Support for Men with ED – Interview

Jennifer interviews Robert, a prostate cancer survivor dealing with erectile dysfunction, about his treatment and the support he has received from his doctor and his coach.

20:00 minutes



Jennifer Stephan is an Intimacy Coach hell bent on moving people forward so that they can have a better quality of life. Yes, she is certified in coaching from a reputable establishment. She truly believes that intimacy is a blending of mind, body and soul. Communication is also key. She is a tiny tornado seeking to destroy sexual barriers, unlock the doors for those that feel shame and defender of rights for all.


Resources for men dealing with Erectile Dysfunction

Read Robert’s guest article, Sex After Prostate Cancer

Erectile Dysfunction and Sex

You have questions, many of them. Not just questions but feelings and you have no idea who to ask or where to look for help. Your main focus was recovering from surgery, survival because let’s face it that is instinctual. Your questions range from “When will I get an erection” to “Will I ever get an erection again” to “How do I have sex without an erection” and many in-between questions.

It easy for others to tell you it is just a matter of time or that there are drugs that can “help”. The fact of the matter is that there has been a very real change that has occurred with your body. You have a right to be worried, angry and confused. It is also important to understand that there are things you can do to improve your situation. Like all things in life there are steps to go through. The first one is understanding that this is happening to you. Everyone experiences it differently but you are not alone. The second is understanding that you are a sexual being.

It is not unusual for people to confuse sex and sexuality, intimacy with the need to want to have intercourse. Sex and intimacy are difficult for most people to discuss. As a society we have decided we will only talk about it behind closed doors. We find it difficult to talk about it with our partners, friends and often our doctors. Often it becomes a taboo subject therefore making us feel ashamed.If you are a man that has had prostate cancer, has a heart condition, diabetes or takes medication you understand that erectile dysfunction can be a very real problem that effects many aspects of your life. Your relationships, how you view yourself, and how you interact with the outside world.  For many men it isn’t even something discussed with their medical professional prior to treatment. It comes as a complete surprise leaving them feeling ambushed.

As human beings we all desire human contact. Understand that regardless of what has happened you are still capable of intimacy as well as sexual gratification. Sex is the actual act of intercourse. Sexuality is the mind and soul. It is your ability to be fluid in your body. You are not just a single part, but a whole being.   Therefore you are capable of many things. While your penis may not be erect you are still able to feel sensations and will enjoy being touched and stroked. You are also capable of stimulating your partner.

Intimacy is communicating. It is sharing thoughts and ideas. It is creating an environment in which you feel safe to share your body, mind and soul. It can be an incredible experience to allow yourself to be that vulnerable. So how do you do all of this? It takes an open mind. It takes hard work and a willingness to explore.

For men with ED issues there are options. I am sure you have researched them in depth but for those of you that haven’t.

  • Viagra/Cialis
  • Suppositories
  • A pump specifically designed for men with ED
  • Injections
  • Penile Implants

There are also counselors, therapists and coaches that specialize in sexuality. It is important to find someone that you feel comfortable with and that understands your needs. There are also many forums and discussion groups online where you may find some support and find a community of like-minded men.

I am not here to blow smoke up your ass. It is a long journey and not an easy one. What you have been through is difficult and the changes suck. Men in particular often are overlooked when it comes to things of this nature. It is a big deal and I get it. The road is long but believe when I tell you that there are things you can do and you are a sexual beast. If you have come this far then nothing can stop you now. Things are going to be different but that doesn’t mean it won’t be incredible.

If you are experiencing ED start being sexual with yourself now. Let your thoughts wander and appreciate your body. If you feel comfortable ask your partner to explore with you. Don’t put pressure on yourself for anything else. Just start there and enjoy your thoughts and take it from there. It is a journey, one step at a time.

Jennifer Stephan is an Intimacy Coach hell bent on moving people forward so that they can have a better quality of life. Yes, she is certified in coaching from a reputable establishment. She truly believes that intimacy is a blending of mind, body and soul. Communication is also key. She is a tiny tornado seeking to destroy sexual barriers, unlock the doors for those that feel shame and defender of rights for all.


