Emily Jamea, Ph.D., is a sex therapist, bestselling author, and keynote speaker. You can also find her here sharing her latest thoughts on sex.
When your partner is facing prostate cancer, the conversation understandably turns to survival, but often getting to the other side begins another challenge – restoring sexual intimacy.
Prostate cancer treatment can have a profound impact on sexuality. Depending on the type of treatment, men may experience erectile dysfunction, decreased sexual desire, changes in orgasm, loss of ejaculation, changes in penile sensation or length, and loss of urine during sexual activity. These changes are physical in nature, but often have major emotional and relational impacts. Sexual recovery from prostate cancer often requires more than just restoring erections. It requires a redefinition of intimacy.
I once worked with a couple – Nolan and Jenna – who came to me after Nolan was treated for prostate cancer. Before the cancer they had a satisfactory sex life, but after the treatment everything felt different. Even though he was cancer-free, he had difficulty getting and maintaining an erection and simply didn’t feel the desire for sex like he did before.
Jenna assumed he hadn’t started because he was embarrassed by his erections. But it was more than that for him. He still loved her and found her attractive, but the inner sexual attraction that he had always taken for granted just wasn’t there anymore.
On an intellectual level, she could empathize with his experience. She knew he had been through a lot. But on an emotional level, she couldn’t help but take things personally. When they tried to have sex, every encounter felt like a test. Would he get hard? Would the erection last? Would intercourse work this time? Would he actually want it once they started? He monitored his body instead of finding pleasure in it. She watched his reaction for signs that he still desired her. Neither could relax enough to enjoy what was actually happening between them.
Furthermore, he was obsessed with the preparation required for an erection. Erection rehabilitation is an important part of recovery, and Nolan had done it all – Tadalafil, vacuum pumps and injections. He had had a consultation for a penile implant. He could become semi-erect, but couldn’t reliably get hard enough to have penetrative intercourse for very long. He suspected that medical treatment was only part of sexual rehabilitation. He knew he needed guidance in dealing with the psychological component and help navigating a new sexual landscape. While both Nolan and Jenna were willing to give Nolan an implant, he wanted to meet all the criteria before undergoing further surgery.
I explained that sex can feel like a performance when an erection becomes the goal of every intimate encounter. And performance is almost always the enemy of pleasure. As a therapist, this is where I come into play.
We tend to organize heterosexual sex according to a predictable script: desire leads to arousal, arousal leads to erection, erection leads to penetration, and penetration leads to orgasm. Prostate cancer can disrupt virtually any step in this sequence. The mistake is assuming that sex itself is over when the old script no longer works. That’s not it.
Read: Prostate cancer taught my husband and me what real intimacy is >>
One of the most important distinctions I help couples make after prostate cancer is separating erection from intimacy and penetration from sex.
Pleasure can include kissing, touching, massage, oral sex, mutual stimulation, vibrators, and other forms of erotic play. For men, orgasm can be possible even without a completely rigid erection. Couples can also discover forms of pleasure that they rarely explored when intercourse was easy and predictable.
It’s not about pretending that the loss of an intimate sexual experience doesn’t matter. Real grief can be associated with changes in both sexual function and desire. Men may mourn the spontaneity they once had. Partners may miss the feeling of being pursued. Both people may miss the effortless way sex used to be. Giving space to this loss is part of healing.
I reminded Jenna and Nolan that mourning your old sex life and becoming curious about a new one can happen at the same time. I encouraged her to temporarily refrain from sexual intercourse. Instead, I encouraged them to spend time touching each other without trying to produce an erection or reach orgasm. They agreed that any partner could initiate an intimate experience and that Nolan’s job was not to induce desire or an erection. It was just a matter of noticing: Does this feel good? Do I want more?
This felt strange to both of them at first. They had become so used to judging whether his body was “functioning” that simply experiencing sensations seemed almost pointless. But over time they felt a change. Touch became a pleasure again and no longer a diagnosis. Nolan stopped monitoring his erection. Jenna stopped using his erection (or his initiation) as the primary measure of whether he desired her. They laughed more. They experimented. Most importantly, they felt like lovers again rather than patients and caregivers.
It’s important to note that sexual recovery from prostate cancer is not just about the person who had cancer. Partners often carry their own fears and losses. Some fear that starting intercourse creates pressure. Others are afraid of hurting their partner. Some experience reduced desire themselves after taking on a caregiving role.
I encouraged both 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 touch felt soothing or erotic and whether they wanted one, the other, or both.
Cancer has a way of making the body feel like it is being treated medically. Suddenly, a body part associated with sexuality and pleasure becomes the focus of examinations, procedures, medication and fear. Reclaiming sexuality can therefore be deeply emotional. It can be a way of saying, “My body is still full of pleasure,” and can remind a couple, “We are more than what happened to us.”
Sometimes the gender that emerges after cancer looks different than the gender before. It may require more planning and flexibility in development. Erections can come and go. Medication or devices can become part of the experience. Pleasure can take on new forms. But different doesn’t necessarily mean worse.
Nolan and Jenna eventually incorporated intercourse into their relationship again, but now it mattered much less whether it happened every time. They had developed a broader sexual repertoire and a new understanding of desire. More importantly, they had stopped using Nolan’s libido and erection as a testament to the health of their relationship.
Sexual healing after prostate cancer is usually not about restoring your old sex life. It’s about discovering that desire, intimacy, pleasure and erotic connection can look and feel different and in many ways better.
This educational resource was created with support from Bayer.
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