Barriers to Sexual Health after Radical Prostatectomy
I came across a research article that looked at the potential sexual barriers couples have prior to surgery or other treatment and their response to the diagnosis of prostate cancer (PC). The overall stress and sexual distress couples go through seem to expand beyond issues with erectile dysfunction, and can also affect them emotionally and socially.1 I think this is an important finding because if healthcare providers do not properly account for these factors, it will be more challenging to assist couples as they seek to return to a state of sexual health that they had before the prostate surgery.
Barriers reported in research
In this study, the researchers looked at the couple as a unit, how they managed the diagnosis of PC and the barriers that affected their sex lives.4 Other researchers felt the diagnosis and treatment(s) can involve a mind-altering transition, connected to an emotional and physical loss, which must be mourned in order to be overcome.3 Given these factors, it seems couples should be able to benefit from medical intervention with the addition of guidance from a therapist. I believe couples have the ability to move forward with the help of medical intervention and sex therapy unless deeply embedded barriers are discovered that hinder their progress. Here are a few potential barriers:
Barriers prior to surgery
Age related loss & decreased emphasis on sex
In this research, couples reported having sex less often. The researchers felt this strategy could be a way to cope with other age-related sexual issues (i.e. erectile dysfunction, decreased vaginal lubrication) without totally disconnecting sexually.2 At the same time, a couple's existing lack of sexual activity may become more of a barrier, as the couple needs to work on sexual interaction post surgery.
Undeveloped skills for maintaining intimacy
A couple’s sexual history is also important. It sets the stage for how they will remain intimate post-surgery. Think of it as practice and maintenance, where the level of intimacy may change but not completely disappear. In other words, the couple knows what they have to do to maintain a level of intimacy that is comfortable for them. They are prepared to and also know how to make the necessary changes for the benefit of their relationship.
On top of the prostate cancer diagnosis and the prospect of surgery with treatments, life still goes on. The bills don't stop and may increase, employment stressors are ever present and other demands of family life are there as well. The level of stress and worry on the couple increases exponentially while they are also trying to maintain their relationship and sexual health.
How couples respond to diagnosis
After the diagnosis, most couples begin to worry about the treatment, surgery and surgical side effects. They often manage this by not thinking about the side effects and may develop highly optimistic expectations of sexual functioning. When these desires become lasting in the face of the evidence, they may complicate the situation unless this is openly discussed. In the research, this has been described as a couple “longing for the past at the cost of adaption to the current circumstances.”
Trouble accepting “artificially” assisted sex
Some men reject the use of erectile aids. Research has shown that many men do not like or don't feel they can adjust to the idea of nonspontaneous assisted sex and viewed it as artificial and unnatural.
Partners may assume responsibility for men’s sexual recovery
This barrier is related to the reality that many partners assume the role of caregiver and sexual partner at the same time. When the partner has less sexual desire, more things to actually do and more things to worry about, their needs and emotions need to also be taken into account. This reality also adds an extra layer of ‘emotional complexity’ to the situation, which can be difficult to manage following the active treatment stage.
Where is the intimacy?
When looking at the barriers before prostate cancer treatment, there are some issues you really cannot get away from. Sexual issues appearing due to age are well documented and commonly occur. Also for some individuals, life is a stressful adventure and is impacted by how you manage the stress. I tend to think the issue couples have the most control over is developing and keeping the skills needed to maintain intimacy.
What was your sex life like prior to surgery? Were you intimate (non-sexually) before the diagnosis? Plus, I have to say this…the sexual health of the couple should not revolve around the gentleman. A focus on the couple, as an intimate unit, is of the utmost importance.
Changing roles, changing perspectives
In closing, I tend to think acknowledging and accepting the situation will help the couple move forward in healing. Memories are great and add richness to the relationship but, when they become a crutch, they can do more harm than good. Secondly, with the diagnosis, the life of the partner also changes so dramatically, she/he needs support too. By adding the caretaker role to her or his life, their place in the relationship just shifted on a variety of levels and perhaps intensity.
I’d like to restate that the focus of care should be on the couple as a whole, not just the gentleman with prostate cancer. With all of the issues the partner just went through with the diagnosis and will continue to go through, they should have access to various types of care (i.e. mental, physical, emotional, etc.).
Finally, the possibility of a man with prostate cancer holding onto the past, so much so that it is causing him to reject “assistance”, can become a major problem in the relationship. In this situation, it may be natural for a man to feel he has "failed" in a central role of his relationship, but his partner is most likely ready for a focus on intimacy and understanding that the "sexual healing" may take time. There are many types of help and assistance, which could get him on the path on returning to being sexually healthy. Thinking about how things used to be is great so, I suggest working on accepting the present and accepting the help so you can be sexually active in new ways in the future.
Which prostate cancer treatment did you first receive?