Sex is important. Without reproduction we would eventually cease to exist. The survival of the human race depends on sex. This means that biologically as adults we are all at some level sexual beings, even if we are not in a sexual relationship. As thinking beings though (with large brains) there is for all of us a more complicated social side to sex.
How prostate cancer affects sex
The prostate gland sits snugly around the base of the bladder and so is right in the middle of the nerves and blood supply needed for an erection. This means that surgery and radiation therapy for prostate cancer can have a direct effect on a man’s ability to get or maintain an erection. There are plenty of easy to find booklets and web pages that outline exactly how and why this happens, but this is the nub of it. A man might find after treatment that he is unable to get or keep a hard erection, or that his erections are unreliable. This can be devastating.
If a man has radiation therapy for a time orgasms might be painful and for all men who have had treatment, the amount of ejaculate will lessen or after surgery to remove the prostate be completely dry. If a man is on hormone blocking treatment, he will find his desire for sex reduces as well as his erections, making it even more difficult to keep an active, pleasurable sex life.
It is important to be clear about this: these are physical treatment effects. They are not ‘in your head’ and to solve them, you will probably need to use medical treatments. There are a range of pills, medicines that can be injected into the penis, sexual aids like vacuum pumps, and even surgery to put a penile implant (pump system) inside a man’s body. The main point is that this is something that will require medical help. As well, many doctors now advise that getting the blood flow back to the penis early in recovery is important for long term erectile function. So thinking about this sooner rather than later is a good idea.
There is a psychological side as well though. The worry of a cancer diagnosis itself can reduce sexual interest, just as you might have found when other tough things have happened in your life. Many men report feeling that if they can’t get an erection they are not sexually interesting or capable and that this stops them from even thinking sexy thoughts.
Finally, sex after prostate cancer needs more planning, understanding, and communication within a couple, as well as medical help. If lovemaking doesn’t work so well in the early days some couples find they feel less inclined to persist in trying and they just give up.
This is really up to you. Some couples do say that they had become less interested in sex before the cancer anyway and that they have talked it over now and decided it was time to give away having sex. For these couples, physical closeness, affection and comfort stays an important part of their lives with cuddling, kissing and lots of hugs becoming their main way of keeping physically close and connected.
For other couples, keeping an active sex life matters. If you want to stay sexually active, or you can see that your partner is frustrated about sex, there is lots you can do. The key things are to talk about it, be informed, be patient with each other, flexible in your approach and open to new things — and to start early. The sooner you get to work on this the more likely you will be to succeed.’
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How do we get started?
When all this is going on it is easy for a couple to have misunderstandings about sex. A man who is worried about whether he can perform sexually might become withdrawn and stop initiating sex. His partner however might see this as rejection and feel hurt and frustrated.
Talking honestly with each other about how sex and love making has changed for you both, and how you would each like sex to be is the first step.
The next step is to be informed about the physical effects of prostate cancer treatments and what treatments and aids are available to help you with these effects. Your doctor will have advice and be able to guide you about what treatments might work best for you and may also refer you to a doctor who specialises in sexual health.
Sex is a mutual activity, so if you are in a relationship you need to work on this as a couple. This means at the outset talking with each other about the options you have and working out which might suit you both best. In the previous chapter I talked about ways to make informed decisions about treatment, and these strategies can be applied here as well. In brief, this means be clear about and list your options, work out the pros and cons, weigh up what you think suits you both best, work closely with your doctor on the plan, and be ready to change the plan as needed. Too many men try a treatment for a sexual problem but give up when it does not restore them right away to their memories of being age twenty. You and your partner may need to try several different treatments before you find one that satisfies you both.
This does not mean though that you should turn having sex into work. When you do put the plan in place make sure to also do the fun romantic things to add a little zing. It does not have to mean a second honeymoon. Just putting a high priority on time for talking, maybe a nice dinner, dancing in the dark to romantic music, or watching a sexy movie, and above all plenty of time and privacy.
Be aware that being anxious about having sex after prostate cancer is normal, but may not be helpful. Taking time to keep physical closeness a part of your life without feeling pressured about sexual performance is crucial. Remember that sex does not have to include penetration. Many couples find other ways to give each other sexual pleasure that is both satisfying and helps them keep a feeling of being physically close and intimate.
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Personal story – Ian
I underwent a robotic prostatectomy in May 2009. I went through the usual urinary leakage (more like a flood at times) which gradually decreased. After six months I began to feel like having sex again, however I could not get much of an erection and certainly could not maintain it for long when I did manage to have a partial one. I tried Viagra and other pills, and a vacuum pump which didn’t help. I looked at penile injections but decided I didn’t want to go sticking those in my penis (it had had enough I thought).
As time went on with no improvement I became very angry and morose. I had been through all this just to face impotency. My relationship with my wife deteriorated and my work suffered. Approximately nine months after the operation, I went to see my urologist for a check up and asked him about an implanted pump. His reaction was that there was no need. All I really needed were the injections and that they weren’t the issue I had built them up to be. He gave me a referral to a men’s health doctor. I think I made the appointment as I was walking out his door.
My first encounter with this men’s health doctor was a revelation and a riot. He spent some time explaining the process in detail and then he showed me how to inject myself. We started with a dosage just under the maximum. There it was — a thing of beauty and a joy forever (well the forever part was right). After I had gloried in the sensation for some time he convinced me that I should inject the antidote. I then left his office (both hands in my pockets) and went back to my own office. The doctor had given me tablets to take if the erection did not go away. It didn’t, so I took the tablets and then remembered that I had a meeting scheduled with two women. It was too late to cancel!
With a strategically placed manila folder I entered the meeting room, quickly sat down and made sure that my errant and rampant erection was securely out of sight under the table. At the end of the meeting (still rampant) I then had to juggle shaking hands, saying goodbye and the manila folder. I then made a beeline to my office and phoned the doctor. I returned to his office (both hands in my pockets) and he gave me another injection of antidote.
After that I experimented with lower and lower dosage levels until I had worked out what was the best for a comfortable erection that went away after a reasonable time. My sex life and my attitude improved exponentially.
Over three years from the original operation I still use small doses of the serum for a fantastic result. If I had had the courage to bring the subject up directly with my urologist and started the injections earlier I would not have gone through so much mental turmoil and my life would have returned to normal much more quickly. My advice, don’t put it off!
The information in this article is an abridged excerpt of chapter six of Facing the Tiger: A Guide for Men with Prostate Cancer and the People Who Love Them by Suzanne Chambers. If you think you, or someone you know, could benefit from the warm and clear information found in this book, which looks at all aspects of prostate cancer, you can purchase it at the AAPBooks website as well as ordering it from your local bookstore.