HisandHerHealth: Information About Sexuality, Prostate, Incontinence

 Written by Aline Zoldbrod, PhD, Vibrance Special Contributor  

The words ".... you have prostate cancer" are a life changing, frightening event for each man affected, and for his partner. At first, sexual concerns recede amidst the time -and -energy -consuming tasks of gathering information, having tests, making treatment decisions, and perhaps undergoing surgery. The life and death quality of dealing with the cancer diagnosis often brings out the best in a partnership, with many partners voicing the mantra "All I want is to have him around for another 30 years, and I don't care about any sexual consequences." A whole year of life may be spent undergoing tests, researching options and treatments, undergoing treatment, and the recovery process.

 In many cases, discovering the effect of treatment on sexual functioning is a waiting game. It can take up to a year post-surgery to know whether enough nerves have been spared for erections to remain intact. Treatment options depend on the stage, location and type of tumor; of course, some men go into treatment knowing that erectile dysfunction afterwards is inevitable. It is important to be well prepared for some of the consequences of treatment, because surprises are terrible. Ironically, though, in an existential sense, there is no real way to be prepared. In the midst of the chaos, hearing that sexual dysfunction may occur does not even register for the patient, so powerful is the fear of the unknown, illness, hospitals, doctors, side effects, or death.

But lo and behold, after the initial crisis of diagnosis and treatment is completed and months and months have passed, any negative side effects of treatment have been ironed out, and the acute medical drama is over. In one treatment, in fact, there is a nerve sparing prostectomy, which spares the mechanism for having erections. You have survived. Although worry about recurrence is a thought that you have to deal with, in other ways life is returning to "normal."

In my experience, men with prostate cancer often are remarkably resilient. Feeling normal is important. It stands for feeling in control. Being able to maintain your sexual relationship with your partner enhances your feelings of connectedness, emotional intimacy and being loved, and the touch involved in being sexual is wonderful for your immune system. Sexuality, then, can be a major component in fighting off depression and in staying physically and emotionally healthy. As soon as you want to resume your sexual relationship, your urologist should be willing to guide you, exploring which drugs, treatments or devices might help you to maintain your ability to have erections. (There are related stories in the Prostate2002 information describing how) If your surgeon is someone who is not interested in working closely with you on your post-surgery sexual functioning, find a urologist who can help you with this stage of your recovery.

But it may be that even with the best treatment and medical follow up, your sexual functioning has been altered. NOW the physician's earlier words about "changed sexual functioning" can be seen on the radar screen of your mind. Now you see that you are still alive, all your medical decisions have been made, and what is left is to live with them.

The Man's Inevitable Fears About Sexual Performance

As the life and death fears recede, most men become very concerned with their ability to resume normal sexual relations-ie. penis-in-vagina intercourse. Of course, you should pursue all the medical treatments available to help you maintain your erectile capacities. But if you find that you are having no luck in finding a pill, injection or procedure, which gives you an adequate erection, you can still continue to have a sexual relationship with your partner. The key is to expand your communication and broaden your definition of what is pleasurable. When I say that maintaining your sexuality is key to staying physically and emotionally healthy, I am not referring to what you might be thinking is the only kind of normal, acceptable sex: penis-in- vagina intercourse.

Human sexuality is multi-faceted and many layered. Women can have pleasure without orgasms. Men can have orgasms and ejaculations without erections. All of us have erogenous zones on our bodies which we have neglected to explore. Learning to tango, or going to a romantic dinner and a movie, and then lying naked together touching each other can be a wonderful sexual experience. Talking about sexual fantasies, or past times of great sex together can be erotic. The connection, the touching, and the experience of trusting another with pleasuring your body are what creates the powerful healing and bonding effects of sexuality. This is a good time to expand your ideas about what is possible and what is pleasurable.

