When RoseMary’s* husband was diagnosed with prostate cancer 22 years ago, the couple faced great uncertainty and knew the diagnosis could change their lives.
What they couldn’t fully predict was how much the treatment would change their sex lives or how they would ultimately learn to redefine intimacy together.
Her husband first went to the doctor because he was urinating more frequently. The tests ultimately led to a biopsy and a diagnosis of prostate cancer.
After considering his treatment options, he opted for surgery – a complete removal of his prostate. RoseMary said they began the procedure knowing there was a possibility of side effects such as urinary incontinence and erectile dysfunction.
Her husband experienced both.
More than two decades later, he still suffers from urinary incontinence and his erectile function has never returned. But he remains cancer-free and has no regrets about his decision.
“The dignity and grace of this man, despite everything he’s been through,” she said. “This is a Marine who has never once complained.”
For RoseMary, however, partnering with someone who had prostate cancer meant realizing that surviving cancer is only part of the story. Couples may also need to figure out what comes next, including how to deal with changes in sex, intimacy, and their relationship.
Prostate cancer treatment can impact sexual health
According to Nazanin Moali, Ph.D., a clinical psychologist and sex therapist who has worked in the field for 15 years, sexual changes following prostate cancer treatment are relatively common. Depending on the person and the treatment, be it surgery, chemotherapy, or hormone therapy, changes may include erectile dysfunction, erection unpredictability, loss of libido, changes in desire, and difficulty experiencing orgasm.
Some people may find that the type of stimulation that worked before treatment no longer works afterward.
This may require couples to rethink what sex looks like.
“You can still have a healthy, fulfilling sex life regardless of the outcome,” Moali said.
The key, she explained, is a willingness to talk about what feels good, what has changed and what each partner needs, and to seek professional help from a sex therapist when needed.
There can be grief on both sides
The physical effects of treatment occur in the person with prostate cancer, but the emotional, relational and sexual effects can affect both partners.
Moali said some women and partners she has worked with are enormously grateful that their partner survived cancer, while at the same time grieving the sex life they had before treatment. Others are sexually frustrated but feel guilty admitting it.
There can also be complicated dynamics involved in initiating sex. A man suffering from erectile dysfunction as a result of treatment may feel ashamed or afraid of sexual performance. His partner, on the other hand, may avoid starting intimacy because she doesn’t want to pressure him or make him uncomfortable.
And when a woman has also taken on a caring role, the transition back to being a romantic or sexual partner can be challenging.
These seemingly contradictory emotions — gratitude, sadness, frustration, grief, guilt and desire — can exist at the same time, Moali said. Instead of repressing them, she encourages couples to acknowledge, understand and accept the different levels of emotions, express what they feel, and talk about what sex and intimacy mean to them now.
RoseMary remembers experiencing some of these complexities herself.
Her husband still had sexual desire after the surgery, she said, but erectile dysfunction changed his perspective on his sexual performance. She sensed his frustration and sadness, even if he didn’t always talk about it directly.
“I needed some encouragement from myself,” RoseMary said. “We developed a different way to pair.”
Over time, they learned to communicate differently and became more inventive when it came to intimacy.
Read: Prostate cancer taught my husband and me what real intimacy is >>
Expanding the definition of sex
For RoseMary and her husband, adapting meant placing emphasis on intercourse and finding other ways to give and receive pleasure.
“We got inventive,” she said.
Massage, touching, and other forms of sexual stimulation became a more integral part of their relationship. So something much simpler: kissing.
“I could devour him now,” RoseMary laughed and said of her husband today.
She said they also relied on openness, communication and even humor to find what worked for them.
Moali regularly promotes this flexibility to its customers. She said it was important to engage in “sexual exploration.”
“There are different ways to experience an orgasm,” Moali explained. “Rather than defining sex solely as penetrative intercourse, couples can consider a much broader range of sexual and sensual experiences, including kissing, touching, sensual massage, oral sex, mutual masturbation and sex toys.”
She encourages couples to think about the underlying meaning of sex in their relationship. Is it about pleasure? Do you feel wanted? Connection? Sensuality? Once couples figure out what they actually want from sex, they may find that there are multiple ways to achieve it.
Read: Good Sex with Emily Jamea: Recovering Sexual Intimacy After Prostate Cancer >>
Preparing for changes before treatment
For Samantha Karcher, these questions are still mostly about what might happen.
Her husband was recently diagnosed with prostate cancer after his PSA (prostate-specific antigen test level), which had gradually increased over several years, required further testing and a biopsy.
The couple ultimately decided to undergo surgery, which is expected to take place in October this year. Although her husband has not yet experienced any sexual changes, they have already spoken to his surgeon about the possibility that his sexual functions might be different afterward.
Kartcher admitted she’s nervous.
Her husband has always had a high libido, and although her surgeon gave him some reassurance, there is no guarantee as to exactly how his body will respond to the treatment.
For now, Karcher is trying to support him without letting her own fear add to his.
“I just plan on being there to support him,” she said.
Moali said these pre-treatment conversations can help couples prepare. She encourages patients to ask their doctors about possible sexual side effects and available treatments and resources rather than waiting until a problem arises.
If sexual difficulties arise, couples can also ask for a referral to clinicians who specialize in sexual medicine or sexual health. Sex therapy can help couples deal with communication, desire and intimacy issues, while medical providers can discuss treatment options for physical changes.
Communication is perhaps one of the most important tools
RoseMary wants couples affected by prostate cancer to know that they don’t have to deal with these changes in silence.
She and her husband didn’t seek counseling specifically for his prostate cancer, but looking back, she believes it can be valuable for couples who have difficulty communicating.
Her advice after 22 years is simple: Don’t blame yourself. Don’t blame your partner. And don’t pretend everything is fine when it isn’t.
“Try to be open and honest and true to your needs,” she said.
This may mean saying that you miss sexual intimacy. It may mean asking your partner what feels good now rather than assuming. And it may mean accepting that intimacy after prostate cancer won’t look quite the same as before.
Today, RoseMary says her sex life has changed, but affection and intimacy remain part of her marriage.
After everything they’ve been through, RoseMary doesn’t describe the impact of prostate cancer on their relationship as a hurdle. She prefers another word.
“Change.”
For women whose partners are just beginning this journey, this distinction may be important. A changing sex life doesn’t necessarily mean it’s going away. Through communication, flexibility and support, couples can discover new ways of being close and new definitions of what satisfying intimacy means to them.
*Last name not provided for privacy reasons.
This educational resource was created with support from Bayer.
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