Many men and their partners have questions about sexual functioning and satisfaction after prostate surgery. Anne Katz, RN, PhD, and author of the new book, Man Cancer Sex (Hygeia Media; 2009), wants men and their partners to understand the sensitive issues surrounding sex after cancer. Her book explores male sexuality and the issues they face when they have cancer such as loss of libido, erectile dysfunction, and fertility issues. Today Dr. Katz answers some questions about sexuality, open communication, and the importance of understanding possible issues before having surgery.
Denene Brox: What are some of the most common sexual questions that men and their partners have about the effects of prostate surgery?
Anne Katz: In the immediate crisis of hearing the words "you have prostate cancer," many men don't even think about the consequences of treatment and instead focus on surviving the cancer. Ideally, men and their partners should have an in-depth discussion about the pros and cons of each of the treatments for prostate cancer (surgery; external beam radiation; brachytherapy; cryotherapy) BEFORE deciding on a treatment. In the real world, this does not necessarily happen. In the rush to be treated, many men accept what is offered by the specialist and then deal with the consequences afterward.
Questions they SHOULD ask include:
- For a man with my level of erectile functioning, what are the chances that I will be able to have and maintain an erection after treatment?
- What kind of support is offered to help me with erectile functioning after treatment?
- Does the specialist provide penile rehabilitation services after treatment?
DB: What are some common misconceptions about sex after prostate surgery and what's the truth to these issues?
AK: Some people assume that a man cannot have an orgasm without an erection; he can and will with genital stimulation. However, it will be a dry orgasm; there will be no emission with orgasm.
Another misconception is that drugs such as Viagra, Cialis, and Levitra will work. In reality they only help about 50% of the time and their success is also dependent on how well the surgeon did nerve-sparing as well as how good the man's erections were before the surgery.
DB: What can women expect after their partner undergoes prostate surgery?
AK: Every man and his partner is different. It is quite common for men to be emotional after surgery and this may be a big change for the couple. Some men become frustrated with the slow progress they make in regards to return of erectile functioning and they distance themselves from their partner and refuse to talk about it. For many men, the incontinence they experience after the catheter comes out is a much bigger deal than the lack of erections. A visit to a pelvic floor physiotherapist before and after surgery can really help with this.
DB: What advice do you give to help couples communicate after surgery?
AK: Many couples find it difficult to really talk about sex and feelings. Meeting with a sexuality counselor or marital therapist can be very helpful. Just having a third person in the room always makes talking easier. The counselor will not let emotions get out of control and will ask questions that help the couple to talk.
DB: What are some creative ways that couples can maintain intimacy and satisfaction if the man isn't able to function sexually after surgery or he has longstanding issues that affect their sex life?
AK: Most of us have been trained that intercourse is the ultimate goal and end point of sexual activity. So if intercourse is not possible, many couples just give up. Most women will admit that they enjoy all the touching that leads up to intercourse way more than the penetration itself. I advise couples to pretend that they are teenagers again, and really experiment with sensual touch. Take time to explore each others' bodies without the aim being penetration. Couples are often surprised at how satisfying that is. Talking about how much you love and care for each other is also important and helps to keep that intimate contact. Intimacy is about the heart to heart connection we have with our partner and NOT about sex!
DB: Any final thoughts?
AK: Prostate cancer, because it is usually diagnosed early, is highly curable. This is the good news. The bad news is that the side effects of all of the treatments cause a significant impact on quality of life. Many men rush into treatment and don't worry about the side effects and what they might mean in their life -- there is usually time to consider these and make an informed decision. The cancer will be cured, but you then have to live with the consequences. Take your time, talk to more than one specialist (e.g. surgeon and radiation oncologist), talk to other men, look at legitimate sites on the web (e.g. Mayo clinic, Memorial Sloan Kettering' Us Two) and then decide.