Between the Sheets: Sex, Intimacy, and Prostate Cancer

Dr. Anne Katz is a Certified Sexuality Counselor and registered nurse in private practice in Winnipeg, Manitoba. She has educated thousands of healthcare providers and cancer survivors about cancer, sexuality, and survivorship. Dr. Katz has also helped both men and women by providing answers to questions about sexual health and intimacy challenges that can result from prostate cancer treatment.

Here, Dr. Katz fields questions from patients, survivors, partners, and caregivers on sex and intimacy from the prostate cancer community.

I am the wife of a man who had prostate cancer surgery three months ago. Ever since then, we have been fighting non-stop. He is distant and irritable, and we can’t get along. 

We’ve always had a pretty difficult relationship, but things are really bad right now. Could this have something to do with the side effects of surgery?

I’m sorry to hear that you are not getting on with your spouse. There are many reasons why he may be more irritable or distant. He may be disgruntled because he is not doing as well as he thought he would be at this stage after his surgery. Is he having a lot of urine leakage? Men are often embarrassed to disclose this, even to their spouse. He may be embarrassed. Or if he is having trouble sleeping through the night, he may be exhausted and, as a result, have a short fuse. What else might be going on? He may be worried if his PSA has not gone down to zero or, if it is rising, that would mean additional treatment.

I often think about a couple I saw for counseling many years ago. The man’s partner told me that they were fighting all the time and that is why they came to see me. I am not a conflict counselor, so I asked her to explain further. It turns out that this couple would create arguments on a daily basis so that they would then have make-up sex! When he was not able to have erections, there was no make-up sex and they remained mad at each other.

Communication lies at the root of healthy and happy relationships, so you have to TALK to him and ask him to tell you what is bothering him. Tell him that while you are not likely to be able to solve his problems, whatever they are, you are able to listen and to help him find resolution where possible. It is important that he knows that his mood is affecting you and that you miss the way things were. Getting some counseling for both of you, separately and together, can also be helpful. 

Good luck!

I’m gay, and I’ve had my prostate removed. 

Will I be able to still stimulate the prostate bed area to orgasm as I did before? I have not tried, and I’m afraid.

The only way to find out is to try! Men have told me that stimulation of the prostate itself produces the sensations and orgasm. But maybe the stimulation of the rectal wall/prostate bed will do it too. 

My suggestion is to either try yourself with a vibrator (be gentle!) or with a trusted partner who will be gentle. Lots of lube and lots of breathing to relax, and a safe word if you want him to stop/pull out/go slow.

You can also ask other men who have had the surgery but remember that everyone is different.

ZERO offers resources, including support groups, to help you to get in touch with other gay men who can give you their advice.

When I received my prostate cancer diagnosis, my wife was my rock as we met with the doctor and decided on treatment. I’m now struggling with managing post-treatment side effects of ED and incontinence. It’s taking a toll on our marriage and my sense of being a man. 

While I have never loved her more, I’m not able to perform sexually like I used to, and we don’t talk about it. It pains me that we’re not able to be intimate and I sense that she’s withdrawing from me. How do we move forward?

This is a common problem – the sexual changes, as well as incontinence – but also the feelings you are experiencing about your relationship and how you see yourself as a man. Sexuality is an important component of male self-esteem and self-image, and changes in this area often precipitate a crisis of confidence.

Men often use sex as a way of showing their love for their partner, but when problems occur – such as after treatment for prostate cancer – they have trouble finding ways to express this. You have included this in your question: “We don’t talk about it.”

Relationships are dependent on communication especially when there is a challenge, such as loss of sexual function. When you don’t talk about what is going on (or what is NOT happening!), the other person starts to make assumptions, similar to when you say that you sense that your spouse is withdrawing. She may be keeping her distance because she doesn’t want you to think that she is initiating something sexual, and you will be upset if you can’t respond like before. She may be withdrawing because she is trying to protect herself – and you! She may be blaming herself for something and thinks that YOU are avoiding her because you are not doing what you would normally do to create and maintain the connectedness that is the true meaning of intimacy and is the result for many couples of coming together sexually.

How can you move forward? It’s simple, but complex – YOU NEED TO TALK TO EACH OTHER, OPENLY AND HONESTLY. She needs to know what you are thinking and feeling as well as  how you are interpreting her reactions and response to you. You need to listen (and believe) what she tells you about her thoughts and feelings. You both need to lean in TOWARDS each other just as you did when you were learning about your diagnosis and treatment options. If you can’t talk to each other without help, then find some help. A couple's counselor, marriage therapist, or sex therapist can help you to talk in a safe environment. Once you have talked you can then discuss WHAT you want to do about the situation. You can explore medical therapies that may help with erections, pelvic floor physiotherapy for the incontinence, or other ways of experiencing sexual pleasure that do not require an erection. The key element is that you have to SHARE and do this TOGETHER.