WHY MEN WITH PROSTATE CANCER OFTEN MAKE BETTER LOVERS

Some recommendations which can make a difference to relationships and to quality of life
A summary of positive guidelines taken from a personal journey - and many case histories exchanged confidentially over at least 17 years.
Roz Baker - Relationship Mentor - voluntary support (PCFA Board WA Chair 2014)

There are few shocks more mind shattering than when a man is told "You have prostate cancer". The symptoms are usually hardly noticeable - most men think that urinating more frequently or a slower flow, or having less sperm volume, are symptoms of getting older. Often there are no specific signs and a PSA blood test and/or medical, including a digital rectal examination can bring this unexpected news.

If the man has a partner, the announcement can be just as devastating to her - I do not remember being that terrified before - both can find it very difficult in the beginning, to somehow accept the fact and then find a way to adjust to the unexpected life changes that follow.

It is a testing time for any long term relationship. Through much negative publicity, prostate cancer is often linked to incontinence and impotency and many men become so concerned about this that they may delay or even refuse treatment. There can be erection problems during or after cancer treatments but medical procedures are improving all the time and some of these problems may be only temporary. Contrary to the rumours and apprehension, few seem to know the good news that after prostate surgery a man with even a half erection, and no sperm at all, can still usually have an orgasm - and a regular sex life...

Many case histories indicate that with more knowledge about prostate cancer and taking the time to focus on and communicate with his partner, plus learning more about sex and alternative measures, a man may turn out to be even better as a partner and lover, than he was before.

STEPS TO TAKE

The first step is to find out all about the cancer. Your urologist can give you most of the information. You may feel sad, emotional and afraid until you can accept what has happened. Those that manage to cope best are the people who face up to their problem, like looking closely at an enemy eye to eye. Talk to people you may know who have had this experience and read whatever you can about it. The more you are informed about it, the easier it will be to understand exactly where you are and what choices you have. It will be a permanent feature in your life in the future and the more informed that you are about it, the easier it will be to adjust and know how to make the most of the experience. The Prostate Cancer Foundation of Australia has support groups all over the country and much can be learned from attending meetings and/or talking to the people there. There are many different Organisations that can help with information and support. Explore this website to find contacts and information: www.pcfa.org.au

Seven basic essentials for survival: Most apply to both partners. Perhaps adopting a combination of the following often tried and tested suggestions, may assist recovery and encourage keeping in a state of mind which generates a feeling of well being. Each individual can take from these leads, what he or she feels comfortable with. The sexual detail may be rather too explicit for some readers but this article is extracted from talks directed towards people attending cancer support group special talks - or those writing in searching for all kinds of support. Some men and women are so shy that they are not able to speak to anyone. Given enough basic detail to follow, they will not have to, and after reading this, may hopefully be able to make better progress and enjoy life more.

1. Affection and staying close: Not everyone is interested in sex, and prostate cancer generally presents in older men when sex drive varies considerably depending on many health and personal factors. However, couples who consciously work to become more affectionate towards each other and face the problems together, seem to have greater success towards leading a happier life. Communication is the key. Not everyone is good at it but it is a must and with practice and determination, one can learn to talk and express emotions and fears to a partner.

Single men, who find a close friend or experienced counsellor to talk to about their experience, often find that after a few months, they can continue dating and enjoying themselves with the knowledge and the confidence of being able to operate sexually, if they wish to.

Many women, especially after about 50, and if post menopausal and in a long term relationship, truly enjoy affection and attention - sex too, but having less sex is easily compensated for, providing they receive more focus from their partner and small but frequent acts which demonstrate that he still cares. At this stage every cuddle does not necessarily have to lead to sex and some women appreciate this. For those still interested in sex, the ability to talk openly and frankly with one's partner about anything to do with sex is essential. It is amazing how many couples go through life without being able to discuss their more intimate experiences, problems and desires together. It might be a little uncomfortable at first to adjust to being more open, but it can be amazingly rewarding.