Resources for men dealing with Erectile Dysfunction

Reclaiming Intimacy after a Major Life Change

You are a male and you have a penis. Let’s assume you have had said penis since birth for arguments sake and the purpose of the article. Everything you know about sexual intercourse, intimacy and pleasure of a sexual nature is in some manner tied up in your penis. This is not an accusation. It is an appendage that you have touched, that has been touched, that has been stimulated throughout the years and let’s be honest, has brought you as well as others great pleasure.

You have aged and now found yourself in a place where there is a possibility your health has affected you. Possibly a heart condition, prostate cancer, diabetes or an accident. There is a great deal of information on these conditions. Medical doctors that can treat you and aid you in recovery. Yet there are after effects of these conditions that linger. I am not a doctor but I do know that intimacy and the information needed to relearn intimacy are necessary in order to have a better quality of life.

How does one deal with something of such magnitude when they are already vulnerable? It is a very difficult situation and not one to be taken lightly. So much has already occurred and now there are more challenges ahead. Understanding that you are not alone, that there is help for you is essential. I realize it is frustrating to have had surgery or have had something happen to you beyond your control and have to face such a daunting task but you are worth it and should know that everything you want is possible if you are willing to make it happen.

It is possible to have a warm, crazy, loving relationship filled with passion and erotic moments. It is just a matter of being patient with yourself and letting go of what was, so that you can enjoy what can and will be.

Intimacy is far more than the connecting of bodies but we have been conditioned to believe that. Men are taught from an early age their penis is a symbol of vitality and masculinity. It is what makes them a man. Sperm is released through the penis, it is how they procreate. So what happens if your penis is no longer viable? Intercourse is but one way to connect. In many cases men that have been treated for prostate cancer are no longer able to achieve an erection. Yet they are still capable of feeling arousal and achieving an orgasm. Is it the same as ejaculating in the typical fashion? No, there is no semen, no erection, but there is pleasure.

It is necessary to relearn the art of intimacy. Touch, communication, to be open to exploring new options. Understand that like all things it takes a commitment and a willingness to achieve what it is you want.

In the case or prostate cancer as well as other conditions there are some options that can improve one’s sexual life. There are penial implants. It is a relatively short surgery in which an inflatable device is placed in your penis and scrotum. It can take four to six weeks to heal and antibiotics will most likely be necessary. Oral medications such as Viagra, Cialis or Levitra can be prescribed as well. Other options include a vacuum device that is used a few times a day to help the blood flow in the penis. Another option is a medication injected into the side or tip of your penis allowing the blood to be trapped and thus maintaining an erection.

Yet all I have given you so far are facts you could have gotten yourself. What I want to give you is more. I want to give you hope. I want to give you the skills and ability to see and feel things in a different way. To have the courage to acknowledge that yes, your body has changed yet you have the ability to feel deep passion and intimacy regardless of all else. That you have survived something that could have been tragic and yet here you are. Producing sperm does not in fact make you a man but is just a physical by product of arousal. You can still be aroused and feel pleasure as well as climax.

When you touch yourself or someone else, do it with renewed life. Don’t just touch, feel. Allow that feeling to enter you. You can feel warmth, you can feel the way another body or even your own reacts to touch. That is the beginning. It is allowing yourself to absorb everything. Understanding yourself will allow you to share with a partner. Climaxing was never what came out of you, it was always about what was in you, the feelings that were created, but we are so conditioned to pay attention to the outer that we lose site of the inner.

Do you want to be intimate? Do you want to find sexual satisfaction? If so are you willing to explore other options in order to achieve sexual satisfaction? You didn’t ask to be put in this situation but here you are and you need to decide how you are going to handle it.

Jennifer Stephan is an Intimacy Coach hell bent on moving people forward so that they can have a better quality of life. Yes, she is certified in coaching from a reputable establishment. She truly believes that intimacy is a blending of mind, body and soul. Communication is also key. She is a tiny tornado seeking to destroy sexual barriers, unlock the doors for those that feel shame and defender of rights for all.

Sex after Prostate Cancer

I am a prostate cancer survivor.

My story is unusual. After my diagnosis, I underwent radiation treatment, which failed to eliminate the cancer. Few surgeons will attempt to remove the prostate after radiation, because the treatment creates scar tissue that makes the surgery very difficult.

