You have spent your life protecting your package — wearing an athletic cup, opting for boxers, learning to shield yourself when you make a particularly stupid remark to your significant other. And now, your center of manhood is the center of your anxieties. Any cancer diagnosis brings with it a measure of apprehension and worry; a diagnosis of prostate cancer can be particularly unnerving because the treatment that will save your life can touch on some sensitive nerves — literally. In addition to the very real possibility of incontinence arising from surgery or radiation treatment, the nerves that control erectile function are located within millimeters of the prostate, and they can be damaged during surgery to remove the prostate, or during radiation, which can cause temporary, or sometimes permanent, impotence. When this happens, although a man isn’t able to physically achieve an erection, the desire for sex remains intact. Hormone treatment for prostate cancer can also lead to impotence, as well as a decrease in desire.

“These things can be pretty paramount to a man’s psyche,” says Scott Bea, Psy.D, a psychologist at the Cleveland Clinic Foundation. “A male’s identity is often wrapped up in his virility and sexual function,” he continues. “Mythically, they may think that women only have them around when they’re needed, so there may be a loss of self-definition, as well as a loss of the sense of being powerful and potent.” Feeling vulnerable about your virility can bring confusion, embarrassment and even shock to you and your partner at a time where you both are already stressed to the limit.

Sexually Speaking
Let’s get the difficult stuff out of the way first: It can take up to two years after surgery to recover sexual function. Impotency rates vary widely depending on the experience of the doctor, type of technique, patient age and a host of other factors. Even for men who are still able to achieve an erection after surgery, sexual intercourse will be different because there will be no ejaculation of semen (called a “dry ejaculation”). During the surgery, the seminal vesicles and prostate, which made most of the fluid, are removed and the vas deferens, which carries the sperm, is cut.

Okay, that’s over. Now for the easier stuff: You know all those times your wife or girlfriend said, “I want to talk” or “I just want to cuddle”? She meant it, and not because she didn’t want you — she just wanted to express intimacy differently. Realize that while intimacy is essential to a relationship, it can come from a variety of avenues, none of which has to involve erections or intercourse, says Dr. Bea. Emotional intimacy involves such activities as sharing time together, traveling, painting or discussing your shared political views. Physical intimacy can include touching, holding, cuddling and caressing. These connections may in fact help you and your partner express greater intimacy than you’ve ever had before.

Most of all, don’t avoid your partner. Approach her about what’s going on: “You may have noticed that I’m having some real troubles sexually, and I’m struggling a bit more than I might have imagined.” Just being able to admit that you’re struggling is a big step toward bringing you closer to your partner.

To help you get through the process, keep these things in mind:

• Learn as much as you can. The fear of the unknown can make everything worse. Being informed can reduce some of the tension, says Dr. Bea.
• Keep to your normal routine as much as possible. Try to follow the same schedule as you did before you learned you had cancer, which shows that, despite your illness, you’re still the same person you were before — and it shows you you’re still valuable to yourself and others. Keep active and do things that make you feel good. Take your grandchildren to the park, go to the movies and keep up with your work schedule as much as you can.
• Talk, talk, then talk some more. “Finding a person or two that you can share your secrets with can help ease the tension,” says Dr. Bea. It could be your doctor, your wife, an occupational therapist or a male friend. A support group is also a great way to connect with other men who are going through similar experiences. The American Cancer Society offers Man to Man, an education and support group, in many areas (call 800-ACS-2345). Talking about your feelings — and hearing others talk — illustrates that you’re perfectly normal and fuels feelings of connectedness and compassion. Connecting with others can also help you find different coping mechanisms and strategies to deal with the rough spots.