longer closes off during ejaculation, so the ejaculate does not spurt out through the urethra but instead passes into the bladder— ‘retrograde ejaculation’. The sensation may therefore be a bit different than before surgery, but sex is still possible.

Some men will have erectile difficulties after prostate surgery not because of any physical damage, but because they are psychologically traumatised by the whole event.

This is quite common as well as completely under-standable—and responds well to a loving partner and some counselling.

Some of the same problems may arise from a TUR done for benign reasons—for example, a prostate big enough that you have to get up to pee six times per night and doing it takes forever. With this surgery there is no damage to the nerves, as in the open operation, but retrograde ejaculation and psychological consequences are common. Discuss all possibilities in depth with your doctor before any surgery to understand what your own particular risks are, and remember that hey! you are still alive, and healthy.

Cancer of the colon is common with both men and women and, if detected early, is eminently treatable. Early detec¬tion is the key here and we urge each of you to utilise the screening methods available, especially where there is a family history of bowel cancer.

Remember that the nerves to the penis leave the spinal cord to come out of the lower vertebrae (see Figure 3.2) and they occupy the space on each side of the rectum as they pass forward to the penis. In surgery—especially extensive surgery of the lower bowel—these can be injured, resulting in an inability to raise the flag. This is much less likely to happen with an early cancer, confined to the inner bowel, so that’s another good reason to do all the suggested screenings regularly. There are also various devices available which can be used during bowel surgery to locate and test the activity of the nerves that bring about erection, thus avoiding damage to them. More detail is beyond the scope of this book, but we urge you, if you are facing such surgery, not to hesitate to discuss
the subject with your surgeon, if sexual functioning after your op is important to you—and why wouldn’t it be? Your partner may also have an interest in knowing what to expect in this regard following your surgery.

Men who end up with colostomies following bowel surgery—usually for cancer, but sometimes for benign reasons—often have problems with body image and depression. This can adversely affect their sexuality, even when nerve function has not been damaged. Again, the role of the partner is critically important: a loving and sympathetic partner can make all the difference in the world. Counselling is also very helpful, and the various ostomy associations are very good for this.

Polyps and cancers of the bladder

These conditions, not rare, are beyond the scope of our book. But their presenting symptoms and signs—blood in the urine (haematuria) or blood coming from the urethra before or after peeing, and pain low down in the belly or burning while urinating—certainly involve Dick. So we’ll emphasise here that any of the above symptoms should prompt a visit to your doctor to have it all checked out.
Bladder cancer may sometimes necessitate extensive surgery, with removal of the bladder required. This results in the wearing of a bag to collect the urine. Such surgery may damage the nerve supply to the penis and the wearing of the bag may damage self-esteem and body image. Either of these puts a serious damper on sexuality.

Radiotherapy for these various cancers, when indi¬cated, may have a variable effect on sexual functioning. It is best to discuss your particulars with your doctor.

Obviously, finding out that you have cancer of any type or description is terrifying news and most, although not all, men are so happy to find they are alive and have a reasonable prognosis for the future that they are more than willing to explore other means of express¬ing their sexuality if necessary. Life takes on a whole new perspective.