A cancer diagnosis is crushing and treatment is often harrowing. Yet millions of people survive cancer and resume normal lives. This is particularly true of prostate cancer which, according to the American Cancer Society, will affect one in seven American men but which when detected early, as 80% of prostate cancers are, has a five-year survival rate of nearly 100% and a ten-year survival rate of 99%. Prostate cancer is a serious illness but most men diagnosed with the disease do not die from it. There are 2.5 million men alive in the U.S. today who have been diagnosed with prostate cancer at some point in their lives.
“After the ordeal of diagnosis and treatment, men and their partners look forward to life returning to normal,” says clinical psychologist and relationship specialist Dr. Daniel Watter of Morris Psychological Group, “and indeed it does in many respects. But most men treated for prostate cancer suffer a disruption in either libido or sexual function – or both – that may be temporary or may be long-lasting. It’s important for the couple to communicate openly with each other and with his medical team both before treatment to be prepared for possible side effects and after treatment to adjust to the physical and emotional impact on their relationship.”
Most early-stage prostate cancers are treated in one of three ways: surgery to remove the prostate gland, radiation from an external beam, or radioactive seed implants. The choice of treatment is based on several factors including overall health, the size and location of the tumor, and consideration of the potential side effects of each option. While some sexual side effects are common with all treatments, surgery is most likely to cause long-lasting erectile dysfunction. That’s because the nerves responsible for an erection are very close to the prostate gland. Surgery often cuts them and radiation sometimes damages them. Depending on the location of the tumor, an approach called nerve-sparing surgery may reduce the risk and severity of post-surgical ED but doesn’t usually eliminate it entirely. Some men recover erectile function over a period of months or even years as nerve tissues heal and those who have had nerve-sparing surgery may regain function with the help of ED medications such as Viagra and Cialis. Other ED remedies, including penile rehabilitation, vacuum devices, and implants have varying degrees of success and side effects.
“Erectile dysfunction and issues related to sexual intimacy can be challenging for couples in the best of circumstances,” says Dr. Watter. “In the midst of the anxiety and stress of a cancer diagnosis and choices to be made about treatment, sex may seem like the least important issue facing a couple. But those who face it early – as treatment options are being weighed – and with open, honest discussion from the outset, will have the most likelihood of successfully restoring sexual intimacy after treatment.”
Tips for Patients and their Partners
Dr. Watter sees the restoration of intimacy as a process that will have successes and failures over time. He offers some advice to couples embarking on the journey:
• Address the challenges as a couple: It should go without saying that loss of intimacy is not a problem only for the patient. His partner must be fully committed to the goal, must accept that things may not be the same as before, and must be willing to explore new options that redefine intimacy. Together they will learn that while their sex life may change, their relationship may ultimately be closer than before.
• Be persistent…and keep your sense of humor: Don’t expect too much too soon. There will be disappointments. Not every option will work for every couple. For example, ED solutions like medication that improve blood flow do not work when the nerves have been cut. Other solutions may fail initially but ultimately be successful or vice versa.
• Sexual satisfaction is possible without an erection: Vanquishing ED is not the only route to sexual satisfaction. Different nerves control erection and orgasm; even without an erection, orgasm is possible. And even without orgasm, emotional and physical intimacy can be maintained. Don’t let confusion or embarrassment prevent you from talking about the possibilities and seeking help.
“The most important bit of advice is to keep the lines of communication open, even when – especially when – it is difficult,” Dr. Watter concludes. “Most men lead long, fulfilling lives after prostate cancer and have satisfying intimate relationships. As long as both partners are honest about their needs, they may find their relationship strengthened in ways they didn’t expect.”