Women's Fears

Female partners have their own fears, of course. " Will my husband be okay with the physical changes that treatment has caused? Will he feel okay about himself and us, or will our relationship suffer? " "How can we maintain closeness, and how can I make him feel loved in every way?" " What is going to happen to our sexual relationship? My husband wasn't a talker. I always felt closer to my husband sexually than I did any other way." "Will I be able to adjust? I always loved the feeling of being penetrated." For women and their partners, the more varied the enjoyable items on the "sexual menu", the easier the adjustment to changes in sexual functioning. (Hint: if insertion is a crucial part of feeling good, experiment with a dildo. Free Yourself from the Tyranny of Masters & Johnson Stages Model of Sexuality)

One of the most important things you and your partner can do in the face of changed erectile capacities is to change how you think about the sex act. (See Dr. Laura Berman's article on VENIS.) A shift from an emphasis on performance to an emphasis on pleasure is a critical step you can make which will pay big dividends.

The idea that there is just one correct way to do sex, that all of the "stages"(desire, a little foreplay, arousal/erection, and ejaculation) have to occur perfectly and in the right order, does very little to help a couples' sexuality under any circumstances. This Masters and Johnson Model is actually a paradigm of sexuality that never worked very well for many women, who care more about touching and caressing and the "flow" and closeness of the sexual act than they do about penetration and orgasm.
Men have been socialized to see their erectile capacity as THE measure of masculinity and the DEFINITION of being sexy. Growing up, most men were socialized to be competitive about their sexuality and their sexual prowess. In addition, most men have used their erection as a "cue" that told them they were turned on. In many ways, men tune out to the other ways of feeling pleasure in their body. This can be a time to tune in to new feelings of pleasure. Lack of erections does not equal lack of pleasure. As one of my patients, who uses the pump, commented:" I still like to be touched on my penis, even though I don't get an erection. It feels just as good inside my body as it always did. All of the internal feelings of pleasure are still there. Plus, it is very reassuring." It is crucial to have these kinds of conversations with your partner, talking about what feels good, whether or not it produces an erection. A wonderful book which can help you loosen up your rigid ideas about erections, masculinity, sexuality and pleasure is The New Male Sexuality, by Bernie Zilbergeld.. Losing the capacity for having erections naturally does not have to make you feel inadequate.

A Few Beginning Steps

What would I suggest as beginning steps in opening up sexual communication, if the insecurity and changes post-prostate cancer have derailed your sexual relationship?

Draw a Body Map: First, both of you could draw a "body map," where you each draw two outlines of your own body, front and back. Now color the maps in, coloring green the areas in which you love to be touched all the time, red for the areas you don't like touched, and blue for the areas that feel good or bad depending on your mood, the kind of touch, or the circumstances. Discuss the body maps. If the medical treatments have changed your body map, talk about that. If you are going to give your partner feedback about the way he or she has touched you in the past, do it kindly! But this is a good time to be honest about what gives you pleasure. Time: Make a plan to set aside time to relax, reconnect emotionally, and get naked and take turns touching each other�s green zones, moving onto blue zones if your partner tells you to.

List Your Sexual Likes and Wants: Each of you make a list of five sexy or erotic activities you would like your partner to do with you that are within your lover's capacity to do (eg., I love to see you naked; I really like it when you play with my hair; I really would love it if you would give me oral sex.) In the beginning, as you are trying to maximize your optimism about having many ways of giving each other pleasure, try not to put things on your list that you are pretty sure that your partner will not want to do. Later on, once you are giving each other consistent sexual pleasure, you can revisit areas of contention and see if you can negotiate.

Expand Your Horizons: Luckily for all of us, there are sex superstores on the internet where books, toys, movies and new ideas can expand our horizons. One part of feeling sexual is being open to sexual stimuli, and having sexual thoughts. There are many fine adult shops on line that can supply you with whatever you need in the privacy of your own home. If Problems Persist, Get Professional Help: Most couples are able to find a way to reconnect sexually after prostate surgery, but some couples need a little extra help. The two organizations of sexual health professionals are the American Association of Sex Educators, Counselors and Therapists (www.aasect.org) and the American Board of Sexology (www.sexologist.com.)