In this interview, Alicia B. Saunders, PhD discusses ways to help couples enhance their sex life when impotence or loss of libido is a problem after prostate cancer treatment, including mutual masturbation. Dr. Saunders is a leading authority on sexual issues who has appeared on ABC’s "The View" and was interviewed by Barbara Walters on "Sexual Healing." A Licensed Professional Counselor by the Board of Marriage and Family Therapy of the State of NJ, and a Board Certified Sex Therapist and Clinical Sexologist, Dr. Saunders is also on the Board of the Prostate Center at the Cancer Institute of New Jersey, and is on the Allied Health staff of Overlook Hospital. She has counseled individuals and couples for over 20 years.
HisProstateCancer: Many wives tell us that their men—especially those on hormone treatment—are not interested in sex or are afraid of not being able to perform.
Dr. Saunders: Men who have dealt with prostate cancer have to learn that sex is a whole body experience. It is not just genitalia. They have to concentrate on finding the parts of their body that are sensitive to touch. We have over a hundred billion nerve cells in our brain, as well as nerve endings all over our bodies. In just one square inch of our hands there are over 9,000 nerve endings. The brain is a big part of sex, as is touching. If you concentrate on rubbing someone’s hands (or feet), you can feel intimate and close. Try this all over the body and find where it feels best to touch and be touched.
HisProstateCancer: Some men may be afraid that they will feel pressured to perform sexually. How can wives/partners help their men feel more at ease whether they choose to explore mutual masturbation or not?
Dr. Saunders: When I define sex, I break it down into three parts. The “S” in sex is for safety. Safety means that you don’t have to worry about an outcome. For women part of the safety issue is “does he like my body?,” so self-esteem is an important part of being sexual. For men, sex is no longer safe because they have to worry about whether or not they can achieve an erection.
The “E” in sex is energy. After surgery or radiation many men have little or no energy, and if they are on hormone therapy there’s not much sexual energy either. Women as caretakers have more responsibility and therefore less energy as well.
The “X” in sex is for exploration. That’s what keeps a sex life going and keeps it new after 10, 20, or 30 years. Exploration and finding new ways to be intimate is essential to a happy and exciting relationship.
"The new experiences may be different, but they can still be good!" Alicia B. Saunders, PhD
HisProstateCancer: Should wives/partners try to re-engage their men?
Dr. Saunders: First and foremost, women must learn their own sexual patterns. For many women this means making friends with a vibrator. We can’t expect our husbands or partners to know our bodies unless we know them ourselves. Learn what you need when interacting sensually and/or sexually. Learn what is and isn’t necessary. For some women it means exploring their personal definition of orgasm.
Women have to become the initiators, especially with men on hormone therapy. Communication is essential. Having a conversation about being sensual together in new and different ways. Women must now be responsible for satisfying themselves. Unless it’s against your religious or moral views, self stimulation—with or without your partner—is an important part of your new sexuality.
One new way may be enticing each other by mutual masturbation. I prefer the term self-pleasuring. Holding each other and self-pleasuring can be exciting. Part of the purpose of this is to get in touch with being intimate and not putting pressure on the man to perform.
One of the things that men do—with or without prostate cancer—is called spectatoring, which means part of them is in bed and part of them is flying overhead and looking to see if they’re getting an erection. As soon as a man does this, it becomes more difficult to get an erection. You can’t watch it and have it happen at the same time. If he gets an erection, fine. If he doesn’t, that’s fine too. Even if he does get an erection, you won’t necessarily use it the way he used to. Couples need to have an agreement ahead of time that this is more about exploration than intercourse.
HisProstateCancer: What are some other avenues couples can explore if mutual masturbation or self-pleasuring isn’t right for them?
Dr. Saunders: Sensate focus is intimate and can be presented as a game. You can say “I’m going to touch you and I want you to tell me if it’s a one or ten (ten being the best) so I can understand where and how you like to be touched.” This needs to be a two-way game so each of you gains a better understanding of each other’s bodies. You can include undressing each other, which can be very sensual on its own. Lingerie is available today for women and men (silk boxers for example) and can add excitement to an intimate interlude.
There are many other things that couples can do together. They can watch sexual videos together. There are many more sexually explicit videos that appeal to both men and women today. Or go to the Internet, where sexuality abounds. Showers are a fun place to play around. Often couples are less inhibited in water. You can bring a small stool into the shower to be more comfortable and perhaps enhance being playful in the water.
There is also fantasy. You can discuss fantasy with your partner and decide if you want to role play any part of them. You can start the conversation by talking about the "dreams" you had and how to incorporate them into your sex life.
HisProstateCancer: For some couples, these new ways of exploring intimacy—such as mutual masturbation or sensate focus—may be a bit scary. What would you say to encourage them to consider something new like mutual masturbation or fantasy role playing?
Dr. Saunders: Regardless of what disease we are talking about, disease makes you realign, reassign, and redefine your sex life. That part of what you’re dealing with. It’s not what it used to be, but being intimate can still be a positive experience. The new experiences may be different, but they can still be good!
HisProstateCancer thanks Dr. Saunders for her insights on how couples can explore new avenues of intimacy after prostate cancer, such as sensate focus, fantasy, and mutual masturbation.
Always consult a medical professional.