Sex & Sociability

Question and commentary on connections, both sexual and social

Male Sexuality and Prostate Cancer

At this time communication is more important than ever.

Last week I was invited to speak to a local Men’s Prostate Cancer Support group on sexuality and the changes those with this disease and their partners might expect. Perhaps because of the topic or probably because this was the group’s last meeting there was a very nice turn out. The men were knowledgeable, articulate, and as a group unusually intelligent. (Do you suppose that’s just the demographic likely to attend a support group or does this cancer tend to strike only men with higher than average IQs?)

I began my presentation with the statement that sometime in every man’s life he is likely to notice changes in his sexual responses. Depending on many factors such as general health, life stressors, the presence and quality of any intimate relationships, smoking and drinking habits, drug use – both recreational and prescribed - these changes may occur at any time in life beginning as early as his 30’s.

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What a man might notice is that it takes longer to achieve an erection. The erection may not be as firm as it used to be and more stimulation of various kinds could be needed for him to get hard at all. He may last longer or, conversely, climax sooner than he used to, and the ejaculations themselves may not be as copious or strong. There may be occasions that he just doesn’t get hard when he expects to or that his erection, once there, may suddenly wilt. Any or all of these changes can afflict any man past his youth and probably will.

Since all of these events are likely to occur in healthy men as they age if the additional distress of being diagnosed with a potentially fatal cancer and the various types of treatment recommended for this cancer is added (surgery, radiation therapy, male hormone blockers and a regimen of female hormones),  you can be sure sex will no longer be “business as usual”. The good news is that though sex may have to be a different set of behaviors than a man’s norm, whatever that was to date, sex does not have to come to an end.

The other news, not necessarily bad, is that a man and his partner are going to have to talk about sex, now more than ever. If they have not been in the habit of communicating about their sexual life this is absolutely the time to start. The first thing that has to be made explicit is that certain things have changed and the two will have to decide together how to deal with those changes.

If, after his diagnosis and treatment his libido decreases, as is very usual, he has to let his partner know. If he has a regular partner who is female her first thought may very well be “He doesn’t find me attractive any longer” (not that a male partner might also share this fear). If a woman is used to seeing her partner’s erections as a barometer of his attraction for her the fact that he requires additional stimulation to become erect, that his erection is no longer as firm, and that he is less interested in sex in general will confirm her worst fears.

Out of pride or fear, she may then become less physically affectionate, just at a period in his life when he most needs such loving reassurances. Without clear communication about what is going on, internally and with the disease and treatment itself, the couple may be apart and alone in their fear and unhappiness when they could be offering the comfort of touch they each need from the other.

Talking about sex and need for touch is extremely difficult for many men in the generation when prostate cancer is most likely to occur. Not only do they now have to deal with waning sexual powers, incontinence, illness, and fear of the unknown it is unnecessarily cruel to face this feeling estranged from one’s life partner if there is one or from the possibility of finding one if there is not.

I urge you, man or partner of a cancer sufferer, to communicate. Let your other know what is going on with you and, quite literally, do not lose touch. It is more important now than ever before.

Isadora AlmanM.F.T., is a Board-certified sex, marriage, and family therapist, lecturer, author, and syndicated advice columnist of "Ask Isadora."

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