Robert Ginyard struggled with the indignity of impotence after radical prostate cancer surgery in August 2010, then a course of radiation and finally hormone treatment this year.
"After hormone therapy, I lived the life of a woman," said the 49-year-old entrepreneur from Baltimore. "I had hot flashes, tender nipples and lost some hair. I even lost my ability to even think about sex. It just took away my libido."
"I have a beautiful wife, but she could be in the best-looking bikini," he said. "But because of the medicine, nothing could happen."
Despite improved therapies for men diagnosed with prostate cancer, most men face erection dysfunction because of nerve damage or blood flow problems. Many also lose their desire for sex and have difficulties reaching an orgasm.
Now, a new study published online in Cancer, a peer-reviewed journal of the American Cancer Society, suggests that counseling can enhance the effectiveness of erectile dysfunction medications to help improve couples' sex lives.
Both Internet-based counseling and face-to-face therapy sessions improved the sex lives of prostate cancer survivors and their spouses, according to the study led by Leslie Schover, a psychologist and professor at the University of Texas MD Anderson Cancer Center in Houston.
"When men get these problems, they see their sexual function as how hard is my erection, and women get ignored and turned off," she said. "And so men get distressed emotionally and feel like they are a failure."
Such was the case with Ginyard who said his wife "didn't know exactly what to say or how to hold me. She felt like an outsider."
Eventually, Ginyard was able to restore his sexual function.
In the study, Internet-based and face-to-face counseling focused on both partners' enjoyment when they "encountered more intimacy and less performance," said Schover.
Other than skin cancer, prostate cancer is the most common cancer in American men and the second-leading cause of death, according to the American Cancer Society. One in six men is at risk for prostate cancer in his lifetime. Each year, more than 240,000 men are diagnosed with the disease and nearly 34,000 die.
And African American males like Ginyard have a 60 percent higher risk for prostate cancer than white males.
The University of Texas study involved 115 couples. In each case, the man's prostate cancer treatment had taken place no more than two years prior to the study. Half of the couples sought no help for three months. The other half had three face-to-face counseling sessions or worked with an online counselor who gave feedback on the Internet.
A third group of 71 couples who lived too far to participate in face-to-face counseling was part of the Internet group.
Couples were also educated about treatment options for impotence: drugs like Viagra that increase blood flow, shots in the penis, vacuum pumps and surgical penile implants.
Each partner looked over the information on these medical interventions and rated them. The computer generated their top three choices.
Couples compared notes then agreed on a treatment option as a first step. They were also monitored by counselors to see how well it worked and to "troubleshoot," according to Schover.
She said treatments can be a "hassle," especially if both partners are "not motivated to really take the time and put a priority on making sex intimate and fun and communicate about what feels good."
"Just having a hard erection doesn't fix things," said Schover.
After three months, the couples who had received no counseling benefits were assigned one of the two treatment options.
Both partners in the relationship filled out questionnaires assessing their sexual function and satisfaction before counseling, after treatment and at six months and one year later.
At the end of one year, 54 percent found effective treatments for their sexual dysfunction. On average, the group "looked like the score of men in a community who don't have erection problems," said Schover.
Men who were more sexually active before cancer treatments fare better than those who are not. And, not surprisingly, she said, men with younger partners or newer relationships also have more success in returning to full sexual function.
She said that many men who initially try erectile dysfunction drugs like Viagra find that they don't work.
"It's not strong enough for those with severe problems," she said. "Most men just stop there and blame themselves and are not given adequate education."
Ginyard said his doctor informed him about treatments for potential impotence, but he wasn't listening.
"Quite frankly, I didn't even think about the side effects ever," he said. "Once they said I had cancer, I said, 'Get it out of me.'"
But later, it was devastating.
"Initially, my wife didn't know how to comfort me because it's a journey and only one person is actually going through it," he said. "The other, the spouse, is there to cheer you on."
But the couple had a breakthrough when Ginyard was going to daily radiation and had what he called his "female moment."
"Do you know what I am going through?" he asked his wife.
The couple had "the conversation we hadn't had in years," according to Ginyard.
As emotional intimacy grew -- and with the help of the erectile dysfunction drug Cialis -- the couple gradually was able to resume full sexual intercourse.
But the interpersonal relationship they developed was key, he said.
"In the evening we just started to reconnect again: 'How was your day?'" said Ginyard. "And it opened up so much dialogue that cancer and the sexual piece took a back seat. And when we did engage, it's been like a new and better love and appreciation for each other."
Today, Ginyard counsels other men through the advocacy group Zero: The Project to End Prostate Cancer, which he now says is his "calling."
Ginyard, who invented a women's tote bag, now donates some of the profits of his company, Shusokumb, to Zero.
"I wish that there had been something else to get my attention in life," he said. "But cancer was a wake-up call, and instead of the end, it has been the beginning of life."
As for his sex life, "Oh my God, it's improved," said Ginyard, who credits his age, exercise and a renewed relationship with his wife.
"My sexual life has come back," he said. "Full steam ahead."