Good Sex with Emily Jamea: Reclaiming Sexual Intimacy After Prostate Cancer

Emily Jamea, Ph.D., is a sex therapist, best-selling author and keynote speaker. You can also find her here, sharing her latest thoughts about sex.

When your partner is faced with prostate cancer, the conversation understandably centers on survival, but often, getting to the other side is when another challenge begins — reclaiming sexual intimacy.

Prostate cancer treatment can have a profound effect on sexuality. Depending on the type of treatment, men may experience erectile dysfunction, diminished sexual desire, changes in orgasm, loss of ejaculation, changes in penile sensation or length, and urinary leakage during sexual activity. These changes are physical but often have a major emotional and relational impact. Sexual recovery after prostate cancer often requires more than restoring erections. It requires redefining intimacy.

I once worked with a couple — Nolan and Jenna — who came to me after Nolan had been treated for prostate cancer. Before cancer, they'd had a satisfying sex life, but everything felt different after treatment. Despite being cancer-free, he struggled to get and maintain an erection and simply didn't experience desire for sex the way he had before.

Jenna assumed he wasn't initiating because he was embarrassed about his erections. But it was more than that for him. He still loved her and found her attractive, but the internal sexual “pull” he'd always taken for granted just wasn't there in the same way.

On an intellectual level, she empathized with his experience. She knew he’d been through a lot. But on an emotional level, she couldn’t help but take things personally. When they did try to have sex, every encounter felt like a test. Would he get hard? Would the erection last? Would intercourse work this time? Would he actually want it once they got started? He was monitoring his body instead of experiencing pleasure within it. She was monitoring his response for evidence that he still desired her. Neither could relax enough to enjoy what was actually happening between them.

On top of that, he became obsessed with the preparation required to get an erection. Erectile rehabilitation is an important part of recovery, and Nolan had done it all – tadalafil, vacuum pumps and injections. He’d had a consultation for a penile implant. He could become semi-erect but couldn’t reliably get hard enough to have penetrative intercourse for very long. He intuited that medical treatment was only one part of sexual rehabilitation. He knew he needed guidance on addressing the psychological component and help navigating a new sexual landscape. While both Nolan and Jenna were open to Nolan getting an implant, he wanted to check all the boxes before having another surgery.

I explained that when an erection becomes the goal of every intimate encounter, sex can start to feel like a performance. And performance is almost always the enemy of pleasure. As a therapist, that’s where I come in.

We tend to organize heterosexual sex around a predictable script: desire leads to arousal, arousal leads to erection, erection leads to penetration and penetration leads to orgasm. Prostate cancer can disrupt virtually every step in that sequence. The mistake is assuming that when the old script stops working, sex itself is over. It isn't.

Read: Prostate Cancer Taught My Husband and Me What Real Intimacy Is >>

One of the most important distinctions I help couples make after prostate cancer is the separation of erection from intimacy and penetration from sex.

Pleasure can include kissing, touching, massage, oral sex, mutual stimulation, vibrators and other forms of erotic play. Orgasm for men may still be possible without a fully rigid erection. Couples can also discover forms of pleasure they rarely explored when intercourse was easy and predictable.

It isn't about pretending the loss of a familiar sexual experience doesn't matter. There can be real grief associated with changes in both sexual function and desire. Men may mourn the spontaneity they once had. Partners may miss feeling pursued. Both people may miss the effortless way sex used to unfold. Giving that loss room to exist is part of healing.

I reminded Jenna and Nolan that grieving their old sex life and becoming curious about a new one can happen at the same time. I encouraged them to temporarily take intercourse off the table. Instead, I encouraged them to spend time touching each other without trying to produce an erection or reach orgasm. They agreed that either partner could initiate an intimate experience and that Nolan’s job wasn't to manufacture desire or an erection. It was simply to notice: Does this feel good? Do I want more?

At first, this felt strange for both of them. They had become so accustomed to evaluating whether his body was “working” that simply experiencing sensation felt almost purposeless. But over time, they felt a shift. Touch became pleasurable again rather than diagnostic. Nolan stopped monitoring his erection. Jenna stopped using his erection (or his initiation) as the primary measure of whether he desired her. They laughed more. They experimented. Most importantly, they began to feel like lovers again instead of a patient and a caregiver.

It’s important to note that sexual recovery after prostate cancer isn't only about the person who had cancer. Partners often carry their own fears and losses. Some worry that initiating sex will create pressure. Others are afraid of hurting their partner. Some experience diminished desire themselves after being in a caregiving role.

I encouraged both Nolan and Jenna to talk about what they missed, about what scared them and about what still felt good. I worked with them to determine what kind of touch felt comforting versus erotic, and whether they wanted one, the other or both.

Cancer has a way of making the body feel medicalized. Suddenly, a part of the body associated with sexuality and pleasure becomes the focus of exams, procedures, medications and fear. Reclaiming sexuality can therefore be deeply emotional. It can be a way of saying, My body is still capable of pleasure and can remind a couple, We are more than what happened to us.

Sometimes, the sex that emerges after cancer looks different from the sex that came before it. It may require more planning and flexibility about what it unfolds. Erections may come and go. Medication or devices may become part of the experience. Pleasure may take new forms. But different doesn't necessarily mean worse.

Nolan and Jenna eventually incorporated some intercourse back into their relationship, but by then it mattered much less whether it happened every time. They had developed a broader sexual repertoire and a new understanding of desire. More importantly, they'd stopped using Nolan’s libido and erection as a report card on the health of their relationship.

Sexual healing after prostate cancer isn't typically about getting your old sex life back. It's about discovering that desire, intimacy, pleasure and erotic connection can look and feel different, and in many ways, better.

This educational resource was created with support from Bayer.