Hugging more often is a great comfort to most humans, especially in times of trouble and although men automatically tend to focus inwards when stressed, a couple should be aware that turning away can become a habit and should try to do more of the opposite. It is time to think about maintaining the relationship and this is so much easier to do if they stay close physically. Hugs help. It also often means much to a man if his partner takes a great interest in everything that happens. The man usually becomes more focused on his health, and especially his penis, when he is diagnosed with prostate cancer. It can be a great threat to his evaluation of himself as a man and everything goes so much better, if he is encouraged and reassured by his partner and can share his changing thoughts and emotions with that person. Quite a few men have written or spoken to me stating that they still feel bad about the way they treated their partners earlier on, after they were diagnosed and whilst they were really battling to come to terms with their fears and feelings of not being in control of a situation. Particularly in the six months following diagnosis and treatment.

In the right environment, with this support, most men adapt very quickly to this uncharted situation. It helps if every small improvement is shared and celebrated. Or if there is a stage of slow or no improvement, the partner helps to analyse why this is the case and assists to find ways to improve the situation, or provides ideas to help both of them focus on other things, to provide distractions to ease away these concerns. The body and mindset take time to heal and one needs to understand this.

Incontinence. Depending on the age of a man and the type of surgery or treatment he receives, bladder control can become difficult. Where men have opted for surgery, it helps if an experienced physiotherapist teaches correct exercises to strengthen the pelvic floor before and after surgery. These exercises really help to strengthen muscle control and improve continence . Men easily forget, and it helps if a partner keeps check. Meal times are a good reminder for single men. Exercises every mealtime before starting to eat! These exercises are essential and must be done correctly. One should ask to see an incontinence expert soon after surgery or treatment, if bladder control is not improving after a few weeks. You may be tensing up anal muscles instead of the ones that support bladder control. They are in close proximity and can be confused. This will not strengthen the bladder control area. Some good surgeons ensure that formal incontinence counselling is part of the post operative programme. Some do not and it is a very important part of early recovery.

Going back to normal bladder control can be a slow process for some and men usually expect it to happen overnight . Progress should be measured weekly or fortnightly and not daily! Again, there is no need to stress. There are many procedures in reserve if they are needed. Recovery can be within a month or take a few months, in older men, sometimes more than a few months. Wearing a pad for a while should not be regarded as too serious. Some women have to live with this problem too. The most important thing to remember is that stale urine has a very strong odour, so care should be taken to quickly wash any clothing which comes into contact with urine.

I have spoken to a few men who have not done anything about their incontinence problems for up to 3 years. After an operation, their problem has usually been resolved. One can read up about the different procedures that are available. It is probably worth waiting for the most experienced surgeon in this field, if an operation ever becomes necessary.

After surgery to remove the prostate, step by step instructions are given about how to make sure that the genital area is given the best chance to recover. Keeping the circulation going is also very important and the surgeon or nurse usually give adequate instructions about how this can be achieved. Purchasing a vacuum pump is just one positive way to encourage blood to flow around the genital area to encourage faster recovery, and keep the penis from shrinking with no exercise. Anything from gentle massage to prescribed Viagra type pills will assist circulation.

Erections are controlled by a complex system of nerves, and the severity of the cancer, and the skill of the medic treating the person, often govern how many of these nerves can be spared. The Seminal vesicles which produce sperm are usually sacrificed during a prostate removal procedure, and ejaculation will no longer happen. However orgasm should still be achievable but with little or no fluid. A couple can soon adapt to this difference. It just takes a bit of work!

Normal erections may take time and with older men, recovery can be slow. In some cases, due to other medical conditions, functional erections never return, but even this is not necessarily the end of a sex life. A man often does not realise that a female partner may not be all that disappointed if he cannot achieve impressive erections. Although he may feel different, he has not really changed at all, and most women do not regard it any more seriously than if he broke his arm and could not use it quite the same afterwards. As long as he does not change in behaviour, communicates his feelings, stays good company, and pays attention to her physical needs, most women will remain contented and happy to work through the situation. Read on about the many ways a man can have sex with a woman without needing an erection at all.

