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. Sexuality is not just about sexual intercourse, it is also about how you feel about yourself and how you express yourself sexually. 

Treatments for advanced prostate cancer may affect your sexuality and impact on your current and future relationships. You may experience a loss of interest in sex, changes in your ability to give or receive sexual or intimate pleasure, changes to the way you see and feel about yourself sexually, inability to have an erection, and difficulties feeling any sexual interest at all. 

If you feel exhausted, out of shape and tired, sex and intimacy may have been put on the back burner. It is difficult to feel good about yourself when you are feeling run down.

Your partner, if you have one, may also have different feelings about intimacy now that you are being treated for advanced prostate cancer and may feel: 

  • rejected 
  • alone 
  • guilty for wanting sex/intimacy 
  • angry 
  • afraid that they will hurt you. 

These are all normal reactions. 

Sometimes men avoid becoming involved in a sexual relationship because they are embarrassed or worried about sexual performance. It is important to talk with members of your healthcare team (e.g. nurse, psychologist, social worker) about any sexual/intimacy issues you may be having because they may not bring up these issues. This is not because they don’t want to discuss sexuality issues with you, sometimes they are waiting for you to bring them up so they can help you with your concerns. There are often solutions such as medications, aids, counselling or support programs that can help people with intimacy and sexuality issues. 

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

‘Men don’t own up to the fact that the loss of their sex life at 50 or 60 years of age means anything to them. I didn’t do that well and we were probably both disappointed.’

Talking about sexuality and intimacy openly can be awkward and challenging because they can be sensitive issues. Talking about fears and concerns can be difficult if you’re not used to talking about these matters. Some men don’t like to talk to anyone about what is going on or they ‘imagine’ and ‘second guess’ what is going on for their partners. However, communication is a vital part of maintaining intimacy in a relationship. If you have a partner, talking with them openly about a range of issues such as 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. Talking about it openly may even bring you closer, and avoid the frustration and misunderstanding that can make it harder to deal with the changes.

Many relationships survive prostate cancer with people saying:

  • they feel closer to their loved one
  • they feel that their relationship has become more honest and caring
  • they feel as though they now truly know and understand their loved one.

If advanced prostate cancer impacts on you and your partner’s relationship

You may want to think of ways that you and your partner can keep intimacy alive.

  • Plan date nights, or other times when you can be alone. 
  • If you’re tired, talk about other ways of being intimate – learn to massage each other, or hold hands, hug and kiss. 
  • Talk about when you first met and other special memories you share. 
  • Say YES when people offer to help you. 

Remember intimacy means more than just sex, and goes far beyond the bedroom. You may have to work to rediscover your sexual self and connection to your partner. But intimacy is a vital part of your wellbeing. 

Advanced prostate cancer can also bring you closer to family and friends. Many people talk about how much they enjoy the time spent together, being able to talk together, sharing in the journey, and learning to appreciate the good things about each other. Being able to maintain your dignity and having a good quality of life are positives people identify as important at this time.