Human Sexuality and Prostate Cancer

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My first academic encounter with the field of human sexuality as a topic was a series of lectures by none other than William Masters and Virginia Johnson at Washington University in 1970. The sexual revolution afforded by birth control pills and the reactionary politics of the late 60’s have been well chronicled in many places but were fairly remote to someone like me who had been studying hard to achieve medical school admission and then trying to keep up with an exceptionally bright group of classmates. Never-the-less, as a prostate cancer specialist, I have been drawn into countless differing situations that impact individual patients and their sexuality issues. While discussing sexual function has become far easier than it was when Masters had the doors locked at the back of our lecture hall in order to show videos of the human sexual response to our class, it is still a delicate topic for most patients, and, I suspect, for most physicians.

Every patient I have encountered has a different history, sexual relationship, and level of interest in delving into the side effects of prostate cancer treatment. There are a few givens that every patient should understand, however. First, in my experience there are virtually no patients who don’t experience negative side effects of ANY prostate cancer treatment, although with active surveillance and focal treatment of a small cancer with a technique like cryotherapy or HIFU , many have minimal side effects (if they are lucky). Even these patients must deal with the psychological burden of being diagnosed with cancer and the possibility that further treatment may eventually be necessary.

A second observation is that even though for most of my patients, sexuality is a “couples experience”, only about half of the men have had a spouse or significant other with them during my initial consultation. In addition, the spouse/SO has her/his own issues regarding the sexual side effects their partner may experience. As a relatively common observation I have noted among heterosexual, married patients, the wife often expresses some version of the following statement: “I just want it out of [George/John/Billy] – we don’t care that much about the side effects…I just want him to be alive 10 years from now…” Often, George is sitting quietly in the patient chair looking somewhat forlorn after such a revelation/statement. There are many books etc. written about the highly variable but often differing interest in sexual relationships among aging couples.  I am certainly not an expert, just an observer, but I have pondered the larger meaning of these sentiments compared to the relatively intense emotions that some attach to, for example, breast reconstruction after a mastectomy for breast cancer. In any case, I think those men who have supportive SO’s who come to their doctor visits with them are fortunate and should express their appreciation to their partners. Sometimes these life challenges can be opportunities for growth in a relationship. Sometimes they are a disaster…

Most of the prostate cancer support groups, and the very large body of literature available on the internet and elsewhere, have sessions and chapters devoted to sexuality, recovery from treatment, and references to other resources. Examples include the ASCO patient website, and a similar one from the AUA. I have cared for a few men from the LGBT community and I was recently sent a book, Gay & Bisexual Men Living with Prostate Cancer,  that I scanned and seems to be a well written and fine resource for those men, but there are also a very large number of websites devoted to that community as well.

The bottom line for men with prostate cancer is that there will be sexual side effects, even if only emotional ones. The same could of course be said for aging itself. Whether one chooses to talk about it or “just deal with it” is an individual decision, and different for each man/couple and no doubt different for men of differing ages. In reality, as with the many competing causes of death/debilitation as we grow older, prostate cancer is but one of the many challenges we all will face. In this regard I rather enjoy this perspective from Willie Nelson:

“I have outlived my pecker.”
The Penis Poem–by Willie Nelson

My nookie days are over,
My pilot light is out.
What used to be my sex appeal,
Is now my water spout.
Time was when, on its own accord,
From my trousers it would spring.
But now I’ve got a full time job,
To find the f***in’ thing.
It used to be embarrassing,
The way it would behave.
For every single morning,
It would stand and watch me shave.
Now as old age approaches,
It sure gives me the blues.
To see it hang its little head,
And watch me tie my shoes!!?


Filed under General Prostate Cancer Issues, Prostate cancer therapy

7 responses to “Human Sexuality and Prostate Cancer

  1. Millerjcl

    MIKE loved your latest post. PSA 362. just finished 6 treatments of XOFIGO! now on to Xtandin. Living in Florida A Big Hug John

  2. Elaine T

    I think it is important to emphasize that there are more parts to human sexuality than achieving and maintaining an erection and vaginal intercourse. There are ways to please a partner that are not dependent on the ability to maintain an erection. By putting so much emphasis on that alone, it can make a man feel inadequate. Giving pleasure is as important as getting it. Communicating about needs and desires has helped us maintain sexual activity. Being able to talk about diminished desire is also imperative.

  3. Nancy M.

    Bravo, Mike! I remember the years we worked together with prostate cancer patients, many who had been ill-informed or even outright lied to about the effects of treatment on their sexual function. As a result, many never had the kind of open discussions with their SOs that could have assuaged some of their distress, and as the previous responder noted, actually promoted a more enriched sexuality. I recall one wife timidly asking if she could “catch” cancer from her husband. Sadly, several newly diagnosed friends have told me that their doctors have side-stepped and downplayed these discussions, even now!

    • Agree. I still hear some urologists (few, fortunately) claim their patients have 100% potency and continence. No one wants to hurt a patient, and surgeons love to say “we got it all” to any cancer patient. Reality is sometimes harsh, but better dealt with in honest, empathetic dialog.

  4. Mary

    The other thing is that men lie about their sexual function. Before my husband had LRP in 2002 I had permission and called several previous patients. They were either all working perfectly or nearly working perfectly With steady improvement.. Looking back I knew I was not told the truth by these men.

    Luckily I was like the other wives you mentioned who would rather have their men alive with or without sexual function. I was so happy he became mostly continent after surgery.

    I really enjoy your writings and thank you so much for sharing you wit and knowledge.

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