Men's things XXXI: Can Intimacy Be Reclaimed After Prostate Cancer?

The Unspoken Battle

It is the unspoken conversation, one I have barely had with myself and definitely not with others, including my partner, my medical and cancer support teams.

When I was diagnosed with malignant prostate cancer in June 2024, the first physical urge that left me was sexual desire, as though someone had just kicked me in the balls. It wasn't pain, just a numbness of confusion and incapacity.

Preparing for the Obvious

Even for a man with African heritage and no need for machismo, I have been open about the bowel and bladder issues. I was quite read up on them and ready to attend to the matters concerned. I didn't want a catheter insertion for whatever reason, but incontinence underwear? I was ready to model it for men of a certain age and body, if necessary. I do like my underwear, and I have used linings too; the situation is manageable.

However, on the sexual part—the big mammoth in the room—I have ignored its presence and viewed it as part of the weight-bearing structure of that space, insignificant if it played dead and never moved. But 17 months after radiotherapy, with all things looking good, the mammoth is awakening from its imposed hibernation.

Weighing the Options

If I wanted sex, and I enjoyed sex, this diagnosis exacerbated and crystallised the ideas of sexual dysfunction in my mind.

In choosing the option for treatment, I first spoke to the consultant surgeon about the radical prostatectomy procedure. A year before, a men's advocate who had undergone it explained that the expert surgeon was able to save the nerves necessary to retain some sexual functions.

The surgeon was quite candid with me: my prostate gland was so enlarged that he couldn't guarantee anything could be saved of my nerves until he was in there conducting the surgery.

Imagining the Aftermath

As this procedure is conducted under general anaesthetic, the prospect of waking up to a surgeon trying to express happiness and sadness in the same facial expression was one I was not intent on seeing.

His professionalism and years of experience might have given him the skill as a comic piece, but it would have been a joke at my expense. “Mr Akintayo, we successfully removed the prostate gland. However, your sex life is gone; you're impotent. But we can make some interesting toys for you, to have some sensation and other elements of pleasure.”

I'd be crying tears of joy for being free of cancer, catheter inserted as there is no urinary control for months, finding where my pelvic floor is, and living happily ever after.

Then I ask, even if this smacks of medical paternalism: should surgeons be more proactive in discussing sexual health outcomes?

Learning from Others

Another friend had undergone the procedure a few years before. He, a straight man, came to me to seek advice about the kinds of sex I know. Much as I could have helped, I felt he needed to join a men's support group to appreciate the experiences of men in similar circumstances before thinking of this, because his views were explorative to my hearing, rather than developed.

From that surgery discussion, I knew it was not for me. At the same time, I needed that cancer excised because, whichever way you look at it, dead men do not have sex.

Another question arises: how do cultural expectations of manhood affect seeking the essential prostate health check-ups first, before considering the treatment decisions and recovery?

Radiotherapy and Its Consequences

As I took radiotherapy, the immediate and enduring side effects have been bladder related, with a few bowel issues. My sex drive is depleted by being unsure of ability and compounded by lacking confidence. It is also not something that can be addressed with bravado.

As you can read, I am tackling this issue alone because I do not understand this vulnerability enough to appreciate the kind of help I need.

The Medication Dilemma

Yes, I can get erectile dysfunction medication and pop pills like sweets, but that not only becomes a prop; it does not address the emotional and mental issues. Rather, it becomes a legalised version of chemical sex, getting a prescription from a pharmacist instead of illicit drugs delivered by a dealer.

The question then becomes, how many highs can I have before drug-induced priapism or severe hypotension with the risk of death is the danger?

Furthermore, because it has been offered, is the medical establishment over-reliant on pharmaceutical solutions rather than psychological support?

Rethinking Intimacy

As men, we are fixated with erection and penetration as the full expressions of sex; the absence of either or both feeds a kind of sexual frustration for the person and their partner. Does sex become a distant memory rather than a present experience with a hopeful better consummation, or are damaged goods being repackaged for a partner with different expectations?

For gay men, where physical intimacy and sexual expression often form central parts of identity and connection, the loss can feel particularly acute. The dynamics of same-sex relationships, where both partners understand male sexuality from lived experience, can create a unique space for empathy and shared problem-solving.

Yet it can also mean both partners acutely feel the absence of what was, and the uncertainty of what might be possible. The fear of being seen as “broken” or inadequate in a community that sometimes prizes sexual vitality can compound the isolation.

