The Psycho-Sexual (Side) Effect
In this article, I’d like to talk about a few of the not-so-commonly discussed issues that are related to prostate cancer. While there are many journal articles written about the direct physical effects of prostate cancer treatments, which include urinary incontinence, bowel problems and issues with sexual performance, I’d like to focus on the emotional and psychological side effects related to Sexual Health. I’d like to conclude this article with a few solutions that some men have found help them.
To begin, lets start by saying erectile dysfunction (ED) is the most common side effect related to prostate cancer treatments, where 60% to 93% of men report ED, depending on the study.4 Most men report that ED is more distressing than other side effects including urinary incontinence2 or a loss of self-esteem.3 With that said, what about the psychosexual changes related to issues with sexual health?
Masculinity and ED
In our society, a large part of how we view our manhood/masculinity is related to sexual conquests, performance, and our self-esteem. So, when our “sexuality” (achieved through penile penetration) is taken away due to an illness or medical treatments, what’s a man to do? This loss can have a profound effect on the emotional or psychological well-being of men, beyond the physical act of sex itself. In response to a comment in a focus group, a gentleman summed up his feelings by saying:
“I think probably for a good bit of your life you're either defined by your feelings about your sexuality or it gets defined for you by the popular culture. And I know what he's saying. I mean something might happen…someone might say ``I'm interested in you,'' and you couldn't pull it off, you know? And I think, you know, this is our manhood we're talking about, you know? And it can be pretty hard to deal with it, but I think that's been a big thing for me and I think probably other people have experienced it.”1
This man is explaining how he would like to have sex with someone but now, he just cannot “pull it off.” This statement captures the realization that his future sex life will be much different than his previous sex life and how it is going to affect his definition of manhood. So now, we understand there will be changes that will accompany your sex life so, what about the emotional and psychological changes?
A research article published in 2001 discussed the effects of treatment on the quality of life of men who had undergone radical prostatectomy, external beam radiotherapy or brachytherapy (radioactive seed implants). The article goes on to mention 4 areas that were affected by erectile dysfunction and some issues related to these 4 main areas:
Anxiety about satisfying a partner and oneself
Hesitation in initiating physical intimacy
Feeling that sex is awkward and unnatural
Relationships with women:
Awareness of loss of potential for sexual intimacy
Disquieting absence of a sexual element in everyday interaction
Qualitative shift in interactions with women
Distressing lack of physical or emotional response to attractive women
Loss of pleasant pastime: fantasizing about sexual intimacy
Sense of oneself as a man is diminished
Loss of sexual function means loss of a defining feature of manhood
As you can see, men often report a loss in physical sexual ability along with emotional impact and psychological doubts as well. Feeling anxious about satisfying a partner, hesitation, awkward, unnatural and distressing are all words used by men to describe their sexual thoughts and outlook. These men also reported their sense of manhood is diminished. It’s my belief that sex therapy and ‘relearning sex’ can be a benefit to men who report these feelings.
While I’m not a medical doctor, I commend the work they do to save lives and add more years to men’s lives. Today, many physicians who treat prostate cancer also work with sexual therapists who help guide men through the understanding treatment options, the possible changes to their physical and psychological sexual response, and also offer options for better sexual activity and sexual health.
Without question, sexual therapy should be included as a part of their patient’s treatment. While adding years to their lives, men with prostate cancer can and should remain sexually active, while adhering to their prescribed medical treatment.
What was the most difficult part of your diagnosis?