When Chris Pearce was diagnosed with prostate cancer about eight years ago, memories of his father, who had died from complications of the disease, flashed through his head. While Pearce’s first priority was getting the care he needed, he also worried about the impact on sexual function his father faced after treatment.
“I was very keen on not getting the same side effects,” he said.
Pearce initially chose a nerve-sparing robotic prostatectomy to help preserve sexual function. But within a year his PSA levels began to rise, and he received radiation treatment at Seattle Cancer Care Alliance.
"I was delighted to be finished with my treatment, but my worst point was after the radiation. I took Viagra and things like that, but it didn't help," said Pearce, a 58-year-old engineer.
At the time he was in a marriage that was winding down, and the sexual side effects from treatment added pressure. “It was enormously frustrating and humiliating for me," he said. "I also found myself getting increasingly angry over the most trivial and stupid things."
It’s an issue often faced by many of the estimated 233,000 U.S. men diagnosed each year with prostate cancer – and their partners.
A recent study, led by Dr. Scott Ramsey, a member of the Public Health Sciences Division at Fred Hutchinson Cancer Research Center, found that 7 out of 10 women reported that their partner’s treatment had negatively affected their sexual relationships. What’s more, it appeared to worsen over time, suggested the report, which was published in the Journal of Sexual Medicine.
For the study, researchers followed 88 prostate cancer patients and their female partners for up to a year following treatment. At six months, 39 percent of the partners reported a “somewhat negative” effect on their sexual relationship. A smaller number -- 12 percent -- reported that it had a "very negative" effect. At the 12-month mark, the percentage of partners who found that cancer treatment had a “very negative” impact more than doubled.
"The biggest takeaway point from our study was not so much the initial negative impact at six months, but that it got worse over time," said Ramsey. "What we think is going on is that the partners expected some decline in the post-surgical period, but they expected it to improve. And when that didn't happen, then there was more disappointment, in that their partners did not regain function."
‘Keep the topic on the table’
Pearce said he struggled with his feelings for several years after his prostate cancer treatment before seeking support from the survivorship clinic at the SCCA and entering counseling. Although he and his then-wife ultimately divorced, therapy helped him better understand and manage his feelings, he said.
Today, he says, he wishes he’d gone sooner. "It took me five years to realize that I was depressed and frustrated with my sex life," he said. "So many guys are unable to express their feelings."
He encourages others to reach out for help early in the process.
“Don’t put it off, seek counseling as soon as you can,” he said.
Now he’s in a strong relationship with his partner, Mary Milburn, a friend he’d known casually through work. The first time they kissed after they began dating a few years ago, he remembers, “the electricity was amazing.”
He also knew he needed to have a frank conversation with her about some of his sexual side effects from treatment.
“I wanted to be open with her,” he said. “And it turned out it wasn’t an issue at all.”
Communication is key
Being able to communicate with your partner is key, said Leslie Vietmeier, a nurse practitioner in the Survivorship Program at Fred Hutch. “I tell patients to 'keep the topic on the table', as the more sex is not talked about, the more it is easy to avoid talking about it."
If sex isn’t discussed, the subject just becomes increasingly awkward and a “non-topic.” Resentment, fear of “failure,” frustration, grief, and anger all intensify when the issues around sexuality are not brought out into the light of day, she said.
Some sexual function may return with time after treatment, but even if it doesn’t, couples can still enjoy a fulfilling sexual relationship, she noted.
"One thing I tell men or couples is that both partners can find sexual satisfaction without the need of a full erection," said Vietmeier. "The cancer survivor can pleasure a partner of either gender without penis penetration, and as long as the nerves are still intact in the perineum, a man can still achieve orgasm without an erection."
This process can take some degree of exploration to figure out what works best for the couple, but she pointed out that orgasm nerve stimulation is not dependent on erectile tissue in the penis.
Finally, it is essential to not have expectations, be willing to stop and talk and have a sense of exploration.
"And especially, a sense of humor and not take it too seriously," said Vietmeier. "Make the expectation one of sharing time, sharing love, being gentle with each other – and if actual intercourse happens, that is a pleasant surprise. Intimacy and connection become the goal then, which relieves the pressure to perform."
Today, Pearce said, he’s able to enjoy his relationship with his partner fully – both emotionally and sexually.
“We have a very equal relationship,” he said. “It’s wonderful.”
Roxanne Nelson is an RN and writer, specializing in health and medical subjects. She has written for a wide number of both consumer and professional publications, with a special focus on cancer and infectious diseases.
Solid tumors, such as those of the prostate, are the focus of Solid Tumor Translational Research, a network comprised of Fred Hutchinson Cancer Research Center, UW Medicine and Seattle Cancer Care Alliance. STTR is bridging laboratory sciences and patient care to provide the most precise treatment options for patients with solid tumor cancers.