By Aline Zoldbrod Ph.D. AASECT Certified Sex Therapist
The words "You have prostate cancer" are a life changing, frightening event for each man affected and for his partner. At first, sexual concerns recede amidst the time and energy consuming tasks of gathering information, having tests, making treatment decisions and perhaps undergoing surgery. The life and death quality of dealing with the cancer diagnosis often brings out the best in a partnership, with many partners voicing the mantra, "All I want is to have him around for another 30 years, and I don't care about any sexual consequences." A whole year of life may be spent undergoing tests, researching options and treatments, undergoing treatment and the recovery process.
In many cases, discovering the effect of treatment on sexual functioning is a waiting game. It can take up to a year post-surgery to know whether enough nerves have been spared for erections to remain intact. Treatment options depend on the stage, location and type of tumor. Some men go into treatment knowing that erectile dysfunction afterwards is inevitable. It is important to be well prepared for some of the consequences of treatment because surprises are terrible. Ironically, though, in an existential sense, there is no real way to be prepared. In the midst of the chaos, hearing that sexual dysfunction may occur does not even register for the patient, so powerful is the fear of the unknown, illness, hospitals, doctors, side effects or even death.
However, after the initial crisis of diagnosis and treatment is completed, and months and months have passed, any negative side effects of treatment have been ironed out, and the acute medical drama is over. You have survived. Although worry about recurrence is a thought that you have to deal with, life is starting to return to normal. You may even begin seeking out sex advice.
In my experience, men with prostate cancer often are remarkably resilient. Feeling normal is important. It stands for feeling in control. Being able to maintain your sexual relationship with your partner enhances your feelings of connectedness, emotional intimacy and being loved, and the touch involved in being sexual is wonderful for your immune system. Sexuality can be a major component in fighting off depression and in staying physically and emotionally healthy. As soon as you want to resume your sexual relationship, your urologist should be willing to guide you, exploring which drugs, treatments or devices might help you maintain your ability to have erections. If your surgeon is someone who is not interested in working closely with you on your post-surgery sexual functioning, find a urologist who can help you with this stage of your recovery. It may be that even with the best treatment and medical follow up, your sexual functioning has been altered. Now the physician's earlier words about "changed sexual functioning" can be seen on the radar screen of your mind. Now you see that you are still alive, all your medical decisions have been made and what is left is to live with them.
The Man's Inevitable Fears About Sexual Performance
As the life and death fears recede, most men become very concerned with their ability to resume normal sexual relations, (ie. penis in vagina intercourse). Of course, you should pursue all the medical treatments available to help you maintain your erectile capacities. If you find that you are having no luck in finding a pill, injection or procedure which gives you an adequate erection, you can still continue to have a sexual relationship with your partner. The key is to expand your communication and broaden your definition of what is pleasurable.
When I say that maintaining your sexuality is key to staying physically and emotionally healthy, I am not referring to what you might be thinking is the only kind of normal, acceptable sex—penis in vagina intercourse.
Human sexuality is multifaceted and many layered. Women can have pleasure without orgasms. Men can have orgasms and ejaculations without erections. All of us have erogenous zones on our bodies which we have neglected to explore. Learning to tango, or going to a romantic dinner and a movie, and then lying naked together touching each other can be a wonderful sexual experience. Talking about sexual fantasies, or past times of great sex together can be erotic. The connection, the touching, and the experience of trusting another with pleasuring your body are what creates the powerful healing and bonding effects of sexuality. This is a good time to expand your ideas about what is possible and what is pleasureable.
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