For men

Discovering that you have prostate cancer has probably brought up all sorts of challenges.

Initial shock

The C word can be an initial shock.Firstly, there is the shock of realising that you have a serious condition, even though you may have had few or no symptoms. Then there is that C word – cancer. Despite major improvements in the diagnosis and treatment of prostate cancer in recent years, it’s likely that you’ve found the diagnosis somewhere between daunting and frightening.

Challenges to self image

If you’ve not experienced a serious illness before, you will have to adapt to a new understanding of your body and your health. This might bring up wider fears about mortality and survival, life achievements, and questions about what is and isn’t really important to you. If you have already experienced significant health problems, this may feel like another blow. Either way, you may initially not feel up to the challenge.

Weighing treatment options

Most men diagnosed with prostate cancer don't die of it.Of course your doctor/s will talk with you about available treatment options, and you will need to decide which, if any, are right for you. That can be challenging. You may focus exclusively on one factor—your survival. It may be hard for 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 work and family commitments and how you will manage these leading up to, during and after treatment. You may have difficulty even deciding how and how quickly you ought to make important treatment decisions. You might also struggle to identify someone with whom you can talk candidly and independently about the intensely personal aspects of prostate cancer treatment options.

Treatment side effects

If you choose to accept treatment for your prostate cancer, you will be facing the possibility of some of the following problems, depending on which treatment you choose:

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

For some men, these symptoms will be temporary; for others, permanent. Many men begin to experience anxiety and depression as a result of these changes after treatment, even men who are not normally prey to such feelings. In any case, it would be natural for you to feel troubled by substantial changes in sexual functioning and the capacity for intimacy. If you are in a relationship, it is likely to be a source of awkwardness and anxiety for your partner, too. You may discover that the two of you begin a dance of withdrawal from each other.

Communication difficulties

If 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, you will find yourself adapting and discovering new ways of doing things. Sadly, many are not endowed with such gifts. If you are like many men, you may find discussing your sexual feelings, functioning and responses quite uncomfortable. And of course, many relationships are not perfect, either. Neither of you may be good at discussing personal issues, listening, or working towards new ways of engaging. Unhelpful baggage may make it easier to dance away from each other rather than dancing closer together.

The emotional landscape

It's not just about your penis!It’s not just about your penis! Of course you will have had a certain relationship with your penis all of your life, and that may well be about to change profoundly. But this won't just be a local, sexual effect. For many men, prostate cancer can cause disruption in their broader emotional landscape: being a man, a partner, a father, a role model, a public figure. These changes can cause some temporary anxiety and sadness.

Single men

How might you communicate fears and hopes about your sexual self with a potential partner?You may not be in an ongoing relationship. This does not mean you won’t possibly face all kinds of questions and dilemmas about your experience of your sexuality or your experience of intimacy. If you are looking for a new partner or are having casual sex with different partners, you may have to grapple with all kinds of questions and issues. When and how should you tell someone you are dating, or planning to have sex with, about erectile difficulties? How might you communicate your fears and hopes about changes to your sexual sense of yourself? How might you even begin to predict and deal with a potential partner’s reaction to changes in your sexual feelings and functioning? If you aren’t in a sexual relationship of any kind, and are not looking to be, you might still experience unsettling changes. You may feel less “masculine,” you may find masturbating different or difficult. Of course you are likely still to be able to achieve orgasm, but there may be little or no erection, and there will be no ejaculation, which some men miss terribly.

Gay men

Many gay men report that the healthcare system is relentlessly hetero-biased.If you’re gay, you may have been lucky enough to find medical practitioners who are sensitive and aware, and your sexual orientation may not pose too many additional challenges. However, many men report that their doctors, urologists, surgeons, and prostate cancer information services and websites are relentlessly hetero-biased. Doctors, surgeons, oncologists—in fact, just about everyone who might potentially help you on your prostate cancer journey—may assume, if they address the question of sex at all, that you are having, or want to have, heterosexual sex. Unless you are comfortable and confident about setting them straight (oops!), this may mean that some of your experiences and concerns will go undiscussed. Some of the things that may be of particular concern if you are gay and dealing with prostate cancer treatment include:

• needing to have 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 of more significance to 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’re having difficulty deciding what forms of treatment may be best for you (or even deciding how to decide), or you have already had treatment and are now experiencing sadness and anxiety, or embarrassment and unhappiness in your intimate life, professional help is at hand. Through my psychology practice, Debi Hamilton Counselling & Consulting, you may find the place you need to work through these troubling issues towards some kind of peace or resolution. 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's partners.