Another First Time

Survivorship Intimacy

Hi (No) Wonder-ers,

In March 2013, on my 29 ½ birthday, I had a heart attack when my Left Anterior Descending (LAD) coronary artery became 95% blocked. Some of my readers are friends and former co-residents who, having trained with me, remember this vividly. 

When you have a heart attack in your 20s, people ask you all kinds of interesting questions like “Have used any crack cocaine lately?” and “Are you SURE you haven’t used any crack cocaine lately?” 

Fortunately for me, for my wife, and for my yet-to-be-born daughter, the excellent interventional cardiology team at my residency alma mater (Stony Brook Medicine, Stony Brook, NY) promptly placed a stent across the blocked LAD to re-establish blood flow to my heart. So if you’re happy to see me or my content, thank Stony Brook… and if you don’t like me or my content, it’s Stony Brook’s fault.

My coronary stent is now 12 years old – almost a teenager. I get reflective this time of year because it commemorates that time my life could have gone very differently (i.e., ended). If my latest stress test a few months ago is to be believed, there was no lasting damage to my heart muscle. So I’ve got that going for me, which is nice. 

One of the main takeaways from this or any medical event is that our bodies are always changing. All it takes is one acute accident, injury, medical event, life event, or complication to change everything – including intimacy – forever. 

Such events will often have implications on intimacy. Just ask anyone who’s had their prostate surgically removed or radiated for prostate cancer, or sustained a spinal cord injury, or developed sequelae from any number of neurological conditions (e.g., MS, ALS). One day you think you know your body, and you think you know what feels intimately good and pleasurable to you… then you are suddenly a stranger in your own body, and you’re having to re-learn how to do everything from taking care of yourself to getting yourself off. 

Saying nothing of the fact that cataclysmic health events can also challenge the equilibrium of entire relationships. It’s not uncommon for well partners to leave relationships once the going gets rough and/or inconvenient. Statistics show that men are over six times more likely to leave when female partners get ill, than for the reverse to be true.

Gender disparity in the rate of partner abandonment in patients with serious medical illness - PubMed

Female gender was found to be a strong predictor of partner abandonment in patients with serious medical illness. When divorce or separation occurred, quality of care and quality of life were adversely affected.

PubMedMichael J Glantz

The men who leave their spouses when they have a life-threatening illness

When relationships are hit by serious illness, it can bring existing gender inequalities shockingly to the surface

The GuardianPoppy Noor

(C’mon men. Let’s do better and step up. Let’s at least TRY not to suck.)

Anyway, having a cataclysmic health and/or life event is awful. It’s tragically unfair. It’s not your fault, yet it’s still your responsibility. I hate this for you.

However. I cordially invite everyone to think back to their first enthusiastically consensual sexual experiences: the titillating sensation felt when certain body parts are touched for the first time, the similarly titillating sensation touching another’s erogenous zones for the first time, mixture of pleasure and excitement (and, if you were raised Catholic, shameful guilt) you felt seeing a partner naked for the first time, the racing heart rate, the butterflies in your stomach, the wetness you felt down there, that tight bulge in your now-too-small pants, the erotic emotion of wanting and being wanted, the release your felt with your first orgasm, the satisfying relief after that… the list goes on. 

Have you ever seen someone reading your favorite book, or listening to your favorite album, or watching your favorite movie, and felt envious that they get to experience it for the first time? Our ever-changing bodies, with each change, offer us an opportunity for “another first time” each time. With some cognitive reframing, we can think of survivorship sex as an opportunity to rediscover sex for the first time in the most recent version of our body.

When our bodies change significantly, we can have an opportunity to experience sex for another first time. 

Now I know what some of y’all are thinking. “Grr, Dr. DeBartolo… you’re just putting lipstick on a pig! You’re pissing on my leg and telling me it’s raining! You’re denying reality! You suck!” This all may be so, and cognitive reframing won’t undo the anatomic and physiologic damage that Father Time unfairly wrought upon your body. Nor will cognitive reframing make it fair or right that it happened. But neither will dwelling upon how unfair and shitty it is that you no longer get to reliably enjoy the intimacy you did before you survived the cataclysmic life event that Father Time dealt you. Sure, urology and sexual health teams will do our due diligence to help restore whatever prior sexual function we can… but in many cases, what’s done is done and our ability to restore prior function is limited.  

Thus, we have nothing to lose by approaching post-survivorship intimacy as another first time – with all its exploration, uncertainty, awkwardness, trial-and-error, and potential. We don’t get a choice as to what limitations our body places upon our intimacy, but we do have some say in how we approach and incorporate these limitations into our intimacy going forward.

Who knows, maybe even this mindset might encourage some men to stick around for a while instead of bolting at the first sign of minor inconvenience.

Onward and upward,

Merrit