The sexual consequences of cancer treatment are often under-estimated. Cancer patients have a right to enjoy a normal sexual life. When a man is diagnosed with cancer it begins a process and he may go through some or all of the following stages:
- Initial Diagnosis
- On-going treatment
- Survivorship and moving on with life
Throughout these stages there are different needs at different times. In the initial stages dealing with the cancer and bringing it under control is the priority for the medical team. The well being of the man, as the patient, is the primary consideration.
A Spouses Story
Often the partner or spouse is not being considered. The following is the story of a spouse of a man going through the initial stages of a cancer diagnosis.
“When he was in the middle of his treatment I would be awake at night watching him breathing. I was consumed by the thought of losing him. I would lie awake wondering what I would do the day he stopped breathing. I couldn’t bear the thought of what might happen, of losing him .I eventually had a nervous breakdown and ended up leaving the marriage out of guilt.
It’s years later now, he’s been in great health. I learned from the situation that when someone is facing a life challenging illness, all the attention is on him or her. Everything is focussed on how they are doing, “How are they feeling? And how is the treatment going?”
I never thought to say “Hey what about me?” That would have felt wrong. I wasn’t the patient, who was I to need help when he was the one dying? So I kept my mouth shut until I finally cracked.
A Space for the Couple
I think that story epitomises the position of the spouse when their significant other is the victim of a cancer diagnosis. It is also understandable that the patient must be put first. However I happen to believe there has to be a safe place for both to be able to talk about their concerns and the affect of the diagnosis on each of them personally and on the couple.
Erectile Dysfunction (ED)
After treatment for prostate cancer men may have difficulty getting or keeping an erection. This is known as erectile dysfunction (ED). This can be a problem for many men going through life and it is more likely to happen, as men get older.
When a man is sexually aroused his brain sends signals to the nerves in his penis. The nerves increase the blood flow to the penis, which then fills the spongy tissues making it stiff and resulting in an erection. Anything that interferes with those nerves, the blood supply or his sexual desire (libido) can make it difficult to get or keep an erection. Surgery and radiation affect the nerves and blood supply.
It is often at the stage of survivorship when men want to get on with their lives and relationships that they begin to realise that the cancer treatment has resulted in erectile dysfunction. This can be distressing for the sufferer and the partner because, even though the man is holding the dysfunction, it affects both parties. If the couple has been penis/penetration focussed they may feel it is the end of ther sexual relationship.
The Effect on the Sex Life of the Couple
So erectile dysfunction is both a personal issue and if the man is part of a couple, a couple issue because both members are affected by it. Whatever change the surgery or intervention brings about we all remain sexual beings. It is part of who we are.
Every living being has a sexual component even if some choose to surpress it. So while the “plumbing and wiring” may be affected by surgery you can still long for and have sexual intimacy as a couple. It may not be the sex you had before your diagnosis and treatment but it can still be satisfying to both.
It saddens me when I hear that many survivors of prostate surgery think it may be time to give up on their sexual lives. I know with the right attitude the couple can go on to have a creative broader approach to what sexual intimacy is. There is so much more to sex then penetration, which let’s face it for most is over within minutes.
What Happens in the Couple when There is a Prostrate Cancer Diagnosis ?
So what happens in the couple relationship when there is a diagnosis of prostate cancer with subsequent treatment? Well unfortunately the medical profession, though excellent in their own field, are not good at issues related to sex or sexual functioning. Many men who have to undergo prostate surgery or radiation may not have been warned about the possible after affects the treatment would have on their sex lives. Because of side effects like incontinence (leaking of urine, perhaps pain and absence of erections), many men become embarrassed and avoid talking about or engaging in sexual activity. This avoidance can then become the status quo and without professional help sexual function my cease for the couple.
The reality is, at this stage, the couple may need intervention to educate them on the broader canvas that being sexual can be. This is where some collaboration between disciplines of the medical profession and the sex therapist could work to achieve a realistic outcome for the couple.
You might pose the question does everyone, post prostatectomy need the help of a sex therapist? The answer is no if you are both managing a way forward together. Though sometimes even a few sessions with a sex therapist, particularly one who has had further training in working with clients who have had a cancer diagnosis, can make all the difference and can set a couple on the right road forward.
How Can Sex Therapy Help ?
So this brings me to how can sex therapy help? Accredited sex therapists are trained to work with any concerns or difficulties that you may have. We work with both singles or couples. A sex therapist will work with you to discover any historical factors, which may have added to your problem. We know your problem was precipitated by surgery but there may also be psychological factors which are relevant which may be out of your awareness.
It is important to know you don’t need an erection to have sexual pleasure and you don’t need an erection to orgasm. The nerves that mediate sexual pleasure and orgasm are higher in the body than the area damaged by surgery or radiotherapy. The most important organ you need to have to be good sexually is your brain. Your individual erogenous zones may have changed, but who knows what new hotspots may be revealed through gentle exploration and experimentation. A man does not need to have an erection to have a sexual encounter. Neither do partners need an erection to reach orgasm. The number of women who orgasm from penile thrusting alone in the vagina is very small.
Deciding to go for Sex Therapy
If you do decide to come in for sex therapy the therapist will need to know the way the surgery and the treatment has affected you. The age you are and any medical conditions that exist. We need to know the reality of the relationship, how close or distant you are as a couple? So this is a time to gather the information. It is important at every stage of life to be as healthy as we can be. This includes a holistic approach of diet and exercise.
To sum up you don’t have to have erections to have good sex. Sometimes if your communication is good enough and you are both able to relax you can get back to being sexual without professional help. Of course if you and your partner both agree not to be sexual then that is another choice you can make. However sometimes it may be an investment in your future to go along and speak to a sex therapist.
To repeat, the sexual consequences of cancer treatment are often under estimated. Cancer patients have a right to enjoy a normal sexual life. There is help out there if you choose to reach out.
College of Sexual and Relationship Therapists (COSRT)
If you believe sex therapy is an option for you it would be important to check that your therapist is an accredited member of COSRT (College of Sexual and Relationship Therapists). This will ensure that your therapist has specific dedicated training in the field, is qualified and is engaged in continuing professional development.
Written by Anne Mathews, Psychosexual Therapist