For straight men, the challenge often involves navigating conversations with partners who may not fully grasp the psychological weight of erectile dysfunction on male identity. There's the added pressure of traditional gender roles and expectations around male performance.

Meanwhile, bisexual men face both sets of pressures, depending on the gender of their partner, alongside navigating healthcare systems that may not fully recognise or address their specific concerns.

Regardless of sexual orientation, the fundamental question remains: how do you maintain intimacy and connection when the language of physical expression you once spoke fluently becomes halting and uncertain?

Confronting the Fear

Yes, I have literally thought through all this with a clear indication that I probably need to re-engage with a support system that would address many of the pertinent issues after treatment for prostate cancer. The questions are not abstract; they are real issues in existing relationships.

You might wonder, if I have managed the bowel and bladder issues that well, why am I struggling with the sexual one? Whether we like it or not, it defines, to a certain degree, manhood, manliness, performance, and self-esteem. Maybe, just maybe, this is part of the fear that stops us black guys from talking about men's things.

One last question: are Black men receiving adequate support and information about sex, sexual health, and sexual expression after cancer treatment?

Moving Forward

Yet we need to talk. Prostate cancer cannot be the last story, and navigating a way to fulfilled sexual satisfaction after prostate cancer treatment must not be greeted by the shock of the experience, but by the hope of new possibilities through therapy, support, and understanding.

How intimacy changes in relationships is a journey that has no clear answers for both parties, and that might not be the prospect a partner desires in what looked amazing before cancer struck and stole our virility.

Check your Prostate Cancer risk in 30 seconds.

Blog - Men's things XXX: Let's talk Prostate Cancer

Blog – Photons on the Prostate - A year from starting radiotherapy

Blog - A prostate cancer diagnosis, one year on

Blog - Men's things - Prostate Cancer blogs

A Google NotebookLM AI Audio Overview Discussion of this blog

The Bottleneck Paradox

Breaking Free from Groupthink

The tendency for us to participate in groupthink can lead to stifling our ability to see things from a different perspective. Then sometimes, I suffer from an inclination to see things from a different perspective first, before seeing the blatantly obvious.

As readers of my blog might have observed in my debunking of the half-glass-full or half-glass-empty debate, this only matters in what is in the glass. You cannot judge my sense of optimism or pessimism from the notion of the glass without examining its contents.

The Contents Matter Most

If the glass contains fine wine, it would likely be half empty because I am enjoying the drink and, by inference, it will remain half full, or full, if I cannot abide the taste, quality, or bouquet of the wine poured in it.

My wine example could spark debate about whether I am proving my point or demonstrating confirmation bias, yet it is in what the glass contains that we can deduce the state. Just as if I knew the glass contained poison, it would remain half full.

This morning, in an engagement with a colleague, he expressed concern that an activity might cause a bottleneck. Here again is the tendency in all definitions to see a bottleneck as a problem.

Reframing the Bottleneck

According to the AI Overview my browser provided, “A bottleneck is a point of congestion in a system—such as production, software, or computing—where a single component's limited capacity restricts the overall speed, throughput, or performance. Similar to the narrow neck of a bottle, it causes delays, reduces efficiency, and creates backups, often requiring the slowest part to be upgraded or optimised to improve the entire process.”

Without thinking twice about it, I responded, “Bottlenecks are good; they make the difference between getting the drink in the glass and spilling it everywhere.” Surely, that is a beneficial feature of bottlenecks and the reason why we do have real bottlenecks, as opposed to bottlenecks in application, production, or business processes, on computers, or in networks or traffic.

Those versed in systems thinking might, in this case, distinguish between designed constraints (intentional bottlenecks), which follow my response, and emergent ones (system failures), which engender the broader definition.

Reconsidering Received Wisdom

There might be other situations where the restriction of flow helps direct and concentrate resources to achieve an aim. These are worth considering further.

The other argument might suggest that the definition of bottleneck has evolved well beyond its original meaning. Just remember, when happy and gay literally meant the same thing.

Yet the situations where received wisdom suggests the negative deserve review from another perspective. There is often more to it than what we have been schooled to accept as the only truth.

Blog - Half of a quarter full of an eighth empty (October 2004)

Blog - Pour the wine and don't you whine (May 2024)

A Google NotebookLM AI Audio Overview Discussion of this blog

Essential Snobbery 101: Letting Mother Help You Choose Good Friends

The Wisdom of Maternal Instinct

Mothers of my generation who happened to be in the UK during the 1960s seemed to acquire a turn of phrase associated with that exposure, which we, their children, sometimes had trouble understanding. However, with hindsight, many of their observations were insightful, intuitive, and prescient.

