‘Why I cut off my testicles’

Eugene Douglas braved a surgery that many Kenyan men would not do. He cut off his testicles to save his life.

‘‘It is like someone cutting off your manhood, then you become sexually inactive. But my wife said it is better to have half of me than none of me,’’ says Mr Douglas, an American who has lived in Kenya for 41 years.

The 75-year-old was diagnosed with prostate cancer by chance. For about 25 years, he had never missed an annual prostate-specific antigen (PSA) test, used to screen for cancer.

In 2014, he did the routine test in a “reputable” clinic in upmarket Nairobi. His PSA reading was 10.9. Most doctors consider PSA levels of 5.0ng/mL and lower as normal.

‘‘I had travelled and when I came back it slipped my mind. I know it is my fault not to have gone back for the results, but someone at the clinic should have tracked me down to immediately see a urologist,’’ he says.

A year later, Mr Douglas started experiencing severe backaches. A doctor gave him painkillers but they did not help much. An MRI scan showed that he had seven tumours in his spine and pelvis.

‘‘Two tumours were in my neck vertebrae, four in the middle of the spine and one in the tailbone. The doctor had to find the source of the cancer.

A PSA test showed that the levels had risen to 99 and I was told I had prostate cancer which had spread to the spine. I was immediately given drugs and the PSA levels dropped to 55 in a day. The doctor also told me that what drives the spread of the cancer is testosterone,’’ he says.

His family agreed that orchiectomy — a surgery where testicles are removed — was the best treatment. Mr Douglas also did 20 sessions of radiotherapy treatment.

‘‘The doctor told me he was shutting down the factory that was fuelling the spread of cancer through castration,’’ he says.

Castration is tough on many Kenyan men with prostate cancer. Some opt for radiotherapy and hormonal treatment for fear of losing sexual function which to most people is similar to lose of one’s identity.

Prostate cancer is one of the top killers of Kenyan men, according to Health ministry estimates, but survival rates are also rising due to better treatments and health insurance.

But after surviving cancer, what next? Sexual dysfunction after treatment of cancers of the reproductive system in both men and women, — from vaginal dryness to shrinkage, impotence and how to deal with intimacy with a partner — are topics that are rarely discussed. Besides removal of reproductive organs, radiotherapy also affects sexual function. For men with testicular and prostate cancers, the treatment may cause impotence and urine leaks during ejaculation which leads to sexual frustration.

Tabitha Ng’ang’a, 49, a cervical cancer survivor whose diseased womb was removed, says sex has become like torture.

‘‘I have no womb so I experience vaginal dryness and have to survive on those gels (lube). If a husband is not patient, he will leave you,’’ says the mother of two.

Survivors of ovarian cancer also experience sexual dysfunction after ovary removal. Some of these women cannot achieve orgasm and experience loss or decreased desire.

Irene Hara, a counsellor at Faraja Cancer Support Trust, says many Kenyans shy away from talking about reproductive organs and sex. ‘‘This is one of the reasons there are low levels of awareness about cancers that affect nether regions. Wives don’t know how to talk to their husbands about diseases that affect their private parts. Men shy away too,’’ she says.

‘‘How are we going to demystify sexuality and cancer? How does a mother tell her son that she has a disease that has affected her private parts?’’

Dr Ahmed Komen, a clinical oncologist at Aga Khan University Hospital, says sexual health is still pretty low on the list of topics discussed during cancer treatment, yet more young women of child-bearing age are getting cancer of the cervix and young men diagnosed with testicular and prostate cancer.

Treatments such as castration are also shunned in Africa. Mr Douglas, together with the other prostate cancer survivors, want to see if Kenyan men can come around to accepting castration by creating awareness and if the surgery can be done in village health care centres.

Orchiectomy costs between Sh300,000 and Sh450,000 in private hospitals.

‘‘Another tough call for men is doing an annual rectal exam to test for cancer,’’ Mr Douglas says.

Even after treatment, the former athlete remains active, walks for an hour, three to four times a week and does daily body stretches and has drastically changed his diet.

‘‘When I went back to the US, I saw an oncologist who told me the treatment that I got in Kenya was first-class. My PSA had dropped to 0.002, almost off the charts. Her only message to me was to change my diet,’’ he says.

He cut off sugar, honey, pork, chicken, dairy products and beef from his diet and occasionally takes almond milk.

‘‘Over my life I have had T-bone steaks, cheese burgers and nyama choma but now I eat lots of vegetables, beans and lentils, no saturated fats, I use canola or olive oil. I take at least five cups of green tea a day, boiled eggs, tuna, sardines and rye bread,’’ he says, adding that he also takes turmeric, Artemisia supplements and a maitake — a Japanese mushroom.