Fortunately, I found an excellent surgeon, Dr. Jonathan Eandi, who has performed several “salvage” prostatectomies, and was willing to undertake the procedure. The surgery went very well. Now, with the help of my partner, I am recovering and dealing with the side effects.

Before my surgery, Dr. Eandi spent a lot of time discussing the side effects (and they are so severe that I seriously considered not having the surgery). A diagnosis of cancer is very scary, and it’s hard to digest all the information and make good decisions.

I was very fortunate that my partner was with me throughout the process. Because I was so stressed, I often didn’t hear or forgot what my doctor said. By coming to the appointments, she was able to able to understand all our options, and remind me of things the doctor said.

Unfortunately, based on my reading, most doctors do not adequately prepare their patients and their partners for the full impact of the surgery, making the effects all the more difficult to deal with.

The Impact of Prostate Cancer Treatment on Your Sex Life

The effects of a prostatectomy are apparent immediately after surgery, while the effects of radiation treatment may occur months or years later, as cells continue to die from the radiation exposure. In either case, the effects can be severe, and may include:

  • Incontinence (uncontrolled leaking of urine)
  • Erectile Dysfunction (the complete inability to get an erection, even with oral medication)
  • Shrinking of the penis (in both flaccid and erect states)
  • Inability to have orgasms

Without proper care and treatment these conditions can become permanent, and even in the best case, recovery can take 6-24 months.

In my own case, I’ve experienced incontinence and ED. It’s important to realize that these conditions are not permanent, and there are treatment options. It’s also important to discuss these issues with your partner, and have his or her support.

Sadly, very few doctors are trained in “sexual rehabilitation” – once the cancer is treated, they consider their job done. Even when sexual rehabilitation treatment is available, there is usually no psychological support, and patients often suffer from anxiety and depression.

If you are facing or have recently undergone prostate cancer treatment, I strongly recommend that you find a urologist who specializes in sexual health and rehabilitation, and a coach or counselor to provide support to you (and your partner).

In the following sections, I’m going to tell you a little bit about the side effects, and treatment options. You’re going to want to know a lot more, so Jennifer has provide some resources for further reading.

Incontinence after Prostate Cancer

Following prostate cancer treatment, you will probably experience urinary leaking. Right after surgery, this may be a pretty constant flow. After time, it will decrease, and will probably only happen when there is physical pressure, which could include standing up / sitting down, coughing, lifting things, etc.

Urinary leaking can also happen during sex, which can have a big psychological impact on you and your partner.
For most men, incontinence lasts 6-12 months.

Practical Advice

  • To recovery as quickly as possible, practice Kegel exercises several times each day. Some doctors recommend starting two weeks before your surgery.
  • To deal with leakage, I recommend Depends Real Fit incontinence briefs for men. These briefs look and feel much like regular underwear. The built-in absorbent pads will wick away urine without feeling wet.
  • Remember that urine does not contain bacteria and isn’t a health problem.

Erectile Dysfunction after Prostate Cancer

After prostate cancer treatment, most men (like me) will experience the complete inability to get an erection, even with oral medications like Viagra or Cialis.

Initially this is due to damage to the nerves that trigger erections. Even with “nerve sparing” surgery, the nerves will be bruised and damaged, and recovery will take six to twenty-four months.

But this isn’t the only problem. The erectile tissues in the penis – the tissues that become engorged with blood – actually require blood flow to stay healthy. This blood flow comes from regular erections (most men have 2 or 3 erections while sleeping each night). Without this regular blood flow, the erectile tissues will be permanently damaged. In other words, if you can’t have an erection, you may permanently lose the ability to have a normal erection.

Finally, there is a psychological “catch 22.” Men who have problems achieving erections experience stress, which releases adrenaline… and adrenaline relaxes the erectile tissues, making it impossible to achieve or maintain an erection.

For most of us, the ability to get an erection is central to our sense of masculinity. Although there are treatment options for ED, it’s very hard to avoid feelings of inadequacy and depression. I am fortunate to have a very understanding partner to talk to, and we are working together to find ways to maintain our sex life. If you’re not comfortable talking with your partner about these issues, it’s important to get help from an intimacy coach or counselor.

