Prostate cancer is widely acknowledged as a couples’ disease, in no small part to assumptions about the man’s role in initiating sex; as a result, the sexual side effects of treatment are deemed to affect not just the man but his partner as well. There is perhaps some truth to this however it is also predominately a disease of aging men and with age comes alterations in sexual potential. The partner of the man with prostate cancer is also older and may have issues related to aging him or herself too.
While there is a plethora of literature on treatment of the erectile changes that are probable after treatment for prostate cancer (surgery, radiation, and androgen deprivation therapy for advanced disease), there is much less published on how to treat the couple and what strategies are useful in the context of lack of communication about sexual issues that is common among couples. Men and women often approach sexual activity from different perspectives; a trite but perhaps accurate saying is that men give love to get sex and women give sex to get love. When sex (or for that matter, love) is taken out of the relationship, problems often occur and many couples do not seek help, or are given help that is focused on function rather than the relationship.
I recently published an article in the journal Sex and Relationship Therapy (doi: dx.doi.org/10.1080/14681994.2015.1102876) on this topic. The review provides information about what happens to the relationship for both hetero- and homosexual couples when a man is diagnosed with prostate cancer. It also discusses the strategies that have been used to treat sexual problems affecting these couples including pharmaceutical, non-pharmaceutical, psycho-educational and counseling interventions.
In short, dealing with just the physical functioning deficits will not address the relationship issues that often ensue and merely attending to the relationship issues without taking into account the effects of erectile problems on male self-image is just as ineffective. Medical professionals are often not equipped to deal with the complex psychosocial issues facing these couples and mental health professionals often lack the in-depth knowledge of the anatomical and physiological effects of treatment on sexual function.
Dr Anne Katz is a clinical nurse specialist and AASECT-certified sexuality counsellor at CancerCare Manitoba. She has written 2 books on the topic of cancer survivorship (After You Ring the Bell: Ten Challenges for the Cancer Survivor [Hygeia Media] and Surviving after Cancer: Living the New Normal [Rowman & Littlefield]) and 3 on cancer and sexuality.
“I am thrilled to be taking on this new role as editor of the Survivorship Section for CKN. Initially you will see regular commentary from me on key aspects of the survivorship experience that I hope will lead you to think about, talk about with your patients and care providers, and then explore further in your own reading and research. Coupled with this will be key references to new research findings in this exciting growth area of cancer care.”
Dr. Katz’ professional life is focused on providing information, education and counselling to people with cancer and their partners about sexual changes that can occur during and after treatment. But there is another important aspect to this work; Dr. Katz wants every cancer patient to be able to have a discussion about sexuality with their health care providers. And so she travels across North America (as well as Europe and the Caribbean!) teaching health care providers to ask their patients about this important part of quality of life.
If you’d like to know more about Dr. Katz and the work she does, or if you’d like her to come to your city or town, health care facility or doctor’s office, you can contact her by email.
“I am always eager to spread the word and break the silence.”