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[Cancer]

[cancer] Chemo, sex, Viagra and me

As I’ve mentioned before, sexuality on chemo has been a real challenge. Not impossible, but difficult. I’ve a very strong libido, which hasn’t been suppressed even by the experience of cancer, surgery and chemotherapy. But since my colon surgery of May 2008, my erectile function has been very erratic. That was a known side effect disclosed and discussed during pre-operative consent. Among other issues, the colon surgery disturbs the vagus nerve, which is involved in sexual functionality and response. As a result, my erections are infrequent, erratic and undependable.

Luckily for me, my sexuality has never been particularly dependent on good old Number One. I’m not even all that orgasm focused for my own part, so sex is still satisfying for me and my partners, but limited in some ways. Viagra has been reasonably effective in managing the erectile dysfunction up til now. But with the advent of chemo, the erectile dysfunction has gotten so severe as to be nearly absolute. Even Viagra is iffy, and I’m supposed to stay off it in part because my chemo cocktail raises my blood pressure, which doesn’t mix well with Viagra’s effects.

Most of the information about sexuality and cancer for men is centered on prostate cancer. I suppose the reasons for this are obvious enough. But any strong course of chemotherapy can interfere with sexual functionality, and as I’ve commented before, the medical information about sex on chemo is iffy. The drug companies and the oncology clinics are so paranoid about the potential for violent birth defects from the cytotoxic drugs — which can create birth defects on a par with Thalidomide &mash; that they simply won’t research or discuss sexuality on the drugs. There is an absolute fear of liability from defective pregnancies that trumps all other possibilities.

As I’ve pointed out to the clinic staff, about half the people in for chemo aren’t fertile. Older couples, gay couples, people who’ve had vasectomies or hysterectomies. Mostly they just won’t talk about it. I finally found one oncology Nurse Practitioner on staff who is a former AIDs educator. She’s willing to be frank, and has told me that most patients don’t even ask the kinds of questions I do.

My questions include:

  • What are the breakdown curves and byproducts of the chemo drugs?
  • What are the concentrations of those byproducts across my two-week cycle?
  • How toxic are my emissions — saliva, sweat, ejaculate — over time?
  • I’ve been forbidden most sexual practices due to bacterial risk. Is this absolute, or does my risk curve change over time?
  • For example, can I practice cunnilingus in my second week if my partner has just freshly washed and cleaned herself
  • Is unprotected penetrative sex a risk if I withdraw before ejaculation? How much so for me? (Ie, infection risk.) How much so for my partner? (Ie, concentration of toxins in pre-come over the two-week time curve.)

No one ever asks these questions, apparently. And no one wants to answer them. Millions of people go through what I go through, male and female, young and old. The medical establishment’s crippling fear of pregnancy liability denies us access to information about sexuality and lifestyle that can been critical to emotional health, relationship maintenance and self-image.

Now in my case, combine this with my insurance carrier’s very strange views on Viagra. The drug is reasonably effective for me, even now, though I can only use it sparingly. My doctor (pre-chemo) prescribed me 20 doses per month. For me, when I’m not exhausted or in the throes of some other major chemo side effects, a dose can provide a 20-30 hour window for effective erections — not continuously, but when appropriate. My carrier only allows five doses per month, at a co-pay so high that it approaches the over-the-counter-cost. My chemotherapy sessions (at $16,800 per pop) cost me less out of pocket than five doses of Viagra. Apparently in their estimation, people have sex one day a week. Which is ridiculous. My libido is dialed up much higher than that. I’m quite happily capable of two or three times a day so long as time and energy hold out.

And the carrier has been playing another rather shitty game with me. Every two or three months, they push back the renewal date on my Viagra prescription by about two days. They don’t do this with any of my other prescriptions. In effect, over about a two-year period, they are eliminating a month of coverage.

I have appealed the coverage all the way up the chain at my carrier. My claim is that Viagra is medically necessary to restore my lifestyle to its reasonable pre-2008 surgery levels. Their claim is that the Viagra limitations are contracted by my employer as part of the policy coverage.

Apparently I’m entitled to life, but not sex. I don’t like this, but it’s consistent with the extremely dysfunctional American attitudes about sexuality in general. But this ongoing rollback of my renewal date is just the carrier stealing from me what little they’ve already given me. And I deeply resent it. I resent a lot of things about what cancer and chemo have done to my sexuality, which is a huge part of my identity, but most of those losses have been natural parts of the treatment process. My insurance carrier stealing a Viagra from me every two or three months is just..what? Chicanery?

I’m going to call tomorrow and try to find out what their justification is. My expectation is that I’ll simply hit another brick wall, as I always do on this. Viagra is apparently the blood diamond of insurance coverage. Such a freaky attitude for something so basic, so medically necessary, and so critical to emotional and relationship well-being.

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