Genital shrinkage is real. And so is the distress it causes.

asco-logo “How can I help you, sir?” I asked because it was clear he wanted help. I could sense the man’s distress over the phone. His voice cracked just a little, and he cleared his throat frequently. I hadn’t met him, and so had no image of him in my mind, but I thought he might be tall, broad-shouldered, and maybe he walked with a bit of a limp.

“Lady,” he said, and I smiled at this. I wanted to joke that I’m no lady, but you have to be careful with humor on the phone.

“Lady, I just don’t know what to do. I’m at the end of my rope, and if something isn’t done about this…”

He went on to tell me that ever since his surgery — a radical prostatectomy 14 months ago — his penis had shrunk to such a degree that he “messed up the bathroom floor,” and his wife was getting mad. He felt ashamed and guilty. But most of all, he was frustrated that this had happened. And what was I going to do to help him?

He continued, “And I can’t believe I’m telling you this, you being a woman and that, but well, I’m circumcised, but you wouldn’t know it to look at me. You know what? There’s so much loose skin there that it looks like a foreskin and the pee, well, it gets caught in the folds and it’s gotten infected, you know?”

I nodded but then realized that he couldn’t see me.

“Uh-huh,” I said, thinking about what I could say to him when he stopped talking.

“So, I went to my doctor here, and he gave me some cream, but it only helped a little bit, and it didn’t solve the problem. So, tell me what I can do? It’s really bad?”

His voice went up just a little bit, and he cleared his throat again.

This was not the first time I had heard this story. Penile shrinkage is not uncommon after prostate surgery, with men experiencing shrinkage in both length and girth.1 It’s not just a private matter, either. These men don’t have the length to be able to urinate in a public restroom. One man, a long-distance truck driver, had told me that suggesting he use the toilet in the stall was not helpful, as they were usually filthy. Men figure out quickly that if they sit to urinate that mostly solves the problem, but in this case, the problem was the excess skin and the folds that resulted.

“And I talked to this other guy I know who had the same problem,” he continued, “and he had some sort of surgery to remove the skin and he said it hurt like stink, and I’m not sure I can do that.”

I took a deep breath. That was going to be my suggestion. A urologist could remove the excess skin surgically, but I knew it was going to be painful. Would short-term pain be worth the gain? This was not my decision to make, but it likely was the only solution.

He was not done yet.

“Why didn’t they tell me this would happen? If I’d known, maybe I would have had the radiation treatment that the other doctor told me about. But no one said anything, and I thought the surgery would be the best thing. You know, get rid of the problem, and then I’d never have to think about it again.”

A common and perhaps intuitive belief is that there is no risk of recurrence once the prostate is removed. I took another deep breath, knowing that what I was going to say next would only make things worse. But I had to tell him the facts; he deserved to know that he could still have a recurrence of the cancer despite the surgery.

At that moment, I longed for the ability to look into his eyes, perhaps reach over and touch his hand, and once again, I silently cursed this COVID plague that has restricted my ability to show empathy and compassion.

“Sir, there is something you need to know about that …”

Anne Katz is a certified sexual counselor and a clinical nurse specialist at a large, regional cancer center in Canada who blogs at ASCO Connection, where this post originally appeared. She can be reached at her self-titled site, Dr. Anne Katz.

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