A Prescription is not a Conversation

After my prostatectomy, I was referred to a urologist for the predictable erectile dysfunction. The referral was fast and the conversation was clinical, which was appropriate, but there was a prescription, a follow-up at six weeks, and that was the whole interaction.

That visit, in compressed form, is what most men get for ED — a pill, a window, and an unspoken assumption that the pill is the conversation. It isn’t.

What the pill doesn’t address is the nervous system that’s gone vigilant after months of monitoring, or the pelvic floor that’s been bracing so long it’s forgotten how to release. It doesn’t address the voice in the back of your head keeping a running tally of every attempt, or the careful silence that grows between you and your partner because neither of you wants to add pressure. And it certainly doesn’t address the slow shift in how you see yourself when your body stops doing what it used to do without being asked.

For a while, I started telling other men about my own ED on purpose. I’d be at a barbecue and say it plainly — that I hadn’t had a reliable erection in over a year — and people were shocked. They didn’t know what to do with it, which was the point. The silence was the problem, and somebody had to break it first.

What I’ve learned coaching men, including men whose ED has nothing to do with cancer, is that the mechanical layer is rarely where recovery actually happens. The nervous system, the relationship, and your sense of identity are all in the room with the pill, and pretending otherwise is part of why so many men plateau on the prescription and then quietly give up. If you’ve been handed a prescription and not much else, you haven’t been given a recovery plan — you’ve been given a starting point.