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Emily Jamea, Ph.D., is a sex therapist, renowned author and special speaker. You can also find her here and share her latest opinions on sex.
September is Sexual Health Awareness Month.
When your partner develops prostate cancer, the conversation understandably focuses on survival, but once that is achieved, another challenge often begins: regaining sexual intimacy.
Prostate cancer treatment can have a significant impact on sexuality. Depending on the type of treatment, men may experience erectile dysfunction, decreased libido, changes in orgasm, loss of ejaculation, changes in penile length and sensation, and loss of urine during sexual activity. These changes are physical in nature, but often have significant emotional and relational impacts. Sexual recovery from prostate cancer often requires more than just restoring erections. It requires a rethinking of intimacy.
A while ago I worked with a couple, Nolan and Jenna, who consulted me after Nolan’s prostate cancer treatment. Before the cancer they had a satisfactory sex life, but after the treatment everything felt different. Although he was no longer cancer-free, he was having difficulty getting and maintaining an erection and simply didn’t have the same libido as before.
Jenna assumed he didn’t make the first move because he was embarrassed about what was happening to his erections. But something else happened. He still loved her and found her attractive, but the inner sex drive he always had before was no longer the same.
On an intellectual level, she understood her situation. She knew a lot had happened to him. But on an emotional level, she couldn’t stop it from affecting her self-esteem. When they tried to have sex, every moment felt like a test. Will he get an erection? How long will the erection last? Will sexual intercourse be successful this time? Will it be something he really wants once they start? He monitored his body instead of experiencing pleasure. She watched his reactions to see if he still wanted her. Neither of them could relax enough to enjoy what was really happening between them.
Additionally, he was obsessed with the preparation required for an erection. Erection rehabilitation is an important part of recovery, and Nolan has tried everything, including Tadalafil, vacuum pumps and injections. He had a consultation for a penile implant. While I was able to achieve a partial erection, I didn’t have enough sustained hardness to have penetrative sex for long periods of time. I felt that medical treatment was only part of sexual rehabilitation. I knew I needed guidance in dealing with the psychological component and support in dealing with this new sexual situation. While Nolan and Jenna were willing to give Nolan an implant, he wanted to consider all options before undergoing further surgery.
I explained to them that sex can feel like a chore when an erection becomes the goal of every intimate encounter. And tasks are almost always the enemy of fun. Then my therapeutic knowledge becomes relevant.
We tend to approach heterosexual intercourse according to a predictable script: desire causes arousal, arousal causes erections, an erection can lead to penetration, and penetration causes orgasm. Prostate cancer can alter virtually every step in this sequence. The mistake is assuming that your sex life will end when that old script stops working. That’s not the case.
Read: Prostate cancer taught my husband and me what intimacy really is >>
One of the most important things I help differentiate post-prostate cancer couples is the difference between erections and intimacy, and between penetration and sex.
Pleasure can include kissing, touching, massage, oral sex, mutual stimulation, vibrators, and other types of erotic play. Male orgasm can be achieved without a completely rigid erection. Couples can discover ways of pleasure they probably wouldn’t have thought of when sex was easy and predictable.
It’s not about pretending that the loss of a familiar sexual experience doesn’t matter. Actual grief may occur, accompanied by changes in sexual function and libido. It hurts men to no longer have the spontaneity they had before. Your partners may miss feeling wanted. Both people may miss the ease with which they had sex. Acknowledge that loss is part of the healing process.
I reminded Jenna and Nolan that grieving your old sex life and being curious about your new sex life can happen at the same time. I invited her not to think about sex for a while. Instead, I encouraged her to spend time touching herself without trying to produce an erection or orgasm. They agreed that either of them could initiate an intimate experience and that it was not Nolan’s responsibility to have sexual desire or an erection. It was easy to notice: Does this feel good? Do I want more?
It seemed strange to both of them at first. They were so used to assessing whether their bodies were “functioning” that simply experiencing the sensations was almost illogical. But after a while they felt a change. Physical contact became a pleasure again and no longer for diagnostic purposes. Nolan stopped monitoring his erections. Jenna stopped using his erections (or his sexual advances) as the primary measure of how much he wanted her. They started laughing more and experimenting more. Most importantly, they felt like lovers again and no longer like patients and caregivers.
It is important to note that sexual recovery after prostate cancer is not just for the patient who has cancer. Their partners often have their own fears and losses. Some worry about the pressure that trying to have sex might cause. Others are afraid of hurting their partner. Some have lower libido due to their role as caregivers.
I encouraged Nolan and Jenna to talk about what they missed, what scared them, and what still felt good. I worked with them to determine what type of physical contact felt pleasurable or erotic and whether they wanted one, the other, or both.
Cancer can cause the body to begin to view itself exclusively from a clinical perspective. Suddenly, a body part associated with sexuality and pleasure becomes the center of tests, procedures, medications, and fear. Restoring sexuality can therefore be something very emotional. It’s like saying, “My body can still feel joy” and reminding couples that we are more than what happened to us.
Sometimes the gender that emerges after cancer is different than the gender that existed before. It may require more planning and the result will be more flexibility. Erections may occur that suddenly stop. Medication or devices could become part of this experience. Pleasure could take on new forms. But just because something is different doesn’t mean it’s worse.
Nolan and Jenna were eventually able to have sex again, but at that point it wasn’t any more of a big deal than before. They developed a much broader sexual repertoire and a new understanding of sexual desire. Most importantly, they stopped using Nolan’s libido and erections as a gauge of their relationship status.
Sexual healing from prostate cancer is usually not about restoring the sex life you once had. It’s about discovering that desire, intimacy, pleasure and erotic connection look and feel different and in many ways could even be better.
This educational resource was created with support from Bayer.
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