Prostate cancer and impotence

How men feel about it

When it comes to prostate cancer and impotence, we would never profess to understand how all men think.

But we can share insights about what men may be feeling when faced with partial or complete loss of erectile dysfunction (ED) and loss of libido (sexual desire) based on literature about recent research.

Setting the stage

It’s important to understand that men who are experiencing ED after surgery or radiation therapy generally do not lose their libido.

Men with advanced prostate cancer who are on hormone therapy (also called androgen deprivation therapy or ADT), however, 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)
• Hot flashes

All of these side effects can be challenging to both men and their partners.  Some couples:

• Grow closer and develop even greater intimacy than before prostate cancer
• 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 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.

Concerning bodily changes, men on ADT may:

• Feel ashamed and embarrassed by their bodies
• Have a hard time adjusting to bodily changes and feel uncomfortable talking about them
• Seek to hide bodily changes and fear that they will be embarrassed by others if these changes are observed
• Avoid public places because they don’t want to be seen naked

Concerning sex, men on ADT may:

• Often experience a significant reduction in libido, but 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
• Accept their decreased desire, but feel uncomfortable when their wives/partners want to discuss it, because they feel there is “nothing to talk about”
• Love their wives deeply — and don’t wish to be with anyone else —  but may be afraid to “start something sexually they can’t finish”
• 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
• Mourn the loss of sexual desire and erectile function, and the loss of their erotic dreams and fantasies
• Fear admitting to their wives/partners that they’ve stopped enjoying sex
• Maintain strong, loving relationships with their wives/partners, but view these relationships as more platonic than romantic
• Avoid social situations where other couples show their affection because it is too difficult to watch

Also, 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 and they may:

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

Men on ADT may also:

• Lose their excitement and enthusiasm for activities, yet may fake these feelings in public for their partner’s sake
• 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
• Feel that they are no longer good husbands because of their failure to have sexual intercourse
• Feel too embarrassed to seek professional help for physical and/or emotional problems

How partners can cope

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 website to help you cope with problems caused by prostate cancer and impotence.

Depression may be a factor

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.

Talk about 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 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.

Many thanks to Richard Wassersug for his help in writing this article.

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References:

Boehmer U, Clark JA. Communication about prostate cancer between men and their wives. J Fam Pract. 2000;50:226-231.

Chapple A, Ziebland S. Prostate cancer: embodied experience and perceptions of masculinity. Sociology of Health and Illness. 2002;24:820-841.

Clark, JA, Wray N, Brody B, et al. Dimensions of quality of life expressed by men treated for metastatic prostate cancer. Social Science & Medicine. 1997:45:580-602.

Fitch MI, Gray R, Franssen E, Johnson B. Men’s perspectives on the impact of prostate cancer: implications for oncology nurses. Oncology Nursing Forum. 2000;27:1255-1263.

Herr HW, Kornblith AB, Ofman U. A comparison of the quality of life of patients with metastatic prostate cancer who received or did not receive hormone therapy. Cancer. 1993:71:1143-1150.

Heyman EN, Rosner TT. Prostate cancer: An intimate view from patients and wives. Urologic Nursing. 1996:16:37-44.

Jakobsson L, Hallberg IR, Loven L. Experiences of micturition problems, indwelling catheter treatment and sexual life consequences in men with prostate cancer. Journal of Advanced Nursing. 2000;31:59-67.

Kornblith AB, Herr HW, Ofman et al. Quality of life of patients with prostate cancer and their spouses: The value of a data base in clinical care. Cancer. 1994;73:2791-2802.

Lavery JF, Clarke VA. Prostate cancer: Patients’ and spouses’ coping and marital adjustment. Psychology, Health and Medicine. 1999:4:289-302.

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.

Always consult a medical professional.