When your mother said, "This friend of yours is too good for my liking," whilst she was not commanding you to break the friendship there and then, she expected you to find ways of extricating yourself from that relationship.

Usually, this meant bringing new friends into your orbit and having something aspirational within those friendships against which she could compare you, urging you to do better. As our parents cannot essentially make our friends for us, they exercise a kind of judgement on our decision-making in the best interests of our protection, even if we cannot see why.

The Mirror of Association

Another saying of foreboding is, "Show me your friends, and I will show you who you are." Association becomes a marker for discernment, character, and principle. Choose and keep the wrong associations, and watch your own reputation go up in flames, even if you are neither involved nor culpable in the nefarious activities of your chosen friends.

Moral judgement, a good conscience, along with a sense of knowing when something is wrong, are instincts we should all have. Beyond that, we need to be aware of when we begin to think that status and means provide immunity for impunity, creating an aura of invincibility bordering on being untouchable. It is the most dangerous cocoon of existence in which a man can find himself.

It is in this light that I have wondered how wise counsel deserted men of wealth and power concerning Jeffrey Epstein. Firstly, the evil and wickedness he inflicted on young, vulnerable women for his pleasure and that of those he corralled into his circle of influence is unforgivable. Lives were ruined and damaged beyond any form of redemption. The most public of them, Virginia Giuffre, took her own life last year.

The Voiceless Victims

For those still living, I can only hope that they find the love and care to give them not merely the will to live, but a purpose that can help them craft a better story regardless of their past. They remain the voiceless in this atrocity, in which he gave himself the easy exit of suicide rather than be held accountable for his actions.

His accomplice, Ghislaine Maxwell, is in prison but hardly languishing in a gulag. She probably holds a bargaining chip of influence and blackmail that could ease the severity of the punishment she truly deserves. However, apart from these two principals in this influential harem of inordinate abuse, almost rivalling the court of Caligula, no one else has faced the remote prospect of indictment, let alone prosecution.

A Global Web of Complicity

The names on Jeffrey Epstein's Rolodex and roll of shame reach into a global Who's Who of money, power, royalty, politics, and academia, touching the once respected, revered, or adored. We have begun to question our own sanity, yet one can only be in awe of how he networked to create a veneer of respectability over his disreputable and criminal enterprise. Those involved became inadvertent enablers, and within that bubble, they were mesmerised into the suspension of disbelief.

The taint of association has claimed scalps and led to disgrace in many spheres. It started with a CEO of a global bank losing his job, the marriage of the richest man in the world for over a decade collapsing, a prince losing his titles and honours, an ambassador sacked with the prospect of losing his peerage, and today, the chief of staff to the Prime Minister resigning for just being a friend of a friend.

That list is not exhaustive, but it is indicative of how a mother's observation could have saved the reputations and honour of some who have now become part of Epstein's story.

Heeding the Warning Signs

It is obvious that we need to regularly review the kinds of friendships we keep, no matter how influential, rich, and connected that person might be. I know those people my mother took exception to; there are two who never became good friends. One of them became involved in criminality in the UK, such that his history stood against his ability to practise law there.

Sometimes, I hear my mother's voice in my head. There are times I hear her in my own speaking, too. In both cases, I am glad there is that premonition to avoid some people.

A Google NotebookLM AI Audio Overview Discussion of this blog

Committing The Treason of Solitude

Misunderstood Perceptions

How I am viewed by others leaves me baffled, if not surprised. If I am not generally considered a curmudgeon, it is assumed I have a temperament easily disposed to petty angst and fits of pique, with a tendency to take offence without cause.

How this figment of imagination takes hold and plays out, as if an alter ego of mine has supplanted my reality and taken my place interacting with others, escapes me. It would be unkind to suggest others are getting ahead of themselves.

My True Nature

In my mind, I would think those with whom I have issues would be in no doubt that I have issues with them, despite every desire for them to think they have done nothing wrong.

Much as I tend to be a loner, keeping to myself and enjoying my own company in the confines of my bedroom, oblivious of the world, I do not pick a grudge for the sake of being contrarian.

The Demands of Others

Indeed, there are times I want to be left well alone. It is a prerogative I seem to have no unilateral licence to exercise without question; there are people who simply need my engagement regardless of my situation.

