For Partners

Consultations in a time of Covid-19

In response to the challenge of no longer being able to see clients in my rooms, I am available for phone, Zoom and email consultations. Please feel free to contact me to discuss how this might work for you. We’re all in this together!

If your partner has been diagnosed with prostate cancer, or has undergone treatment, you are likely to be experiencing many strong and sometimes conflicting feelings.

Initial shock

How to help him may not be clear.It is not only your partner who will experience initial shock. If you love and care about him, you are going to be knocked sideways by such a serious threat to his health. You are going to be concerned about whether and how he will survive. You will want to help and support him, but how to do that may not be all that clear.

Weighing treatment options

Most men diagnosed with prostate cancer don't die of it.Of course the doctor/s will talk with him and you about available treatment options. In the best of all worlds, you and your partner will attend medical appointments together and share the discussion and decision-making. You may even be in a position to help with note-taking and keeping track of significant treatment information. However, this may not always happen. You may not be available to attend appointments, the two of you may not be close enough to manage such a thing, or your partner may actually shut you out of this process. However it happens—together with you, or unilaterally on your partner’s part—he will need to decide which, if any, treatment options are right for him. This can be challenging. You/he may focus exclusively on one factor—his survival. It may be hard for either of you to remember that most men diagnosed with prostate cancer don’t die of it. You may initially be concerned more about practical matters such as how the two of you will survive financially, and if you have a family, how you will manage leading up to, during and after treatment. You may have difficulty even deciding how—and how quickly—you ought to make important treatment decisions. The two of you may not agree on this. You might struggle to identify someone with whom you can talk candidly, either as individuals or as a couple, about the intensely personal aspects of prostate cancer treatment.

Treatment side effects

Your partner may experience some or all of the following side effects following treatment, depending on which treatment he chooses:

  • incontinence
  • erectile dysfunction
  • changes in the experience of orgasm
  • penile shortening
  • loss of libido.

These may be temporary or permanent. He is also likely to experience some degree of anxiety and/or depression, which in a small number of cases can become quite serious. Of course these things won’t just affect him. They will affect you, too, and your relationship with him. If you haven’t been great at talking freely and intimately about these sorts of things, this is going to be tricky.

Relationship dilemmas

Perhaps you have been blessed with the capacity to talk about and explore sexual functioning and sexual feelings fully and openly, and you are in a relationship that can weather serious challenges to the expression of intimacy. Then you will find yourselves adapting and discovering new ways of doing things. In fact, for some couples, a reduction in the possibilities of standard penetrative sex has led to an awakening of all kinds of other sexual and intimate exchanges that have deepened the relationship. And of course there will always be couples for whom sex has become less important over the years, and for whom erectile dysfunction and changes in libido cause few ripples.

You may find discussing your sexual feelings uncomfortable.However, it is really important never to assume that this is how your partner feels, or to ignore unmet sexual feelings of your own. Sadly, many relationships are not perfect gardens of communication. If you are like many people, you may find discussing your sexual feelings, functioning and responses quite uncomfortable. Or one of you may be comfortable with such conversations, but the other isn’t. Unhelpful baggage may make it easier to dance away from each other rather than dancing closer together.

It’s not all about you

If your needs are not met you're not going to be much good to yourself or to him.This may be your very real problem. You—or the world around you—may be highly focused on your partner: on his medical needs, his practical needs, how he is feeling and coping with it all. And, up to a point, this is how it should be. However ... actually, it is about you. You are an important part of his life; he is an important part of yours, however wonderful or troubled your relationship is. If your needs are not recognised and met, you are not going to be much good to yourself or to him. In fact, research shows that in the first 12 months after diagnosis, partner distress is higher than patient distress. (This research has so far only been done with heterosexual couples, so we don’t know whether this is also true for gay couples.) It is really important that you monitor the following:

  • Sadness and grief: Any threat to your partner is also a possible threat to your relationship with him. You may experience intense feelings of sadness that are not only to do with sympathy for the things he may lose, but also for the things between you that you both may lose.
  • Anxiety: You may find it all so overwhelming that you have trouble sleeping, sitting still, concentrating on anything, even breathing properly. While some anxiety is a normal response to stress, it is important to seek help if you’re experiencing serious or ongoing anxiety.
  • Depression: Sadness and grief are adaptive responses. Depression is a sign that something needs fixing. If you have lost all sense of hope, can’t stop sleeping or can’t sleep at all, if all joy has gone out of everything, if you can’t stop crying, you need to seek help. Depression is an unnecessary pain and it’s important that you do something about it.
  • Caring for yourself: While you are under this kind of strain it becomes even more important to make sure that you eat well, get enough sleep, exercise regularly, and do enjoyable things for yourself.
     

Gay relationships

Most gay men report that the healthcare system is relentlessly hetero-biased.If you are the male partner of a man who has been diagnosed with prostate cancer, you are likely to be facing similar problems and dilemmas—and potential difficulties with intimacy—as a female partner. However, you may find there are added issues. Even if the two of you have come out, you may find that the medical system is relentlessly hetero-biased. Your partner may not be asked about his sexual preferences or behaviours. It may be assumed that he is having heterosexual sex (or, in the absence of an obvious wife, no sex). Men often report that all the forms they fill in, and all the prostate cancer and medical literature, address them as if they were heterosexual. This matters in two ways. Firstly, and most importantly, it fails to acknowledge the primary bond that you and your partner have, and the fact that treatment will be having an effect on both of you. Secondly, there are some specific issues that may be particularly important to gay couples:

  • having your sexual orientation acknowledged and accepted
  • serious concerns about changes to body image, including scarring or loss of muscle mass and libido (depending on treatment options)
  • absence of ejaculate, which is often more significant for men and their partners in gay relationships
  • greater effect of erectile dysfunction on penetrative sex as firmer erections are necessary for anal than for vaginal intercourse
  • receptive anal sex being more difficult and less stimulating as a result of particular prostate cancer treatments.

And—if you’ve got two men in a relationship who find the business of talking deeply about intimacy and sexuality difficult, then this won’t help the whole dance of avoidance and distancing.

Help is available

Whether you are joining with your partner in facing the prostate cancer journey, or you are struggling to communicate well about it, you may need someone to talk to who is independent of your social network and who understands the complexity of the feelings you’re dealing with. Through my psychology practice, Debi Hamilton Counselling & Consulting, you may find the place you need to work through the issue of how to deal with your partner’s difficulties and how to have your own needs and feelings addressed too. With both face-to-face and online consultations available, as well as individual and couple consultation, there’s no reason to remain stuck in the dilemma of treatment decisions or the misery of unaddressed changes in intimacy, sexual feelings and functioning. Why not contact me today for a confidential, no-obligation preliminary chat about your situation?

 

See also information for men.

 

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