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Sexual Intimacy after Prostate Cancer Treatment - Part 1

Posted Oct 27 2010 12:00am

Sexual intimacy is on the minds of many women whose husbands undergo prostate cancer treatment such as surgery, radiation or hormone therapy. That is not surprising since about half of all men who are subjected to prostate cancer treatment suffer afterwards (if not before) with ED and often with the loss of libido. Many women have sought ways to get their husbands to consider recharging their sexual relationship and emotional intimacy. I’ve summarized this here in a question-and-answer format. -Rabbi Ed

My husband’s sex drive since his prostate cancer surgery a year ago has come to a grinding halt. I’m at a loss because he no longer touches me when I reach out to him. He has a hard time responding to vaginal or oral sex and rarely kisses me.

I’ve done my best to tell him I love him and that we need help, but he continues to avoid the subject of sex. In short, his desire for intimacy with me, while great before the surgery, is now gone, as his ability to have an erection. He refuses to see any professional counselor or read educational or support material including what you offer. I’m wondering if his disinterest will force me to remain celibate from here on. What can I do?  

: I've been there and done that: withdrawing emotionally and physically from the person who matters to me most, to wit, my wife. Like your husband I did this for about a year and longer after prostate cancer surgery. Like him I felt that even with nerve-sparing, intense ED made me less than a man, and besides, my libido was nil due to biochemical castration with my testosterone levels down to 8 ng/dl, when low normal starts at 240 to 300 ng/dl (nanograms per deciliter of blood).

What helped arouse my libido was the realization that I could go above castrate level only by seeking testosterone replacement therapy. With that in mind I urged my surgeon (now my contributing author) to prescribe synthetic testosterone.

About two years after my robotic surgery my doc told me I was a "poster boy" for TRT (testosterone replacement therapy), by virtue of still having an undetectable PSA. At that point he gave me a prescription to go to a local compounding pharmacy, where testosterone cream was 1/3 the price of what my Medicare plan covers. He preferred that to other methods of supplying testosterone, such as injections.  He told me it would not only improve my sexual functioning, but help promote a sense of well-being, muscle maintenance, bone growth, and a sufficient level of red blood cells.

Within 6 months my testosterone level climbed and went above  the low normal range, reaching 360 ng/dl (the normal range is generally regarded as 240 or 300 to 1200 ng/dl). My libido came back increasingly stronger without some of the side effects testosterone can cause. Perhaps armed with my experience or those with a similar tale, you and your husband could arrange to talk with his medical doctor, as opposed to a counselor or sex therapist, which your husband evidently won’t see right now. Your husband (or you initially, if he's not easily convinced) could inquire about following the same path, which will perhaps work for him as it has for me.

But please note: ED for me remains a problem, so I've had to develop my own brand of sensate focus, that is, emphasizing sensuality that engages different body parts (mine and my wife’s) in what I call "whole-body sex."  This has allowed us to broaden what we mean when referring to sexuality, and shifting to this outlook has renewed and deepened the emotional intimacy we enjoy.

I’d go a step further to indicate that our sexual interaction in some ways is qualitatively better than it was what before the surgery. But as most men can concede after prostate cancer treatment, even when sex gets better, it's never the same as it once was.

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