Prostate cancer is the second most common cancer in men (after skin cancer), with around 12,000 new cases diagnosed each year. Men’s overall risk of contracting prostate cancer before the age of 74 is 1 in 11.

There are 3 main treatments for prostate cancer; a surgical Radical Prostatectomy, pelvic brachytherapy (the implanting of radioactive seeds in the prostate), and hormone treatment that deprives the cancer of the testosterone that feeds its growth.

Prostate cancer treatment damages nerves and blood vessels, so getting aroused can take much longer, orgasm may feel different and ejaculation may be different or missing. It may affect the rigidity of erections, how long the erections last and the ability to get an erection in the first place.

Diagnosis alone can cause erection difficulties. 70-90% of men have erection problems for some time after treatment and 40-50% of survivors continue to have ED (erectile dysfunction) in the following years.

In addition, concerns about incontinence, fatigue, depression, the cancer recurring and a lack of sexual desire make sexuality a huge challenge for survivors and their partners.
Delving deeper than the obvious mechanical changes, research by Barbara Bokhour in 2001 identified 4 areas affected by erectile dysfunction that impact on quality of life.

The quality of sexual intimacy
Without reliable erections, men feel anxious about their ability to satisfy themselves and their partner sexually. They feel hesitant to initiate emotional and physical intimacy, as in the past this usually led to intercourse, now a potentially awkward and embarrassing experience. What was once comfortable and familiar can feel unnatural if they have to use artificial assistance to achieve erections.

Relationships with Women
Erectile dysfunction also affects the way in which men relate to women outside their intimate relationship. Where previously they would have been aware of the potential for sexual intimacy with women they met, that loss of potential now defines him and those interactions as non-sexual. Even though they might not have been actively pursuing a relationship, there had been a sexual undercurrent; the absence of that element in their everyday social interactions with women compounds a lack of confidence.

Sexual Imaginings

Part of being a man means being aroused by the sight of an attractive woman and fantasy is a part of most men’s everyday lives. There is a profound sense of loss that they can no longer imagine themselves as potential sexual partners and this is enhanced by a distressing lack of physical or emotional arousal. Many experience nostalgic feelings and a deep sense of loss over the demise of this small ordinary pleasure, even those who weren’t sexually active at the time of diagnosis. “It’s a capacity you’ve had all your life and then it’s gone.”

Masculinity
These changes undermine men’s masculine identities. The inability to connect with women sexually and the knowledge that they’ve lost their sexual capabilities leads to a diminished sense of oneself as a whole man. Sexuality is seen as a substantial part of what defines an individual as a man and men who have lost sexual functioning find themselves challenged to redefine themselves as masculine in our society. The ability to project self confidence depends on that underlying sexual capability.

As men have a tendency to do, many suffer these feelings in silence, not knowing how to talk to their wives or peers about it, and not seeking help from their doctors. Their wives feel bewildered and powerless; their husband’s have survived the disease but have withdrawn from them. They don’t want to pressure but mourn the loss of intimacy.

Orgasm is possible without an erection or an ejaculation, a fact often met with scepticism. For many men, an act without penetration and erection is not sex. Their partners say it’s not the lack of penetrative sex but the shutdown of sexual intimacy and sensual touch that they miss so much.
It is common to feel helpless but there are many avenues for assistance. Approach your doctor. They can give information about support groups or individual survivors who have experienced the same things.

The Cancer Council (at least in Victoria) can also refer you if you phone them. Seeing a sex therapist can help you reconnect with your partner to rediscover sexuality and intimacy. This can be a golden opportunity for couples to work together toward a much better sex life for both of them.

As always, wishing you happiness and great sex

Lynda Carlyle RN, MHSc (Sexual Health)

Ripponlea Medical Centre
100 Brighton Road, Ripponlea, Vic, 3185
Ph (03) 9525 6200