Tribute, attention, communication and calls must be made or answered, or an inquiry is instituted bordering on an inquisition. My guilt is decided without the option for innocence, all in a day, or even shorter, between dawn and dusk.

No Hiding Place

In this, I have no hiding place. My solitude is a room with too many keys, distributed freely to others who enter at will, demanding tribute in the form of my time, my attention and my immediate response. No excuse is ever good enough for breaking formation; I must meet expectations or face sanction.

If I had the temerity to consider changing the locks, just imagine how the charge of treason would stick, because I belong to something beyond myself. My boundaries and borders are without demarcation, access taken rather than given.

Why does a moment cloud and crowd out the significance of the enduring, from which the narrative and story bear their existence? I suppose I would never understand where, for some, the spectrum of security is transient, whilst for others it is a bond of endurance that cannot be nicked by ephemeral conniptions.

Thought Picnic: Rest, Sobriety, and Social Sacrifice

Treasuring Rest and Sobriety

There are two things I treasure: the opportunity for rest and keeping my sobriety. I get my sleep whenever I can, except when it is interrupted by obligation or responsibility—work or other necessities.

This means that even when I do not get sufficient rest during the week, which is usually the case due to what is essentially nighttime insomnia, I make up for the shortfall at the weekend. I will have a good lie-in on Saturday, not getting out of bed for most of the morning if I can help it, and sometimes I do give my Sunday to rest over religious commitment.

It is strange that some who are aware of these irregular sleeping patterns still seem totally oblivious to this knowledge in some self-serving way. I suppose that is to be expected.

A Teetotaller With Exceptions

On sobriety, I would consider myself generally a teetotaller, though not to the point of total abstinence. I do like wine. My work experience in a brewery laboratory at the age of 15 quite literally put me off beer, lager, cider, and ale.

It is not for religious belief that I rarely consume alcohol; rather, I have seen how drink loosens the tongue, prompting people to speak more candidly. These are thoughts they once had the wherewithal to keep unspoken. Moments of indiscretion or regrettable garrulousness accommodate the emptying of the bottle into the belly.

One core principle I keep more than ever is never to drink alone and mostly to drink only with meals. This makes drinking a social activity and forestalls the advent of hangovers. I probably drink with the utmost moderation; my experiences with light-headedness have come from prescribed medication rather than from losing control, paying homage to Bacchus.

The Darker Side of Drink

Walking up through the Gay Village near where I live, many a doorway is fouled by vomit. At night, you behold the sight of people barely able to stand on their own two feet, so inebriated to the point of incapacity.

The whole thing is quite scary to me: the thought that a portion of your sensibilities is lost to a void of nothingness, your memory failing to recall any recent event.

Then imagine a sober man keeping the fully drunk company, subjected to the inanities that make you question your own sanity. As much as it is part of socialising and being a social animal, you do you; I do me. Some sacrifices are necessary to make the world go round.

The Just Can't Wait Card Test

The Tale of Two Responses

It was eventually going to happen: a moment when I wielded my Just Can't Wait Card and was met with a Just Can't Be Bothered apathetic response. It was yesterday, just before 7:00 PM, when I alighted from the tram at Cornbrook, slightly pressed and hoping to make up the shortfall of my daily 10,000 steps.

As the breezy chill of the cold hit me, my bladder was at bursting point. I needed to go and go now. I turned into the entrance of one of the new developments and showed my card to the concierge, pleading to use a toilet on their premises.

She gave it no consideration, expressing the fear that if her manager found out a non-resident had used the toilet, she would be in trouble. Lady, the reason I came here was that I have a medical condition. I need the respite borne of your human kindness to allow me access. Surely, no manager of human provenance would think helping someone with a medical condition is so bad as to warrant a sanction. Common sense should prevail.

It fell on deaf ears; this conversation was going on as Brian was on the other end of the phone. She then said I should try the Co-op shop around the corner, to the front. The daring I once had of telling anyone who refused my entreaties that I would do whatever was pressing standing in front of them deserted me.

A Worrying Contingency

In the worst-case scenario, I would have wet myself and depended on my incontinence underwear to save my blushes in the 30-minute walk home. However, I did go to the Co-op shop and showed my Just Can't Wait Card. The lady at the till immediately summoned the store manager.

