Sexual Recovery after Prostate Cancer: 9 Tips from a Sex Therapist
Erica Marchand, PhD
If you or your partner have experienced prostate cancer, you might have questions and concerns about sexual recovery and rebuilding your sex life. This article will help identify things you can do now, wherever you are in your recovery, to start to create a sex life you want. With prostate cancer, as with many things in life, there are the physical realities of the situation, and there are options for dealing with those realities. How we deal with the realities influences how they affect our lives. Try to adopt the mindset that you will do your best to create what you want sexually, within the boundaries of what’s physically possible.
What do you think of when you think of life after prostate cancer? For many people, sexual concerns are at the top of the list. What are some common concerns related to sexual functioning after prostate cancer?
Erectile dysfunction
Changes in orgasm & ejaculation
Loss of desire
Feeling less masculine
Fatigue
Partner communication issues
Fear or anxiety
Sadness or loss
Erica Marchand, Ph.D. is a licensed psychologist specializing in sexual and relationship concerns. She earned her Ph.D. in counseling psychology from the University of Oregon, and arrived in sunny Los Angeles in 2010 for postdoctoral training at UCLA. She fell in love with southern California and never left. She has conducted research in the areas of family influences on sexual behavior, and sexual adjustment after cancer. She helped to develop and deliver a workshop called Life after Breast Cancer in her role as Project Scientist at UCLA, and is currently co-authoring a book chapter called ‘Sex and Cancer’ in the Textbook of Clinical Sexual Medicine, due out next year. She has a private practice in Los Angeles.
Let’s talk about physical care first. For many people, there’s a period of physical healing from 6-24 months after surgery or radiation. During that time your doctor may prescribe medications or activities that are intended to help with healing and sexual recovery. Be sure to do the things your doctor has recommended. Be consistent. This will give you the best chance of recovering full sexual function. If your doctor hasn’t talked to you about sexual recovery, ask him or her about it specifically.
For many people, there’s also a period of mental and emotional adjustment after treatment. You and your body have been through a lot. Give yourself time and space to feel whatever you feel. Sadness, fear, loss, worry, grief, anxiety, anger, and other difficult emotions might be part of your experience.
We can place a lot of pressure on ourselves to minimize difficult feelings and “push through” or “keep your chin up.” However, it’s not possible to skip over hard feelings when something difficult happens. They’re still there, and if we don’t acknowledge them, they tend to come out in other ways. So if you’re feeling shaken up, know that it’s normal, and give yourself time to process it. You might talk with a friend, write about it, make some art, play some music, move your body, or just sit with yourself and experience what’s going on inside. Trust that the feelings won’t consume you, and you’ll come out the other side stronger.
9 Tips for Sexual Recovery
When you’re ready to think about sex again, these tips can help:
Define what you want. What do you value and want in your sex life? It’s easy to get caught up in fearing what we don’t want, but it’s more helpful to define what we want. Even with physical changes, how would you like your sex life to be following prostate cancer? Think of some adjectives – hot, fun, pleasurable, sexy, active… Think of some activities you’d like to include, and how you’d like to feel. Spend some time visualizing all this, so you’ll know what you’re aiming for.
Manage fear and anxiety. Notice what happens when you visualize what you want. You might feel a mix of emotions, including fear and anxiety. You might be thinking about how you’re ever going get back to what you want sexually. Accept these thoughts and feelings, but don’t let them stop you. If you have doubts and fears, try thinking of them as your inevitable companions on this journey back to better sex.
It’s normal for them to be there. You might think of them as passengers in your car. You get to drive the car down the road toward where you want to go, and your doubts and fears can accompany you, in the back seat. Notice that you don’t have to kick doubts and fears out of the car entirely. In fact, you probably can’t. But you can bring them along for the ride rather than having them stop you. They don’t get to sit up front or drive the car. They have to sit in the back seat while YOU drive the car. You get to be in charge of envisioning what you want regarding sexual recovery, and try your best to get it.
Talk with your partner. If you’re concerned about changes in sexual function, or differences in how you feel, or wondering what your partner might be thinking, the best thing to do is to talk about it. Pick a good time, when you’re not tired, not pressed for time, and your partner is available to talk—maybe over coffee or a glass of wine. You might start by saying something like, “Hey honey, I want to talk to you about something… Our sex life is really important to me and I know that prostate cancer has changed things… I want to talk about what’s on my mind, and anything that might be on your mind, and where we should go from here.” You might tell your partner about what you want in your sex life at this stage, and ask what they want as well.
Explore your body. Once you’ve healed enough that it’s safe to do so, spend some time with sexual self-stimulation to see how your body responds. What do you notice about what kind of stimulation you need to get aroused? The amount of time needed to get aroused? How your physical response matches your mental response? How orgasm feels? Try to do this with an open mind and a sense of exploration. This will help you know what to expect in a sexual encounter, and any changes you might want to tell your partner about.
Identify what would feel good. What might you want to do with your partner, after knowing a little more about how your body is responding right now? For many guys, erections don’t return right away, or they may return but be different that what you’re used to. It can be tempting to put off sexual activity until things feel more “normal” again. In doing so, though, you and your partner might be missing out on opportunities for pleasure and connection. If you’re willing to experiment, identify some activities you and your partner might enjoy that don’t necessarily require an erection. Then, try them. And enjoy.
Play. Take a deep breath and try to mentally take the pressure off of yourself to perform or achieve anything. Try to re-frame your role in sex to something less achievement-oriented – a participant, not a performer. Especially when you’re re-learning and adjusting to changes in your body, internal pressure to achieve can be counterproductive. It can be helpful to give yourself permission just to play -- participate, experiment, and see what feels good to you and your partner, with no particular outcome in mind.
Start from neutral. One of the top complaints I hear about prostate cancer treatment is loss of desire for sex. This might be from androgen-deprivation therapy, physical, and psychological effects of surgery or radiation, or just garden-variety stress and fatigue. If you’re not spontaneously desiring sexual activity but know that you want sex back in your life, consider starting from neutral. This means making a conscious choice, based on your own vision for your sex life, that you would like to engage in sexual activity, regardless of how much desire you feel at the outset. For many people, desire can emerge in the process of starting to be sexual and experiencing arousal, even if the desire wasn’t present at the beginning. If you’re accustomed to your sex life being driven by spontaneous desire, this might be new for you. I’d encourage you to give it a try and see what happens.
Be extremely kind to yourself. Again, your body and mind have been through a lot. It can be vulnerable to open up sexually to a partner after all of this, and it helps to be on your own team, cheering yourself on through the changes. If you tend to be self-critical, watch out for this tendency during sexual recovery. Try to congratulate yourself instead for small successes, and especially for showing up and trying to get what you want.
Take good care of yourself. This goes along with the previous tip, and it’s fundamental. Eat well, sleep, exercise, give yourself downtime when you need it, talk to your support system, do things you enjoy. Sexual recovery is easier with a good foundation of self-care.
Conclusions
Hopefully, this gives you some ideas for how to regain and re-create the sex life you want after prostate cancer. If you get stuck, or you and your partner run into problems you can’t solve, remember that a little bit of counseling can go a long way to helping you get past those bumps. Don’t hesitate to seek out a good therapist if you think it could help you create a more enjoyable, satisfying sexual recovery.