Between the Sheets - March 2022

QUESTION FROM PROSTATE CANCER SURVIVOR:
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?

RESPONSE FROM DR. ANNE KATZ:
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, just as you are doing 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 and 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 or 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 – 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.

Originally published in the September 2018 Hot SHEET newsletter. 

Do you have a question about sexual health or intimacy? If so, we invite you to send it to ZERO. We’ll select questions to feature in future Between the Sheets columns. Please email your question to: bts@zerocancer.org.