Prostate cancer care centres mainly on men in terms of diagnosis and treatment. Therapy focuses primarily on eradicating the cancer, and can entail side effects that reach far beyond physical changes alone. While men often find it difficult to cope with these side effects, prostate cancer doesn’t happen to them in a vacuum. In most cases, there’s a wife or partner who is also deeply affected. More and more, healthcare professionals are examining the impact that prostate cancer has on women as well as men and acknowledging it as a couple’s illness.
Treatment affects body and mind
Treatment side effects are well known: fatigue, erectile dysfunction, penile shrinkage, urine leakage during orgasm and incontinence. If hormone therapy is used, you can add to the list hot flashes, growth of breast tissue, lowering of sexual desire, loss of body hair, weight gain and decreased mental sharpness. The psychological consequences can be as devastating as the physical, affecting men’s self-esteem and sense of identity. Illness itself is incompatible with westernized notions of masculinity. Our culture requires men to be physically strong, capable, independent and able to protect. The sick role, which often includes feeling fatigued, not being able to accomplish normal tasks and needing physical care, leads many to feel they aren’t “real” men. So men often avoid medical exams, minimize problems and ignore health information and assistance. Erectile difficulties, signs of feminization and incontinence can magnify men’s feelings of lost manhood to an even greater degree.
What about the partner?
Although the focus is often on the man’s physical functioning, the partner’s life and couple’s relationship are also impacted. For example, with illness come shifts in roles: who takes care of the bills, cares for the lawn, makes meals, schedules appointments etc? Finances may change, as one or both partners have to take time off work to focus on the recovery. Caregivers must learn to look after their partner in new ways, such as by flushing catheters, buying incontinence pads and fielding phone calls from friends and family. In addition to these instrumental changes, couples must deal with their own and each other’s emotions. Both individuals may feel worry, fear, anger, insecurity and intense uncertainty about the future.
Coping with these changes, either after many happy years of marriage or in a fragile new relationship, can be extremely challenging. For the partner, it requires flexibility, willingness to learn new tasks and take on extra responsibility, and even making the transition from the one being protected to the role of protector. Along with the worry that comes with a loved one’s cancer diagnosis, this situation can cause considerable distress.
Several studies have shown that prostate cancer and its treatment may cause even more distress for the partner than for the patient. One reason may be that the healthcare system often neglects partners, offering most of the attention and support to the patient. The partner may end up feeling she has to shoulder a great deal of responsibility and adapt to significant changes with little or no support. When help is offered, partners sometimes decline because they don’t feel entitled. We commonly hear, “He’s the one with cancer, not me.”
Sexual challenges
Prostate cancer also brings special challenges to a couple’s sexual relationship. A change in a man’s sexual functioning and his masculine identity can make it difficult for a couple to maintain physical intimacy. The side effects of some prostate cancer treatments have even been found to erode the marital bond, decreasing the couple’s sense of closeness. Couples may need to try new sexual activities, explore assistive aids and renegotiate their routine. They may have to learn a new way of communicating about their desires and needs. What felt like a natural sexual relationship may begin to feel awkward, difficult and stressful. Unfortunately, many couples end up abandoning their sexual relationship because of these challenges.
Only a few studies have examined the importance of a man’s sexual functioning to a woman’s sexuality. In a survey of female partners of men treated for prostate cancer, almost half of the women reported decreased sexual enjoyment and interest. Another study found that male erectile dysfunction is associated with a decline in the female partner’s sexual desire, arousal, orgasm and overall satisfaction. Although their partner’s recovery from cancer is often the most important concern for women, sexual fulfillment has a significant impact on marital satisfaction, self-esteem and the emotional and physical health of both parties.
With the advent of oral medications such as Viagra®, Levitra® and Cialis®, many professionals believe that sexual problems are now easily treated. Likewise, many men wrongly believe the pills will provide a “quick fix.” However, while most men can find a treatment to restore function, 50% stop using the aid within a year. Oral medications won’t work if there’s extreme anxiety, inadequate sexual stimulation, low testosterone or excessive venous outflow (i.e. blood flow from the penile tissues affecting erection). Over time, some men find that relying on a drug erodes their feeling of self-efficacy. Most concerning are the men who, when medical treatments don’t work, withdraw from all intimate contact and become despondent.
Counselling helps
Left to their own devices, couples often avoid talking about these sensitive issues, afraid of making matters worse. But we’ve found that if couples seek professional counselling, they improve their chances of success. Counselling can help couples have meaningful discussions about difficult issues and express pent-up feelings.
Women want to be positive and upbeat, and feel they should be grateful for their husband’s survival. This can be a source of further strain, as it may not allow room for the understandable sadness and distress that is a very real part of everyone’s cancer experience. To even consider the possibility that their partner might die of cancer feels disloyal, and to express any personal needs seems selfish. Women often find that talking with a professional provides them with an opportunity to express the feelings they keep under tight control when they’re with their husband.
Despite the significant impact of prostate cancer on women, very little research has specifically examined how they cope. But some women have begun to speak up and discuss their experiences. Most cancer centres now have professional counsellors who are equally available to men and their partners. It’s good news that the emotional care of patients and their loved ones has become increasingly integrated in cancer management and is now seen as a vital component of high quality care. Healthcare professionals and researchers are beginning to acknowledge and examine the effects of prostate cancer on women and appreciate that women, too, “have” prostate cancer.
