A woman told me that her husband had lost his erections after prostate cancer treatment. Her sister told me he had not. It took all my self-control to keep from starting a debate. Still, their words cause me to wonder: Do we use the same language in regards to erections? Not according to a recent panel of the American Urological Association. What it found has implications for how you react to the promises the doctor makes.
Over the last two years a panel of the American Urological Association reviewed over 400 articles about prostate cancer treatment. It asked a simple question: how do researchers define and measure erections? Among its findings was that definitions varied from the simple “erectile dysfunction” to the vague “concerns about sexual function.” It also found such different scales of dysfunction as a rating system from “none” to “a lot” and varying numerical scales such as “1 to 3” or “1 to 5.” The panel concluded: “Clinical studies reporting erectile function outcomes after localized prostate cancer treatment often demonstrate poorly interpretable and inconsistent manners of assessment.”
If definitions of erections vary, then maybe both sisters were right. Like the scientists, maybe they just used “poorly interpretable and inconsistent manners of assessment.” For the hundreds of thousands of men who face a prostate cancer treatment decision, such inconsistency represents a barrier to valid comparisons of treatments. Until definitions of erections are standardized and until the standard definitions are applied in appropriate studies, you and I will never have a valid scientific basis for claiming that one treatment preserves erections better than another (or that one doctor is better than another at preserving erections).
From a practical point of view, if you find a doctor who makes dogmatic claims of treatment superiority, you should be suspicious. If what you want is to understand how you will function after treatment, start with an assessment of what we know affects erections: age, obesity, smoking history, illnesses, medications, mood, and the like. These factors are as important, if not more so, as the treatment you choose.
Filed under: Living with Prostate Cancer | Tagged: american urological association, Arnon Krongrad MD, erectile dysfunction |
THE "NEW" PROSTATE CANCER INFOLINK 
It wouldn’t seem very difficult to create a set of fairly objective metrics that a guy could use to record an “erection diary” in the weeks and months before and after a procedure.
If popular fiction and my own experience are any guide, many of us kept an “orgasm diary” during our teenage years, often encoded. (“April 10. Caught five butterflies today. A new record.”)
I’m not a urologist, and I tend to come up with too many metrics, but I could imagine a set of metrics that looks like this.
A1. Firmness / engorgement.
Note: No human penis ever gets as hard as a pencil or a bone, let alone “hard enough to drive nails with”.
10 = can’t imagine it any harder (like a spasming muscle)
8 = can achieve anal intercourse (think tube of toothpaste)
6 = “stuffable”: barely able to achieve vaginal intercourse.
5 = semi-hard (think hardboiled egg–without shell).
4 = getting there (think slice of white bread).
3 = soft, but not totally (think cylinder of Silly Putty).
2 = quite soft (think relaxed lower lip).
1 = totally limp (think overcooked noodle).
A2. Nondeflectability / rigidity / stiffness:
Usually matches scale A1 (firmness), but not always.
10 = any deflection is painful. Release from deflection causes immediate bounceback to the same angle.
1 = totally wobbly; no resistance at all to deflection.
B. Tactile sensation, if any
e.g., physical response to stimulation
C. Libidinal sensation, if any
e.g., emotional/psychological response to stimulation
D. Intensity of orgasm, if any
E. Ejaculation, if any
At first, I was unable to get any reaction even with Viagra and Cialis. Since I started taking a mail order “male enhancement” capsule, I have been able achieve partial erections. And I have experienced what I guess is as near to an orgasm I will ever have.
Since, I don’t have a wife I guess this is not as important as it is to married men. I will admit to masturbating and will tell you that it requires more and stronger stimulations than before the surgery. But I feel this is a small price to pay to be cancer free!!
hard enough to maintain sexual intercourse and have an orgasm … spontaneous nightly partial erections do not count
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It’s interesting that the man could get an erection for his wife’s sister! That may be one of the answers to our question!