He explained that there were no customer-side toilet facilities, but he would take me into the back of the store and would have to wait outside until I had finished. The difference? Human compassion with a sense of humanity, rather than the readiness to sacrifice suffering on the altar of keeping the rules. More so, it is the presence of initiative, agency, and autonomy.

I had this large, disabled-equipped convenience to myself for as long as I wanted, and I was done in a few minutes. I thanked him profusely and made for home: relieved, succoured, and comforted by understanding human beings.

The Absence of Initiative

My earlier experience made me wonder: beyond manning the concierge desk, if any resident had suffered an emergency, would this concierge have risen to the situation to help? I would be quite doubtful, because she would be thinking her manager would upbraid her for any attempt at being human. It is best not to be distracted by the other descriptions that are present in what could be hitting below the belt.

My condition was manageable. I would not want to extrapolate on a more serious condition with someone else, who needed the presence of mind, the abundance of initiative, and just a modicum of courage, with the beating heart of humanity. How would our conscientious concierge, attending to her duties in the strict diktat of the letter of her contract of employment, have responded?

Names and Places

On getting home, I wrote to the management company of that apartment complex. I may not get a response, but what it takes to escalate this episode by averring to the press that there are certain establishments in this friendly Manchester city of ours, heartless apparatchiks are in customer-facing roles, oblivious to the charitable consideration of the disabled or those with medical conditions.

Heck, I have been in places where I had neither my card nor a Radar key, and I was allowed the use of their toilets and a place for respite before I continued on my way. The talk on this matter is not over yet. Names and places to come in due course.

A Reckoning With Remo Secondary School at 80

A Reluctant Beginning

It is a part of my history I cannot ignore: a ploy by my parents to move me from the privileged environment of international primary schooling to experience integration into their culture, norms, and values, in order to foster independence and resilience during secondary boarding school, within the context of their tribal roots.

In the 30th year of the founding of Remo Secondary School, Sagamu, I gained admission after sitting the common entrance examinations and arrived from the north, ill-prepared, ill-equipped, and scarcely excited by the prospect. At age 10, my only options were between this school and Odogbolu Grammar School.

A Blur of Survival

The five years of being a student are a blur; I do not retain any particular friendships or bonds from that time. The people I considered friends were probably just fellow survivors trying to cope in a hostile environment, as we have scarcely maintained those connections since graduating.

If my memories are to be recalled, they would be in the names of the teachers rather than my classmates. The principal during my admission was Mrs Adebambo, a stoic lady who seemed to have eyes everywhere; you could hardly hide when not in the designated student assembly.

Yet I do remember hiding in a cavity behind the shrubs backing Falode House hostel as she walked by. I broke that myth.

Houses and Early Years

I was in Adedoyin House, and for my first three years, we took the wooden spoon at the Inter-House Sports Day. I was never a sportsman, but we cheered just for participation. Mr Abiona, I remember him as a kind housemaster; one of his sons was my classmate. The other two houses were Igimisoje and Mellor.

Remo Secondary School (RSS) was founded 80 years ago today by a Methodist missionary and community leaders as the first coeducational secondary school. Reverend William Frederick Mellor died in my first year at RSS.

Teachers Remembered

Of all the people who taught me, I remember most fondly Pascal Housenone, my mathematics teacher from the neighbouring Benin Republic. He taught me in my third form. Mr Adekoya taught English; he tarnished my school report that year by remarking that I was a truant. No one wondered why I was bothered, disinterested, and distracted in class; I preferred being in the library.

Of the malevolent lot was Mr Okonji, who earned the nickname Study-Study but was never able to enthuse us with his French lessons. He failed at imparting knowledge, relying on the cane; a sadist whose gratification was inflicting pain. With Mrs Odutuyo, the Yoruba teacher; the only lesson I learnt from her tutelage was adding diacritical marks to Yoruba; they both personified wickedness and abuse without accountability.

Collective Punishment

In my final year, we attended summer classes, and some classmates, intent on meeting girls one night, ran amok and caused damage and injury in the girls' hostel. Instead of investigating who the real culprits were, the school decided on collective punishment, expelling us from the boarding arrangements for the final year.

I remember the vice principal coming to the hostel and saying loudly that she knew these boys were not involved, but the decision had been made. That shaped my view and experience of RSS since the summer of 1980. I graduated in the Class of 1981; I have not returned since.

A Distance Maintained

I have observed activities of the RSS Old Students' Association from afar but have never been persuaded to join, as some of the leadership in the UK are reliquaries of memories I’d rather forget. For the record, I post this note.