When two people have a loving partnership and one of them is diagnosed with cancer, it’s as if they are both slammed by a semi-truck. Although one is the patient, as a couple they are interdependent. This means that over their history of togetherness, be it short of long, they have developed sensitivities to the feelings and needs of each other as they have each leaned on and cared for the other. When cancer strikes, the partner suffers as much as the patient.

This impact is especially poignant for prostate cancer (PCa) patients, because PCa treatments can affect sexual intimacy. According to the Sexual Medicine Society of North America (SMSNA), “When a man has prostate cancer, his partner may feel the effects, too. Those effects might not be direct, but they can greatly change a partner’s quality of life.”

Specifically, treating localized PCa can have a short-term, or even long-term, impact on a man’s ability to get and maintain an erection. This may tax the positive coping strategies the two partners have developed over the years. While they may have succeeded in resolving financial problems, childrearing issues, job and career changes, etc., a break in accustomed sexual intimacy may stress the relationship itself.

Problems in the bedroom

No doubt, every couple has occasionally come up against emotional and communication difficulties that have interfered with loving, satisfying sex. However, if PCa treatment leads to a sudden halt or stumbling block in their sex life, it’s the other way around. Sexual problems can now trigger emotional and communications difficulties. If the two partners cannot enjoy the intimacy they are used to, it raises complicated personal feelings of disappointment, loss of confidence, questioning one’s appeal, blaming each other, etc. Practically overnight, what used to be loving, fun, playful, and reassuring has become stressful. Plus, there are additional stressors like doctor appointments for penile rehabilitation, trying medications, injections, devices—all the spontaneity of sex seems to vanish. This situation requires mutual willingness to make time to speak honestly about sadness, helplessness, discouragement and frustration, without pointing fingers. It requires empathic listening and patience.

Couples-focused cancer care

Fortunately, in the world of cancer care there is increased sensitivity to couples’ physical, mental and emotional needs. Doctors are trying to be more attentive and available in the aftermath of treatment. For example, in 2015 a multidisciplinary team surveyed healthcare professionals and couples to identify the issues faced by couples, and how their needs could be better met during the cancer journey. Several themes emerged:

1. Positive and negative coping strategies used by couples, and their perception of lack of helpful engagement by healthcare professionals,
2. While couples did not necessarily feel a need for specialist intervention (e.g., social worker or psychologist), healthcare professionals who were not themselves trained to intervene in “psychosocial problems” were of the opinion that couples could use specialty support, and
3. Couples expressed a need for more and better information at every stage of the cancer journey, and emphasized the need for better relationships with their physicians.^[i]

Often, the patient’s PCa diagnosis, treatment, and possible side effects eclipse his partner’s needs as mate and caregiver. The American Urological Association’s patient website, urologyhealth.org offers these helpful suggestions for PCa partners/caregivers:

• Go to doctor appointments. Take notes. Research shows that people coping with cancer may not hear everything and miss important information about their care.
• If asked, help explore treatment options.
• All prostate cancer treatments have side effects; it is important to discuss with your loved one how you’ll be involved in supporting him.
• Take time to do what nurtures you. Take a walk, talk to friends, read and play music – you are important and your well-being matters too.
• If your loved one is overwhelmed, talk to him and his doctor about counseling.

With regard to sex, the third bullet point identifies the importance of discussion. Conversations about possible sexual side effects and how the two partners will deal with them between the sheets should begin well before treatment. While it’s impossible to anticipate what it will “really be like”, agree to take it slowly, one step at a time, and acknowledge that one partner’s timing and comfort threshold will likely differ from the other’s. Also, agree in advance to ask for outside help/counseling if your own efforts aren’t working. After all, neither partner. has an Owner’s Manual on how to deal with a medically interrupted sex life and experimenting with medically prescribed therapies. Trust that each partner values love and respect above all else, and that your relationship will survive and thrive.

When considering treatments, today there are more potency-preserving options for patients with localized disease. The key is to establish “best fit” to ensure a choice with the greatest cancer control and fastest return to baseline function. This means obtaining accurate, thorough knowledge of one’s PCa. Our Center provides state-of-the-art multiparametric MRI, real-time in-bore MRI targeted biopsy for the most accurate PCa grading and staging available, and genomic analysis as indicated. For carefully qualified patients, we also offer three focal treatments with very low risk of interrupted erectile function: Focal Laser Ablation, Exablate MRI-guided Focused Ultrasound, and TULSA-PRO. Contact us confidentially for more information.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

[i] Regan T, Levesque JV, Lambert SD, Kelly B. A Qualitative Investigation of Health Care Professionals’, Patients’ and Partners’ Views on Psychosocial Issues and Related Interventions for Couples Coping with Cancer. PLoS One. 2015;10(7):e0133837. Published 2015 Jul 29.