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Your Life Together

Any form of cancer usually has a significant impact on both partners–and prostate cancer is no exception. Uncertainty about the future is common with all types of cancer. But there are some specific fears associated with prostate cancer–specifically around the sexual relationship, incontinence and the impact of both on the couple’s quality of life–that partners often face in their journey with the disease.

“We cherish our relationship even more because of the threat of cancer and of having gone through this experience together.”

Your Sexual Relationship

Erectile dysfunction

As you have read in the treatment options section, temporary or permanent erectile dysfunction is a common side effect of many types of prostate cancer treatment. For many men, sex equals penile penetration of his partner’s vagina. A man with erectile dysfunction, therefore, often feels as though a satisfying sex life for him and his partner is over. However, for most women, fulfilling sex can involve a wider range of activities. The good news is that there are many ways to overcome a man’s inability to have an erection and still have a sex life that both partners can enjoy. Oral medications, injectable drugs and medical devices can all be used to induce an erection. Your partner’s doctor or a sex therapist can discuss the options with the two of you and you can decide if you’d like to try them.

Good communication will be a key to discussing alternative activities that may be sexually satisfying to you both. There are many good books—with illustrations—that can help open up new avenues for you to explore. Watching a movie together can help put you both in the mood. A sex therapist can be a big help in this area as well.

Whichever way you decide to proceed, focus on the process, not the end goal, to keep the pressure off and the pleasure on!

Fertility

If you and your partner choose a prostatectomy (surgery), external beam radiation therapy, brachytherapy or hormonal therapy your partner will significantly lessen his ability to father children. Couples who want to have children should consider having
the man’s sperm frozen before any therapy begins so they have the option of in vitro fertilization at a later date.

Sex drive (libido)

Decreased libido is a side effect of hormone therapy, which lowers the levels of testos- terone in the man’s body. If the course of the therapy is less than about a year, your partner’s sex drive will likely return to his usual level. If it goes on for longer, the change is usually permanent.

Sex before, during and after treatment:

The potential effect prostate cancer has on his sexual relationship is often the most profoundly worrying aspect to a newly diagnosed man. For couples who already have an active sex life, many continue to express their intimacy through sex despite a diagnosis of prostate cancer. This is a healthy approach and can provide the couple with essential nurturing and mutual support at this stressful and uncertain time. As for any illness, treatment will have an effect on your activities. Here are the recommendations for sexual activity around the time of treatment:

Watchful waiting/active surveillance:

You and your partner have no restrictions on sexual activity. You are not at risk for contracting cancer from him.

Following surgery:

There is no anatomical reason why a man’s desire for sex would change. However, anxiety associated with the unknown and the fear of not achieving an erection can interfere with libido. Achieving a natural erection shortly after surgery is not common but it is still important to allow fantasies and libido to take over. Foreplay and achieving orgasm play an important role in the healing process and are encouraged any time after the catheter is removed.

During external beam radiation therapy:

You and your partner can have sex as usual. Toward the end of the treatment your partner may experience a burning sensation during orgasm. This will disappear a few weeks after treatment is finished.

During brachytherapy:

Sexual relations can resume following the treatment, but it is recommended that your partner wear a condom for about a month to prevent passage of blood and radioactive material (both of which may be contained in the ejaculate) to you.

Did you know?

Prostate cancer is sometimes called a “relationship disease” because of its effect on the partner of the man diagnosed with it. If you were diagnosed with any other condition, you’d talk to your own doctor about it, wouldn’t you? Well, why not talk to your doctor about prostate cancer too? He or she is focused on your health and can help you deal with challenges you are currently encountering. Whether it’s cancer-specific questions, issues around sexuality or how to cope with your partner’s incontinence, your doctor is there to help. A side benefit of looking after yourself is that you’ll be in better shape to help your partner!

Consulting a sex therapist

Couples who are struggling with the challenges of a prostate cancer diagnosis and treatment are often helped by making an appointment with a qualified sex therapist. The therapist can provide help in a number of areas:

  • Offering coping strategies for physical problems arising from treatment.
  • Facilitating communication between the partners.
  • Suggesting alternative sexual activities that will be satisfying for both partners.
  • Providing help on using medications or devices.
  • Addressing psychological issues around altered sexual function.

3 "Bs" for Better Coping

  • Be an active part of his healthcare team.
  • Be discreet and respect his privacy.
  • Be a good friend to him—and to yourself.