Personal View of Prostate Surgery and Sex

Neil, age 74, offers this startling information about sex after prostate cancer surgery. I’m grateful to Neil for his willingness to share his personal story:

A diagnosis of cancer is very frightening. For me the journey was scary enough without the myths and misinformation I was told about cancer of the prostate. I share my experience in the hope that this information will be of help to others.

Myth # 1: “After Age 55, Sex Doesn’t Matter That Much Anyway.”
I heard these words from a physician who specializes in the treatment of prostate cancer. A very nice person, considered extremely competent, he believed his words would be comforting. They weren’t!

Sex does matter after 55. I promised the doctor that I would look him up on his 55th birthday and tell him to “cut that out.” He sheepishly smiled and said, “Oh my. I think I said something wrong.”

Myth # 2: “What You Have At The End Of A Year Is What You Get.”
Although many men are told that any rehab after prostate cancer treatment will peak in twelve months, every case is different. Some methods of prostate cancer treatment can result in serious damage to sexual performance. On the other hand, robotic surgery and nerve sparing have greatly improved sexual potential. Whatever the case, don’t give up! There are options for almost every case of sexual impairment.

But I must warn about some of the product advertisements that flood the market about penile enhancement, instant erections, and so on. Some of these products can be harmful to a cancer survivor. Some are loaded with testosterone which can cause further growth of prostate cancer. Check with your physician before trying any of these medications.

At all times, keep your partner involved in the options you’re considering. They can be our most precious friends and supporters. They deserve to be part of the solution to our new life experiences.

What We Are Often Not Told:

The penis will be about an inch shorter after surgery. Because the urethra passes through the prostate, when the prostate is removed, that portion of the urethra is removed as well. Then, when the urethra is resectioned, the penis is drawn in towards the abdomen. Secure circumcised males seem able weather this storm but uncircumcised males have an additional problem. The surgery leaves more foreskin than before. This additional tissue traps urine and produces odor. Baby Wipes do a very fine job of solving this problem. They are easy to carry and save a lot of embarrassment.

The “Missionary” position usually is no longer successful after prostate surgery. Because the prostate stabilizes the penis and prevents it from receding into the abdominal cavity, removal of the prostate decreases penile stability. The angle of the vagina, coupled with a shortened penis with no internal stability means vaginal intercourse may not work. However, “Doggie Style” and “Woman on Top” work just fine.

I welcome feedback about the experience of others regarding sex and prostate surgery!

9/22/2009: Neil added these comments about how his urologist saved his life.

Intimacy after prostate surgery

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.

–Joan

Gerald Haslam talks about prostate cancer and sex


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.

Please read my review of Gerald Haslam’s Grace Period. Click here to view or order Grace Period on Amazon.

Changes after Prostate Surgery: Tina Tessina

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.