Prostate cancer and impotence:
What your man may be feeling

When it comes to prostate cancer and impotence, we would never profess to say that we are even close to understanding how men think. But we have reviewed some of the literature describing recent research about what men may be feeling when faced with partial or complete loss of erectile dysfunction (ED) and loss of libido (sexual desire).

It’s important to understand that men who are experiencing ED after surgery or radiation therapy generally do not lose their libido. However, men with advanced prostate cancer, who are on hormone therapy (also called androgen deprivation therapy or ADT), typically lose both their desire for sex and their ability to have an erection (this depends, in part, upon which drug(s) they take). These side effects are usually more severe with luteinizing hormone-releasing hormone analogs/agonists (such as Zoladex and Lupron). Other bodily changes that are drug-dependent, and have been found to be most bothersome to men, can include fatigue, weight gain (in areas that women typically gain weight), and hot flashes. All of these can be challenging to both men and their partners.

We also need to acknowledge that some couples grow closer and develop even greater intimacy than before prostate cancer. However, many couples experience some level of frustration, anger, confusion, sadness or disappointment with prostate cancer and impotence. Studies also report that wives may experience greater levels of stress than their husbands, particularly when men refuse to discuss the problem of prostate cancer and impotence.

What follows is a summary of insights taken from various medical journals (most were reports from studies involving men with advanced prostate cancer on ADT). Please note that this information does not represent all men with prostate cancer (and some of these reactions may be extreme), but it may help you understand some of the feelings that your loved one may be experiencing.

How men may feel about bodily changes:

• Men on ADT may feel ashamed and embarrassed by their bodies
• They may have a hard time adjusting to bodily changes and feel uncomfortable talking about them
• Men may seek to hide bodily changes and fear that they will be embarrassed by others if these changes are observed
• They may avoid public places because they don’t want to be seen naked

How men may feel about sex:

• While men on ADT often experience a significant reduction in libido, they may still act like they are interested in sex in front of others. This tends to occur in social situations where they know that their actions won’t lead to an actual sexual encounter
• Other men may be accepting of their decreased desire, but feel uncomfortable when their wives/partners want to discuss it, because they feel there is “nothing to talk about”
• While men may still love their wives deeply—and don’t wish to be with anyone else—they may be afraid to “start something sexually they can’t finish”
• Men may view touching and caressing as “foreplay,” and consider “real sex” to be vaginal penetration and orgasm. Women tend to view touching and caressing as part of “real sex” and cannot separate these actions from the final act of intercourse. Touching and caressing may feel “dangerous” to men (and they avoid it), because it can lead to feeling like a failure if they cannot complete “real sex” through intercourse
• In addition to mourning the loss of sexual desire and erectile function, men may mourn the loss of their erotic dreams and fantasies
• Men may be afraid to admit to their wives/partners that they’ve stopped enjoying sex
• While strong, loving relationships can be maintained between men and their wives/partners—men may view these relationships as more platonic than romantic
• Men may avoid social situations where other couples show their affection because it is too difficult to watch
• A man’s sexual ability before prostate cancer may have been defined by his sense of “manhood.” Without it, he may feel less manly, and may become angry or withdrawn

Men often use avoidance as a coping mechanism:

• They may become totally immersed in their work, or other activities, as a way of avoiding their sadness
• They may pretend that they are “fine” when they don’t feel that way
• They may act more macho around others to overcompensate for their lack of feeling as “manly” as they used to

Other observations:

• Men on ADT may lose their excitement and enthusiasm for activities, yet may fake these feelings in public for their partner’s sake
• They may not share their feelings with their wives/partners because they believe they can’t resolve them. If they are pretending that “everything’s fine,” opening up “blows their cover.” They may also be afraid of upsetting their wives/partners if they reveal their own distress
• Men may feel that they are no longer good husbands because of their failure to have sexual intercourse
• They may feel too embarrassed to seek professional help for physical and/or emotional problems

No easy answers for prostate cancer and impotence

While there are no magical answers to solve problems caused by prostate cancer and impotence, women need to know that it doesn’t have to be this way. If you and your loved one have good communication—and are willing to work and experiment together—you will be able to experience intimacy in ways that can be enjoyable for both of you. You can find some suggestions on this web site to help you cope with problems caused by prostate cancer and impotence. We also encourage you share your suggestions with other women by using the submission form on our “About this site” page.

If your loved one is unwilling to discuss your sexual needs—or has completely shut you out—it’s important to determine if he’s suffering from clinical depression. You can consider calling his doctor to express your concerns. This will alert the doctor to be more observant during your loved one’s next visit. Hopefully, the doctor will ask the right questions (and hopefully your loved one will answer honestly). If depression is diagnosed, there are many medications available to treat it.

You can also suggest joint counseling. Sometimes a third-party professional can be very helpful in getting couples to open up with each other. It may also feel less threatening to your loved one when a suggestion comes from a professional. If your man refuses to go to counseling, you can consider going on your own to learn ways to cope with his prostate cancer and impotence.

You may find great comfort talking to other women about prostate cancer and impotence. The Prostate Cancer Forum for Ladies only has a special forum called “intimacy” where women talk about prostate cancer and impotence, intimacy, and sexual relationships. They will welcome you with open arms—and will freely share their support and suggestions—because they understand what you are going through. You can also join Prostate Pointers’ intimacy list as well to learn more about prostate cancer and impotence.

Thanks to Richard Wassersug for his help in writing this article.

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Navon L, Morag A. Advanced prostate cancer patients’ ways of coping with the hormonal therapy’s effect on body, sexuality, and spousal ties. Qual Health Res. 2003;13:1378-1391.