Originally published 12/22/2015
The blog below is focused on how sexual side effects of prostatectomy can affect a couple’s intimacy. According to a 2014 study, those who are impacted report feelings of grief and diminished confidence. They have to work at intimacy in order to regain more natural spontaneity and enjoyment. This is just one consequence of sexual side effects of whole gland prostate cancer (PCa) treatment. More broadly, a more recent paper explores how relationship dynamics may be altered as couples adjust to diagnosis, decision-making, going through treatment, and the ups and downs of recovery. These may be new emotional territory for a couple. If so, the coping process may “lead to a threatened identity, including sexual insecurities,” write Collaço, et al.[i] The authors also point to conscious or unconscious choices that confront couples:
- Adaptability vs. maintaining continuity
- Connection vs. disengaging from each other
- Need to protect themselves as individuals vs. protecting their couple-ness.
In addition, the partners of patients may experience more demands and responsibilities as caretakers, and some partners “report feeling unsupported and side-lined both by the man they are caring for and by healthcare professionals.” Even couples who consciously embrace the value of going through the PCa journey together may discover unforeseen stressors that expose weaknesses in their relationship. In short, the PCa journey can be harder to get through than couples anticipate. The authors therefore recommend that healthcare professionals should strive “to employ a couple-focused approach where appropriate.” As we stated in our original blog, we endeavor to be sensitive to both members of a couple, and blend education with empathy in order to support each of them in their respective roles.
It is a fact that a diagnosis of prostate cancer doesn’t just affect the patient, but also his partner. The first wave of emotional impact will likely consist of shock, worry, fear for the future, and confused decision-making. Troubling feelings may have an impact on the couple’s love life during the research and decision-making period, as will the fatigue that accompanies the first steps on the road to recovery. What happens to those feelings once treatment has occurred, especially if there are sexual side effects?
A new study from the University of Michigan focused on radical prostatectomy (RP) patients to learn about a particularly intense emotional aspect of the journey: regaining sexual intimacy after treatment[ii]. Twenty couples participated in semi-structured interviews before radical prostatectomy (RP) and three months after. The men’s and the women’s sexual function were assessed separately, and questions about their emotional experience were part of the interviews.
Not all of the couples were equally sexually active (30% of men had ED and 84% of partners were postmenopausal). However, they all valued sexual recover and were concerned about treatment side effects. Most of them overestimated erectile recovery, and lost confidence because of the post-RP sexual dysfunction. Their intimacy decreased. According to the study, “Couples reported feeling loss and grief: cancer diagnosis was the first loss, followed by surgery-related sexual losses.” Part of overcoming the disappointment was learning to schedule sex, use erectile aids, and deal with each other’s lack of interest. In a very real sense, they had to work consciously at sex in order to once again enjoy unselfconscious intimacy. The authors recommend that pre-RP patient education include the effects of nerve damage, and address feelings of grief and mourning in sexual recovery.
Not every prostate cancer patient will be a candidate for focal treatment, and not all focal treatments will be able to assure immediate or even long-term return to baseline sexual function. Focal laser ablation (FLA) is incredibly promising with regard to preserving erectile function. Despite the lack of long-term data regarding efficacy against cancer, even the short-term studies indicate that for upwards of 95% of patients, FLA has no effect on their potency—and if it does, return to baseline will occur within a few months at most.
At our Center, we understand that not just the patient, but also his partner are going through a scary time. All the more reason to turn to each other to express love at every level, including physical love. We are grateful that FLA allows that all-important aspect of their relationship to flourish through all stages of a journey that both members of the couple share.
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.
References
[i]Collaço N, Rivas C, Matheson L, Nayoan J et al. Prostate cancer and the impact on couples: a qualitative metasynthesis. Support Care Cancer. 2018 Jun;26(6):1703-1713.
[ii] Wittmann D, Carolan M, Given B et al. What couples say about their recovery of sexual intimacy after prostatectomy: Toward the development of a conceptual model of couples’ sexual recovery after surgery for prostate cancer. J Sex Med. 2014 Oct 31.
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
