Sexuality and intimacy are different, but often intertwined. When people speak of intimacy they are referring to the giving and receiving of love and affection, comfort and safety, understanding and warmth. Sexuality refers to feelings of sexual desire and engaging in sexual activity. But sexuality is not just about physical sex because it is also about how you feel about yourself and how you express yourself sexually.

‘Our ongoing sense of intimacy sustains us as we deal with periods of anxiety, depression, and anger ... we were supportive of each other. Our lives continue to be good together.’2

Some prostate cancer treatments affect your sexuality and may have an effect on your current or future relationships. For example, you may be unable to be the insertive/active partner during anal sex (the ‘top’) due to erectile difficulties, your erection may not be ‘hard’ enough for anal sex; you may have less pleasurable sensation during receptive anal sex (the ‘bottom’), or there is an absence of ejaculate (‘cum’) after a radical prostatectomy. If you feel exhausted and unwell, sex and intimacy may have been put on the back burner. These are all genuine concerns and support is available (see Section 7 – ‘Where can I go for help?’).

Are you avoiding sex/intimacy because you are afraid to talk about it?

Even though sex and sexuality are very important for many gay and bisexual men in how they see themselves and their social lives, talking about these issues openly can be awkward and challenging. Some men don’t talk to anyone about how prostate cancer and treatments have affected the way they feel about themselves sexually, or they ‘imagine’ and ‘second guess’ what is going on for their partners. Communication is a vital part of maintaining intimacy in a relationship, and can bring couples closer. If you have a partner, talking with them about your concerns, changes to your body, fears, expectations and performance can help improve your relationship and sexual experience. One uncomfortable moment may be nothing compared to what you can gain by taking the risk to open the conversation.

(Parkin & Girven, 2005, p.142)

Starting a new relationship

‘I felt all at sea about how to explain the fact I couldn’t get a hard–on with the guys I met at the sauna and these were guys I’d known for years.’

There are men (gay, bisexual or straight) who have had to deal with a prostate cancer diagnosis and treatments without a partner. Finding a new partner can be hard even without your cancer experience. When you’ve had prostate cancer, you may be concerned about the possibility of prostate cancer returning, how cancer and treatments have affected you physically, emotionally and sexually, and whether or not to tell potential partners that you have or have had prostate cancer. Some gay men worry about how to talk with new sex partners about their prostate cancer diagnosis.

One way of dealing with these concerns is to talk with others who have had similar experiences, such as by joining a support group specifically for gay and bisexual men. Another way is to see your cancer experience as something you can share with a potential partner in getting to know each other. How much to tell them depends on your comfort level, but being open about your cancer experience, and how it has affected you, may prevent misunderstanding later on and help you develop a sense of intimacy with him. As to when to tell and how, there isn’t a ‘right’ time or way to bring up the subject, just the ‘right’ time and way for you. It may be useful to practise what you want to say and in the way that you want to say it so it feels familiar. Deciding to tell doesn’t mean you have to tell everything you want to say in one conversation, it may be a series of conversations.

For some men, starting a relationship after what they had been through with prostate cancer and treatments is not what they want to do. Not everyone wants to be in a relationship, and even though this sounds obvious, it is your decision.

Fertility

Having children after treatment might be important to you. Talk to your healthcare team about fertility before you start treatment so you can consider options such as sperm banking (having some of your sperm stored in a clinic). You can also ask to be referred to a fertility counsellor who can help you work through concerns and issues you might have, and advise on options before starting treatment.