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Question: My husband had surgery for prostate cancer in 1993. At the time the surgery was very progressive and successfully saved all sexual function. Sex and our intimate life in general were quite wonderful. Several years after the surgery, my husband required treatment with external radiation when his PSA rose.

He is now undergoing treatment with hormones for prostate cancer. His libido and ability to perform sexually have disappeared. In all other ways, his life is normal, active and happy.

We have what I have always considered an extremely happy marriage with wonderful communication, but on the issue of my wanting to have a sex life (I’m 62), he shrugs and says he’s dealing with enough. What is your advice?

Dr. Pat: This is not an unusual situation. In the 21st century so many people have had the opportunity to live with cancer, not die from it. However, the quality of life for the patient and the partner are often affected. This is a significant problem. The wonderful news is that due to the advances in medical treatment, your husband has survived cancer of the prostate since 1993. That is 14 years.

For many years after surgical removal of the prostate and even external pelvic radiation therapy, you indicate that sexual function was still possible. For the past three years, your husband has been treated “hormonally.” I assume you mean that your husband has been given medication by implant or long-lasting intramuscular injection. There are many treatment regimens for these anti-androgen medications. Some patients receive monthly, quarterly or yearly dosing regimens. The goal of this treatment is to greatly lower testosterone in order to prevent recurrence of the prostate cancer.

These drugs produce a state of medical castration and potentially have some very unpleasant side effects for some patients, including profound loss of interest in sex, loss of energy, muscle loss, change in body shape and depression.

If after three years of this medical castration therapy, your husband truly has no libido, the options are:

1. Taking a hormone holiday, if the oncologist feels that this is safe. Testosterone will often slowly recover. The obvious drawback from this option is that the prostate cancer may recur. There are urologic oncologists who do allow certain patients to take a holiday in order to restore the physical intimacy of the relationship.

2. Penile implant surgery takes about an hour. Most of these devices can be inflated whenever the couple chooses to have physical intercourse. Many men who have struggled with a prolonged fight against cancer often find this option emotionally and physically difficult to accept.

3. Options that are easily available include the use of a vibrator and private sexual pleasure. Not ideal for you, since you understandably want the return of your partnered, loving, sexual life. But, according to your note, your husband is living, is happy and the relationship is still good. When your husband shrugs and says he is dealing with enough, I am sure that he is. But, this answer may also hide the shame and loss of masculine function that his inability to be an effective sexual partner creates.

I spoke with psychologist Cecilia Ford, Ph.D., about your situation, and she adds these comments:

When someone loses functioning of part of the body, it affects one’s identity profoundly. This is true for men as well as women. It is especially true when it applies to the sexual function, something that many men measure themselves by. By losing his physical and hormonal “maleness,” your husband no longer has the anatomical markers that once defined him as a man. Testosterone provides not only sexual drive, but also the emotional energy that is the basis that makes a man feels sexy, flirtatious and attractive — in a word, libidinal.

Most important however, a man who cannot perform sexually does not want to put himself in a position that sets him up for failure. Such a situation is bound to produce feelings of painful loss and even humiliation. Given the intimacy that you have shared all these years, there is still a good chance that some compromise can be reached. But you must realize that despite your frustrations, empathy for your husband’s sense of inadequacy and loss at this particular moment is what’s called for. If he feels emotionally secure, after a while he may be able to re-enter the sexual arena and find plenty of ways of satisfying you.

Dr. Patricia Yarberry Allen, director of the New York Menopause Center, is a gynecologist affiliated with New York-Presbyterian Hospital and a board certified fellow of the American College of Obstetrics and Gynecology.

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  • Patty January 11, 2008 at 3:58 pm

    This is probably a ridiculous question but seems to be bothering my husband and he does not wish to broach it with his physician. My husband has been diagnosed w/ prostate cancer. What effect does us continuing to have a sexual relation have on me, if any?