Several readers have posted and emailed me about sex and intimacy after prostate surgery. I asked Anne Katz , RN PhD, author of Breaking the Silence on Cancer and Sexuality: A Handbook for Health Care Providers and sexuality counselor at CancerCare Manitoba in Winnipeg, Manitoba, to respond to a common question:
Ever since my husband had his prostate removed because of prostate cancer, he has been reluctant to touch me. This is so upsetting. I love him very much and don’t know what to do.
It is common for men to be unable to have an erection after this surgery. Depending on the type of surgery (nerve sparing or not), his ability to have erections may or may not return. Many men are deeply distressed by this and may avoid all physical contact with their partner so as not to “lead them on” or disappoint them. This leads to a very unhappy partner who wants to express his/her love and support but feels cut off and cut out.
What is important is for the couple to TALK. It is often really difficult to talk about a sensitive topic when emotions are running high. But talking goes a long way to healing and connecting. Start with an “I” statement: “I miss touching you and being touched by you. How can we reconnect again?” Or perhaps: “I love you so much and want our relationship to be the way it was before the surgery. What can WE do to help this happen?”
While there are medications and treatments that may help, further treatment should be a couple’s decision and the man should always include his partner in medical appointments so that both people can express themselves and have their questions answered. Because communication is so important, the couple may need professional help to start the communication flowing. But seeking help is the first step.
For more posts about cancer and sexuality, please click “cancer” in the “labels” list in the right-hand column.
Is this helpful? Let me know what questions you’d like me to explore as we age and encounter physical and emotional challenges to our sexuality.
Gerald Haslam, author of Grace Period, is living with prostate cancer. He wrote a stunning summary of his views of the importance of sexuality while living with cancer for my upcoming book. I know I have many readers who are looking for information on sexuality and cancer, so I’m giving you an advanced look at some of the insights he shared:
A seventyish man who was recovering from a prostatectomy asked fellow members of a prostate-cancer support group how they could have sex if they were leaking urine. He ended with a timeless observation–“My wife is willing to be pissed off but not pissed on.”
Despite the laughter that followed, his was a serious problem, but the first response solved it: “Put a band on your penis –a cock ring. A lot of older guys who aren’t incontinent use them to maintain erections, but if you’re leaking they’re a good answer, especially if you use a pump.”
The first man was honest enough to admit, “I hadn’t thought of that. We’ve never used any…devices. Of course, I’ve never had prostate cancer before, either.” In fact, the prostate cancer world introduces many guys to devices and positions and concepts previously unimagined.
A physician pal said to me shortly after I was rendered impotent by prostate surgery and radiation, “You’d better start pumping up your penis every day, whether you’re going to use it right away or not, or it’ll shrivel into a Vienna sausage. As soon as you lose spontaneous erections you lose penile tone. No tone, and there’ll be nothing to pump when you do want to use it.”
In fact, sex seems to be the second most common topic–after cancer therapies–in discussions at most prostate cancer support groups, and I learned that many men, rendered impotent and perhaps stripped of libido by hormonal ablation, simply but not happily accepted the verdict that their sex lives were over, a defining activity lost. A dread frequently mentioned to me by my fellow prostate-cancer survivors has been not only the sudden absence of sex but of sexuality itself. This is especially grave since sex and sexuality can represent the life force’s most powerful affirmation in the face of death.
Unfortunately, many of us men grow up believing that our sexuality dwells almost exclusively in our genitals, so a damaged penis may lead to a damaged personality. As one wife admitted at a session for couples, “There’s not much fun in our lives anymore, and I don’t just mean sex. He’s just so sad.” A penile fixation may also lead one to forget how much sexual satisfaction can be achieved by giving pleasure to a partner you love.
Have you ever consulted your doctor about your changing sexual responsiveness or about reclaiming your sexuality when you have a medical condition that makes sex more difficult?
What happened when you asked your doctor for advice about sex? How did he or she respond? Did you get the information you needed? And for the benefit of the medical professionals reading this — how would you have liked your doctor to respond to questions about sex? What advice would you give professionals about how and when to talk to their older patients about their sexuality?
I am planning to write a magazine article about this topic, so please feel free to comment here or email me and let me know if you’d be willing to be interviewed.
