Sign up for the Slatest to get the most insightful analysis, criticism, and advice out there, delivered to your inbox daily.
How to Do It is Slate’s sex advice column. Have a question? Send it to Stoya and Rich here. It’s anonymous!
Dear How to Do It,
I’m a cis man in my early 40s. A few years ago, I had kidney stones, which required a rather invasive but minor procedure. During the scan that discovered them, a tiny, malignant tumor was also detected. Thankfully it was early and it hadn’t spread. But the surgery to remove it was pretty massive and occurred only two months after the kidney stone procedure. Physically, I recovered fine, but ever since then, I’ve felt like a different person. Whereas before I enjoyed being active—kayaking, hiking, biking, etc.—now I don’t feel like doing much. I can’t say I’m happy to be a couch potato, but that is my default setting now.
I’ve been dating a wonderful woman in her late 20s for over a year. She knows of my medical history and even visited me as a friend when I was in the hospital. But now that we’re together I have a frustrating problem—one that might push her away for good.
I have almost no sex drive anymore. She has a very high sex drive, and I’ve been able to open up to her about my lack of desire. It has nothing to do with her. She’s beautiful and attractive and wonderful and I love her very much. I feel that it is connected to this giant change in my life. I don’t know if it’s physical or psychological. I’ve started seeing a therapist and counselor, but I haven’t really gotten any good feedback or insight into it as of yet. They’ve been supportive and listened, but I just haven’t been able to sort it out with anything they’ve said.
I feel terrible because I love this woman and she’s been so patient and understanding. But even though I feel that I could go months and months without sex, I want to be available for her. The doctor even mentioned I could get some ED medication, but I don’t think that’s the problem. Even if I did get that medication, it wouldn’t solve the issue of desire. It’s hard to talk about it with friends because I feel there’s the idea that men should always be the one chasing sex and there’s something wrong with me if I’m not craving it all the time. I know I’m not in my early 20s, but I’m also not elderly yet. I still want to become a father. I’m hoping that the therapy and counseling will provide results, but mainly, I just feel so lonely with this problem. Am I really that alone?
—Shadow of My Former Self
Dear Shadow of My Former Self,
You’re not alone; plenty of people deal with desire issues in their 40s and even before. It’s part of getting older and it sometimes comes with medical procedures. This is true of nephrectomies, which I believe is the surgery you underwent (during a nephrectomy, part or all of the kidney is removed). A 2020 study of the impact of nephrectomy on sexual function reported: “Patients experience significantly more problems in their sexual relationships after surgery. Very few were informed about this, showing the need to offer sex counseling before surgery.” That you would be experiencing issues is not a surprise in light of this information, though if you weren’t informed of this possibility in the first place, it may indeed come as a surprise to you.
The results of this study shed light on how not alone you are. Of the 53 sexually active male participants who were sexually active before the operation, more than half (28) said that they had sexual problems after their operation, versus 14 who reported sexual problems before their operation. In another phase of the study, a smaller sample of participants were interviewed. Of the 12 interviewed men, four, or a third of them, reported their sexual desire had been negatively affected by the surgery. Says the paper:
One connected the loss of desire to the development of erectile dysfunction. Others stated that the entire situation affected their desire. “I don’t have the same desire anymore; there are other things to take into consideration.” Six of the men complained about ejaculatory dysfunction: “I have the feeling (orgasm), but it won’t come out.”
What exactly to do for the next steps is a bit cloudier. You’ve talked to a doctor about this and they recommended PDE5s. I would follow up and ask for your blood levels to be tested. If your testosterone levels are low, you could look into supplementation. “It is difficult to explain what causes the sexual dysfunction, because it is not the surgical approach, but it could be being upset by having cancer, life stress, and losses,” write the authors of the study cited above. Stick with the counseling. Also, keep in mind the woman you are dating seems to accept the situation. If I have the timeline right, you got together with her after your surgery, which means that you have had low-to-no libido for the duration of your relationship. She hasn’t gone anywhere. If you aren’t already, it might be useful to engage directly with her sexuality, desires, and fantasies even if it’s just in conversation. It would allow her to feel seen and it might demystify some of the situation for you. You have many expectations for yourself that she is falling short of; what are hers? What does she make of that fact that you aren’t available sexually and how is she coping? By all means, attempt to treat your low libido, but you should also know that you may not have to in order to keep the relationship. You may, in fact, be in the perfect relationship for your situation.
—Rich
More Advice From Slate
I’m a woman who’s been married for a month. The wedding night was the first time for both of us. Turns out penetration doesn’t feel like much to me, but my husband has been happy to use his fingers and tongue for my pleasure. The trouble is, I don’t think I’ve orgasmed yet. His strategy leaves much to be desired, and I keep almost climaxing, then not … quite … getting there. I’m not comfortable trying toys, especially this early in my sex life. Do you have any advice?