A prostate cancer diagnosis can change life in many ways. For many men, the immediate priority is survival: get rid of the cancer, have the surgery, complete treatment and get through it.
Initially, questions about life after cancer including sexual function, intimacy and relationships can feel secondary. But as more men survive prostate cancer and live for years after treatment, those issues matter more than ever and experts say they should be addressed before treatment, not only afterward.
Preparing for life after treatment
"When you get a cancer diagnosis, it's overwhelming," says Dana D'Alessandro, LICSW, a sex therapist at Tufts Medicine who works with cancer patients and survivors. "Sex may be the last thing on your mind."
But thinking ahead helps patients see that treatment is only one part of a much longer journey. Conversations about sexual health can begin before treatment. This approach, sometimes called "prehab," helps patients understand how treatment may affect sexual function and what they can do to prepare.
The goal isn't to suggest that patients should be thinking about sex while undergoing treatment. Illness, fatigue and anxiety often make sex a low priority. Instead, early conversations recognize that sexual health can become an important part of life after cancer.
What can change?
Prostate cancer treatment can affect sexual health in several ways. Depending on the treatment, men may experience erectile dysfunction, difficulty reaching orgasm or a decrease in sexual desire. Hormone therapy, in particular, can reduce libido and affect erectile function.
The effects can be temporary or long-lasting, and they vary from person to person.
“But the impact isn't simply physical. For some men, changes in sexual function can affect confidence, identity and their sense of masculinity,” said D’Alesasndro.
There can also be grief and loss. Even when treatment is successful, a person's body or sexual life may have changed. Those feelings are legitimate.
Different doesn't have to mean worse
According to D’Alessandro, one of the most important messages for cancer survivors is simple: different doesn't have to mean worse.
“Sexual intimacy after treatment may require more planning and may not be as spontaneous as it once was,” she said. Some men may need medication, devices or other treatments to address erectile dysfunction. But intimacy doesn't have to disappear.
Rather than continually comparing the present with the past, patients can ask: Given where I am now, what can I create going forward that works for me and my partner?
D’Alessandro similarly encourages men and couples to reconsider the idea that sex has to follow a particular sequence or depend on an erection or orgasm. Broadening the definition of intimacy can reduce frustration and create new opportunities for connection.
Focus on connection and pleasure
More often, people describe wanting connection and pleasure.
That perspective can open up new possibilities. If intercourse isn't possible, or doesn't work as planned, the experience doesn't have to end in disappointment. Couples can develop a "Plan B," identifying other ways to maintain intimacy and pleasure. Touch, affection and exploring other forms of sensuality can become part of rebuilding an intimate relationship.
Touch is an important part of intimacy, encouraging couples to explore the entire body rather than making sexual activity dependent on genital function.
No one is a mind reader
Communication is critical. Cancer treatment can affect desire, arousal and sexual function. Partners may interpret those changes personally, wondering whether they are no longer attractive or whether they have done something wrong. At the same time, the person experiencing the changes may worry about disappointing a partner.
"No one's a mind reader," D’Alessandro said.
Even couples who have been together for decades cannot automatically know what the other person is thinking or feeling. Talking openly about desire, expectations, anxiety and what feels good can help prevent misunderstandings. Partners can also participate in therapy when appropriate, giving both people a chance to understand that changes in sexual function are not necessarily about attraction or rejection.
Listen to your partner
Rather than assuming you know what your partner wants or needs, ask. What feels good? What feels comfortable? What creates intimacy? What would you like to try?
Those conversations can provide a roadmap for rebuilding intimacy.
Men may also benefit from recognizing that sexual arousal isn't purely physical. Anxiety, fatigue, stress, relationship difficulties and the emotional impact of a cancer diagnosis can all affect arousal. Medical treatments can help address physical problems, but changing expectations and approaches to intimacy can also be an important part of recovery.
Getting help is part of recovery
Sexual health doesn't have to be something men and their partners figure out on their own. A urologist can address physical issues and discuss treatment options, while a mental health professional or certified sex therapist can help with the emotional and relationship aspects. D’Alessandro recommends these resources as part of comprehensive support for men dealing with the effects of prostate cancer treatment.
Seeking help isn't an admission that something has gone wrong. It can be part of learning how to move forward.
3 things to remember
- Sex is about connection and pleasure. Sexual intimacy doesn't have to be defined by one act or outcome. Couples can explore new ways to experience closeness and pleasure.
- Grief and loss are real parts of survivorship. Being cancer-free doesn't mean every emotional consequence disappears. Changes in sexual function, body image and identity can take time to process.
- Don't lose hope. Sexual intimacy may look different after prostate cancer treatment, but different does not necessarily mean worse.
For someone newly diagnosed with prostate cancer, talking about sex may seem far down the list of priorities. But introducing the conversation early can help patients understand that sexual health and intimacy are legitimate parts of survivorship.
The goal isn't to promise that everything will be exactly as it was before cancer. It's to help patients see that surviving cancer and having a fulfilling personal life do not have to be mutually exclusive.
People who survive prostate cancer deserve more than simply being cancer-free. They deserve the opportunity to reconnect with themselves, their partners, intimacy and pleasure, and sometimes the first step is simply starting the conversation.
Sexual health is an important part of cancer survivorship. If you’re experiencing changes in sexual function, intimacy or desire after prostate cancer treatment, our sexual health specialists can help.