As background, I wrote the post that follows in March 2006, and I’d like to revive it now that I have many more readers. I invite your comments.
[post originally dated 3/29/06:]
I’ve been speaking to groups in the midwest and the San Francisco Bay Area, and corresponding with readers who send me emails. Over and over, this comment comes up: older-age sexuality is a huge gap in the education of medical professionals.
I keep meeting doctors, nurses, therapists, and alternative practitioners who are hungry for information for their patients and clients — and often for themselves. One woman’s eyes got teary when she said, “I’ve been so lonely wishing I could talk to someone about this.”
I’ve heard from women who have read my book and ask, “Why didn’t my doctor ever tell me that I have to ‘use it or lose it’?” These are usually older women who are not in relationships right now and didn’t realize the importance of internal massage, regular orgasms, and Kegels to keep their vaginas tuned up and healthy, or penetation in the future might be painful. (For more information about what to do, read Vaginal Rejuvenation & Health from A Woman’s Touch, a wonderful sexuality resource center which I had the pleasure of visiting in Madison and Milwaukee.)
I’m also talking to many women over sixty who didn’t know that lubricants and sex toys can enhance their sexual pleasure — solo or with a partner — by heightening arousal and speeding up orgasm. They thought that slow arousal and difficulty reaching orgasm were a part of aging that they had to accept. I’m distressed that many doctors tell women this — often without running tests to see whether hormone levels or other conditions which may be treated might be affecting sexual response.
I’m not dumping on doctors, just on their training. I’ve been thrilled by the response of medical professionals to my book. One Santa Rosa, CA gynecologist bought 14 copies of my book for her patients — and then, after she had given them all away, she bought 10 more!
Several readers have written in about their medical challenges since this post originally appeared. To read more on this topic, check on “medical attitudes towards sex and aging” or “cancer” in the “labels” column to the right, and you’ll see other related posts.
Many of you have been reading and asking about prostate cancer, how it affects sexuality, how spouses/lovers can communicate and keep their love strong while living with it. Some of the most widely read posts on this blog have been those dealing with prostate cancer, such as “A man asks about sex after prostate cancer” and “Grace Period: a novel about living with prostate cancer.”
In response to your interest, I’ve asked Tina Tessina, Ph.D. to comment on this subject. Besides being a psychotherapist and author, Tina writes from experience: her husband is living with prostate cancer. Here are her comments:
The changes that come after prostate surgery are, like all changes, not easy. We don’t like to have to deal with changes, especially those that confront us with our mortality. But, I can happily report, with some encouragement and enthusiasm from me, my wonderful husband is quite functional sexually. His surgery was in 2002, he just got another ‘undetectable’ PSA test, so we are blessed.
For us, the blessing is in how heightened our love and appreciation (which was pretty good before) has been by the threat of terminal illness. Richard is lucky — they got it early, it has not spread, the surgery went well. His second surgery to have an artificial sphincter put on his urethra, also went well.
Others, I know, have a more difficult time. But, as Gerald Haslam wrote in Grace Period, “Live for the moment, since that may be all you have.” Richard and I decided to do that in 2002, and we’ve been making the most of our moments ever since. Every day is a gift, another cup of sweetness, and we drain it to the last drop. One of our joke lines is “I’d like another one of them there drinks,” from Scrooge, referring to the Cup of Human Kindness given to him by the Ghost of Christmas Present.
For some couples, the tension of serious illness creates crabbiness and bickering. Richard and I have never wanted to waste time arguing, and we haven’t for a long time. I don’t believe it helps anything that’s going on. In my newest book, Money, Sex and Kids: Stop Squabbling About the Three Things That Can Destroy Your Marriage out from Adams Media spring 2007, I help couples who are fighting learn new methods of getting along so they can enjoy their time together.
For more, see Tina Tessina’s Dr. Romance Blog. Dr. Tessina is a psychotherapist, author of several books including It Ends With You: Grow Up and Out of Dysfunction, How To Be a Couple and Still Be Free, and The Unofficial Guide to Dating Again. She writes the “Dating Dr.” column on www.CouplesCompany.com and “Dr. Romance” on Yahoo! Personals.