It’s bad enough battling the Big C but to come out a winner and pay the price with shrinkage of the old fella seems a little rough. I’ve been writing about prostate cancer for an article just about to be published in The Australian, on Friday April 5.

One of the issues I talk about is the shrinkage problem which so often occurs after prostate cancer surgery. Ending up with a shorter penis may not seem a big deal given what these men have gone through, but believe me, it matters to many of them. It’s just one more indignity, one more insult to a man’s sense of masculinity.

I so often hear from men who have been given no warning by their doctors that this might happen, let alone taught how they might avoid it, or at least minimize the problem. I’ve written before about “penile rehabilitation,” the process of regaining sexual functioning after prostate surgery. The idea is that giving the man regular erections  soon after the cancer treatment (within four weeks or even earlier) brings a regular supply of oxygen to the penis by increasing blood flow. This prevents scarring of the penis and keeps the erectile tissues healthy and functional until the nerves have had a chance to recover from the surgery – which can take up to two years.

Normally this oxygenation process occurs as a result of the 4-6 erections most men experience in their sleep. But following the nerve damage which usually occurs even in “nerve sparing” surgery and other treatments like radiation therapy, night-time erections often disappear and erections need to be artificially induced to keep the penile tissues healthy.

It’s a classic case of use it or lose it. But here the potential losses include not only erections but actual penile size and that’s something most men are desperate to avoid. Urology Associate  Professor Prem Rashid is the author of “Prostate Cancer – your guide to the disease, treatment options and outcomes, “ which includes an excellent discussion by Dr Rosie King on the complex reasons for this shrinkage. “About seventy per cent of men report some shortening, with just under half noting a decrease of 1cm or more and that’s something which really bothers many men,” reports Rashid, explaining the exact reason for the shrinkage is not known but explanations include: scarring of the penile tissue which then gradually shrinks; alterations in the casing of the penile tissues; loss of a section of the urethra; and what’s known as “competitive sprouting” which means the surgery affects the normal balance of  contraction and relaxation nerve fibres, giving the contraction nerves the upper hand.

So it is a complex issue, with various causes possibly contributing to the shrinkage problem. But the important point is often the loss of length can be minimized with penile rehabilitation. Usually this means using a combination of regular doses of one of the ED pills, like Viagra, Levitra, and Cialis plus injection therapy a few times a week and possibly the use of the vacuum pump.

What’s needed is for men to talk more openly about this issue. Men with prostate cancer need to have the courage to question their doctors before treatment about all this and maybe even tell their friends about what’s happening to them.  Men’s embarrassment about these issues is the major reason so many suffer in silence instead of demanding the proper education they need to keep their tackle in the best possible shape.