For the past 3 years I have been planning to lead a group of able bodied and adaptive cyclists on an incredible trek across Southern Africa. Now in the final days before the trip starts, I am focusing on lists. What will I need to bring, what do I need to do before I am ready to start riding 3,000 kilometers across 5 countries.
In the years since I lost the ability to walk, I have learned that rules about privacy and discretion around what we would otherwise consider personal, get tossed out of the window. There are so many complications associated with spinal chord injuries or the host of neurological diseases that cause one to to be categorized as lame, para- or quadra-plegic, cripple. Is sexual intimacy possible, how do we take care of bathing and toilet needs. Looking back, I realized that all these difficult questions are answered at two distinct points in our lives. The first is when we are toiled trained. The second is when we learn about sexuality in our adolescence and early adulthood.
Disabilities acquired later in life, require learning these things all over again.
I have been training on a handcycle and preparing for a trek crossing Southern Africa from Namibia to Mozambique as part of a group of adaptive and able bodied cyclists. It is now less than 30 days until I leave for Namibia and I am busy putting together my checklists for what I need to bring in terms of clothing, gear, spare parts, tools and equipment. Most of my list is the same as it is for my able bodied cyclist colleagues, spare cables, spokes and chain, hydraulic fluid to bleed my disc brakes, vaccinations, first aid kit, travel insurance…. Going through my list, I realized that there are also items only the disabled cyclist list: checking for sores, catheters, ramps for wheelchairs, shower and toilet chairs, catheters, circumcision. Circumcision?!
Like many paraplegics, I suffer from urinary incontenence. The handbiike further complicates things because it is very difficult to extract myself from my bike, transfer to a wheelchair, and find a place to pee, all before my bladder just opens its flood gates.
Pissing oneself, except for the very young and those with golden shower fetishes,…is not fun. Doing so on a daily let alone multiple times per day basis, is less fun. Doing so for almost 50 days in a row, is not only not fun, it is a sure way to get a range of crotch infection, making a transcontinental cycling event, a painful nightmare.
Currently I use what is called an intermittant catheter. An intermittent catheter, requires passing a narrow tube, down the shaft of the penis and into the bladder. My experience with intermittent catherters is that I need to stop and cath, every 90 minutes or so. That is a lot of stops and a lot of opportunities to introduce infection.
Hours of internet research, taught me that there are alternatives. These are Foley or in-dwelling catheters. These work by fixing a semi-permanent tube either up the urethra or through the belly button and into the bladder. This did not seem desirable to me for a lot of reasons.
The other alternative, seeming much more desirable is what is called a condom catheter. No tubes need to be inserted up ones urethra. The instructions seem simple, roll the condom on, attacahing the other end to a drain hose. The hose can be attached to a collection bag or drain directly on to the ground.Sounded perfect.
So I ordered a sample pack of condom catheters and with great anticipation, I awaited their arrival. Several days later, with a level of excitement that reminded me of the first time I practiced with a pack of Trojans in anticipation of an event that did not occur for several years. But at least I was ready.
As soon as I opened the packet and removed the condom, I realized why all the condom instructions and tasteful, and less so, videos all instruct one to begin with an erect penis. The instructions for applying a condom catheter were deafeningly silent on the erection thing.
I am of an age where I can recall shortly after HIV/AIDS was discovered to be sexually transmitted, that there were lots of community workshops teaching just how to use a condom. These workshops tended to go through an awful lot of almost ripe bananas. I don’t think that I need to go into detail. The process is actually pretty easy, especially with erections and or unripe bananas.
Putting a condom on a completely flaccid penis however is a totally different matter. The closest parallel would require a significantly over ripe banana. Now remove the peel. You should have something in your hand, remotely phallic in shape but pretty mushy. Now gently unroll the condom over the mushy banana. I did not have to keep trying to know that success, was a lot of bananas away.
Shrinkage and retraction.
But somehow, I did manage to get the condom on—eventually. I attached the tube and the collection bag and with a sense of accomplishment, drank a liter of water to test this thing.
Thirty minutes or so later, I sensed the warm stream of failure running down my thigh. WTF?
There is an episode from the’90s sitcom, Seinfeld, where George and Seinfeld, are discussing the ‘shrinkage’ problem and the misunderstandings that might arise if one is observed by a potential intimate partner during ‘shrinkage’. In my own experience, coldwater and stress are big shrinkage drivers. A brief investigation confirmed that my penis had just shrunk itself out of the condom, moments before my bladder opened up.
But that was only part of the problem. Exacerbating the withdrawal from shrinkage problem, was the retraction problem. So I took a break from putting together my list of spare parts and tools I would need for a trans Africa trek, and started reading. One of the first things I realized is that most of the condom catheter websites were completely equivocal on the issue of foreskin. A few sites did offer slightly different advice for how to roll on a condom catheter if one were uncircumcised. This was potentially useful information because I was.
Several attempts later, yielded the same results. My penis, shrunken from the total absence of the slightest erotic thought, did what foreskins were meant to do, it retracted, right out of the condom. If you are a man in similar circumstances, or a close friend of someone who is, hear this, all the webpages and listserves that say that it does not matter if you have a foreskin when it comes to using a condom catheter, are lying. It does.
I was back to square one. More research confirmed what my urologist acknowledged. If I wanted an alternative to using 4-5 intermittent catheters daily, I had two options. Either run a tube through my belly button to my bladder, draining into a semi permanent bag, or….Get circumcised.
So three weeks ago, I took a little time off from my training schedule and went in to get circumcised. The surgical team was professional. There were no shrinkage or retraction jokes and in a few hours my friend Joey drove me home. Removing the bandages and seeing my penis completely covered with stitches, I wondered if Mary Shelley’s Dr. Frankenstein paid as much attention to the little things. Remember, shrinkage.
Healing is taking longer than I had hoped, but I was able to get back on my bike the following day. It will take another week before I can try the condom catheter but I am optimistic.
At least now, I can get back to my checklist for my transAfrica trek.
Tent, check;
Sleeping pad, check;
Sleeping bag, check
Extra tubes & tires, check
Hydraulic fluid to bleed disc brakes, check
Spare bike chain, check
Extra spokes check.
Circumcision, Check
Condom catheters, check.