Practical Advice

  • There isn’t much that can be done to hasten nerve healing, but it’s very important to prevent long-term damage to erectile tissues. Studies have shown that taking a small daily dose of erection-enhancing medications (Viagra, Cialis, Levitra) will produce enough blood flow to preserve healthy tissue. Another option is to use a penile injection of a drug like alprostadil to produce an erection at least three times per week.
  • It’s important to understand that complete erectile function may never return, but most men will eventually be able to produce an erection with a full dose of Viagra or similar drugs. In the event that this can’t be achieved, you may need to consider options such as regular penile injections, a vacuum pump, or a penile implant.
  • Whether used short-term or long-term, many men find that they are able to achieve a serviceable erection using a vacuum pump device. This certainly takes the spontaneity away from sex, and I can state from personal experience that the use of a pump can be uncomfortable or even painful – though not all men experience problems. I recommend the Pos-T-Vac manual vacuum pump. It’s inexpensive, and the manual pump gives you more control than electric pump models.
  • Sexual rehabilitation coaching or counseling may be needed, for you and your partner, to reduce stress and feelings of depression, and to encourage intimacy during your recovery process.

Shrinking of the Penis after Prostate Cancer

Several studies have shown that following treatment for prostate cancer, even after recovery, the size of a man’s erection may be smaller. Surgery does not directly cause this, so doctors believe that it’s due to damage to the erectile tissue.

Practical Advice

  • Maintaining blood flow in the penis preserves healthy erectile tissue, and is believed to prevent shrinking of the penis.
  • Regular use of a penile extender traction device (several hours per day over a period of months) has been shown to maintain or even increase both the flaccid and erect length of the penis.

Lack of Ejaculation (“dry” orgasms)

Two organs – the prostate and the surrounding seminal vesicles – produce the semen that is ejaculated during the male orgasm. When these organs are surgically removed, or damaged by radiation, no semen is produced. Men can still experience an orgasm, but no “ejaculate” will be produced.

For some men a so-called dry orgasm does not feel as satisfying (though a small number of men say that orgasms are more intense after treatment for prostate cancer).

In other cases the lack of ejaculate can be psychologically damaging.

The lack of semen production is permanent; there is no treatment for this condition.

Inability to Have Orgasms

Many men are surprised to find that they are able to stimulate the penis and achieve an orgasm even without an erection. This can be a good way to preserve a sexual connection with a partner.

However, some men find that they are unable to have an orgasm, even if they achieve an erection using oral medicine, injections, or vacuum pumps.

There is no physical reason that prostate cancer treatment should prevent orgasms, but there is a great deal of psychological stress for most men. Overcoming a lack of orgasms will therefore require counseling or coaching.

Treatment Options

As described above, restoring the ability to have an erection depends on maintaining blood flow through the use of low-dose oral medications or injections. It’s important to start this soon after your cancer treatment, and continue with daily doses.

In the interim – and possibly permanently – options for achieving erections include penile injections and vacuum pumps. I personally found the vacuum pump to be uncomfortable, and it did not give me a satisfactory erection.  I have started using an injection of “bi-mix,” prescribed by my doctor, and I’m pleased with the results.

If erectile function cannot be restored, it is possible to surgically implant a device that can be inflated (using a small pump in the scrotum) to achieve an erection.

The important thing to remember is that there are options to restore your erectile functions, although it may take some time. You should also explore ways to achieve sexual intimacy with your partner without having an erection. This is another area where sex therapy or coaching can help.


The side effects of prostate cancer treatments – both physical and psychological – can have a severe impact on your sex life and intimate relationships. There are treatments and techniques that can greatly improve your recovery process, but it’s important to understand that it will take time and effort.

Studies have shown significant benefit from early steps, such as the use of low-dose oral medications, penile injections, or vacuum pump therapy.

Most men (and their partners) will need advice, support, and counseling that are not usually available from urologists or other medical practitioners.

Coaching or counseling will help you to:

  • Understand options and find resources to help
  • Keep a positive outlook and avoid depression.
  • Stick with your recovery program and exercises.
  • Communicate with your partner and have an active and intimate sex life during your recovery and after.

If you’d like to explore how coaching can help you and your partner, please contact Jennifer.