The Impact of Prostate Cancer on the Sexual Health of Partners
By: Daniela Wittmann, PhD, LMSW | Posted on: 01 Mar 2021
Attention to sexual dysfunctions in prostate cancer survivors will inevitably lead to the inclusion of partners in both clinical care and research because of the significant role partners play in the man’s sexual recovery and the recovery of sexual intimacy of the couple. Early research on men’s experience suggested that their postprostate cancer treatment sexual dysfunction made them lose confidence, fearing that they could no longer satisfy their partners. Gay and bisexual men reported feeling sexually “disqualified” after prostate cancer treatment.1 When offered pro-erectile aids, men often reject them or do not sustain their use. Dislike or lack of motivation to master pro-erectile aids by men who want to resume penetrative sex can be seen as an expression of grief about the loss of sexual function that becomes a barrier to staying sexually active.
Including partners in counseling after surgery for prostate cancer has proven to facilitate the uptake of pro-erectile aids, as was demonstrated in randomized controlled trials, most recently in Australia by Chambers et al.2 In addition, association has been found between patient and partner sexual function, suggesting that there may be a mutually influential process at work when sexual problems arise after prostate cancer treatment.
Most research has been done with female partners who have been traditionally seen as distressed supporters of the men, finding ways to adjust to the loss of sexual relationship, often privileging the men’s needs over their own. Although sexual health interventions for couples have included recommendations for mitigation of female partners’ sexual dysfunction, partners have typically not been asked about their own sexual needs either in research or in clinical care. Research on male partners is only emerging.
Recent qualitative research on couples after prostatectomy has begun to illuminate partners’ sexual concerns. Both male and female partners reported unmet sexual needs and difficulty initiating sexual activity either for fear of distressing the man who now lacked confidence or because the role of initiator was new to them and they were uncertain about adopting it. Importantly, patients were not aware of their partners’ sexual and support needs. A study of partners of Black African and West Indian patients by Bamidele et al highlighted the importance of understanding the impact of culture on partners.3 Partners reported that the role of the man as the head of the family limited the partners’ inclusion and ability to negotiate a role in the sexual recovery process.
Partners do have a point of view. In a study of patient and partner sexual health intervention priorities by Mehta et al, female partners expressed worry about being judged for pursuing sexual goals in the context of both vulnerable male partners and culturally biased expectations of sexual passivity in women. Male partners wished that providers would understand and address same sex couples’ sexual practices and concerns.4 Including cultural issues in the context of counseling couples as they work toward regaining sexual intimacy after prostate cancer was recommended by Bamidele et al.3
Loeb et al published a “Call to Arms” this year in the Journal of Sexual Medicine, urging the multidisciplinary community engaged in prostate cancer care to take up the cause of partners’ sexual health.5 As in any system, neglecting the well-being of a critical part will endanger the health of the whole. Couple sexual well-being requires mutual needs awareness and responsiveness by both members of the couple. The urology community has always sought to maximize sexual health outcomes for prostate cancer patients. It is important that it widen its lens and include partner sexual health needs in its purview. This will primarily require that partners be involved in prostate cancer care from the first consultation, that they be educated about the sexual side-effects and rehabilitation and asked about their sexual concerns, and that both patients and partners be given the option to pursue sexual health counseling as they navigate sexual recovery after cancer treatment. If this kind of support is not already embedded in usual care, urologists can find certified sex therapists near them on the website of the American Association of Certified Sexuality Educators, Counselors and Therapists (aasect.org) and develop collaborative relationships. A holistic approach that recognizes the integral and equal role of the partner in the recovery of sexual intimacy after prostate cancer treatment will go a long way to improving patient and partner sexual well-being in survivorship.
- Ussher JM, Perz J, Rose D, et al. Threat of sexual disqualification: the consequences of erectile dysfunction and other sexual changes for gay and bisexual men with prostate cancer. Arch Sex Dis 2016; 46: 2043.
- Chambers SK, Occhipinti S, Schover L et al: A randomised controlled trial of a couples-based sexuality intervention for men with localised prostate cancer and their female partners. Psychooncology 2015; 24: 748.
- Bamidele O, Lagan BM, McGarvey H et al: “…It might not have occurred to my husband that this woman, his wife who is taking care of him has some emotional needs as well…”: the unheard voices of partners of Black African and Black Caribbean men with prostate cancer. Support Care Cancer 2019; 27: 1089.
- Mehta A, Pollack CE, Gillespie TW et al: What patients and partners want in interventions that support sexual recovery after prostate cancer treatment. Sex Med 2019; 7: 184.
- Loeb S, Salter CA, Nelson CJ et al: A call to arms: increasing our understanding of the impact of prostate cancer on the sexual health of partners. J Sex Med 2020; 17: 361.