The ADT treatment which stops the testosterone production in a man can reduce a man's sex drive and also leave him lacking in his lust for life. It is not easy to combat this but I can assure you that I have seen these disadvantages overcome by some men. They do it by carefully studying what the treatment does, finding ways to keep their minds focused on other interests, and learning eventually how to live with the side effects of the treatment. If a man is determined to live his life as close as he can to the way it always has been, he will probably succeed. His sex life will be different but it will still be possible. It only takes study and determination. Every person is different and some men will give up sex completely as soon as they have erectile problems. This applies to many men in the world after a certain age or with various health conditions. Some will explore the various compensatory options available to them and this is wonderful for their partners, if they wish to continue healthy sexual exercise well into their senior days. The subject is very personal to each individual. Very few people think about the many single people without partners and how they cope. They do not lose their sex drive because they are alone. They also have the option to give up sex if they have no partner, or have a regular sex life by using compensatory methods.

Partners need to understand that men who have erectile problems need much more encouragement and praise, as they often feel very different, even unmanly and vulnerable for a while, whilst they adjust. They will eventually realise by gaining more knowledge and renewing their confidence, that not much has changed after all. They may need help from the partner to discover that there is plenty of support and assistance available within reach, to help their situation and all that they have to do is look or ask for it.

Where couples turn away from each other and he becomes quiet and withdrawn, or short- tempered and grumpy, or she takes no interest in what he is going through, and does not work towards having an honest face to face talk, to compare feelings, their wedding vows soon become lost forever and this can lead to separations and depression and no quality of life as a couple.

The closest person to us is often the easiest one to turn on in frustration, when we are going through a crisis. Behaviour patterns develop quickly, so although it is difficult to do, if one partner behaves in this manner, it should be pointed out gently, and discussed early - before it becomes the norm! Once behaviour develops into habit or a pattern, it is much more difficult to change.

2. Normal routine and starting new ventures: Life needs to get back to normal as soon as possible. By returning to the things which were regularly done before, at work or at home, recovery is much faster for any medical condition. However, now is also the time to take up projects or pastimes which keep both partners from dwelling too much on health, and what can sometimes seem a slow recovery. By looking ahead and having things to look forward to, life soon becomes progressive and more positive.

3. A Healthy diet and exercise: There are books and articles everywhere on this and both are essential. Preferably a small amount of 5 fruit and 5 different vegetables daily and the more variety of other foods eaten with these, the better. Animal fat and dairy products to the minimum. Alcohol and caffeine too. (Hopefully a little of what one cannot resist, cannot do too much harm!) Asparagus daily, red coloured fruits and vegetables (chillies good but not capsicum), brazil nuts, blueberries, water melon, cooked tomato - these all seem to contain special diet minerals and enzymes which promote good health.

Exercise is good for circulation and is essential. Men on hormone blocking treatment will lose muscle tone but this can be built up again by using light weights. Some physiotherapists run special classes for men on ADT treatment. The results are very positive. There are many fitness experts to consult. Even a short brisk walk can relieve built up tension. Exercise is one of nature's best tranquilizers.

4. Vitamins and Health Therapies: Often the drugs prescribed cause other medical conditions. The hormone suppression treatment for prostate cancer can cause tiredness, anaemia and bone loss and rather than allowing this to happen, one can be proactive and take advice from experts in health shops and take, for example, vitamin B12, calcium, magnesium and extra vitamin D, plus the more concentrated quality fish oil capsules, regularly, to counteract the side effects of the medications. It is worth having regular blood tests to monitor that the blood is showing no deficiencies. (Sometimes your GP has to be reminded to do this!) Ganoderma mushroom spores, phytoplankton, multi-vitamins and other immune boosting products are taken by those who believe that they help. Read up on these things. Most are beneficial in some way. Small regular amounts of vitamins are usually better than a huge amount every now and then.

Try to study all about the supplements that are taken. I recently found out that we should not be taking the standard cheaper type of calcium that is in most calcium pills, because we have both had kidney stones. I have now changed to another recommended type of calcium. Thirst decreases as we age so extra water should be taken daily to help prevent kidney stones. Unfortunately alcoholic drinks do not count because alcohol tends to dehydrate the body. Oh well...

I believe that trying new products and different heath therapies can be very therapeutic! There are many forms of relaxation including basic massage and various treatments which keep the spine in alignment and the muscles balanced. Bowen treatment and Kinesiology can be very beneficial and can give relief to necks, shoulders and backs that are painful. (Both partners)

5. Meditation: This age old treatment for relaxation and mind control is well worth exploring. It was invented long before medicines and drugs came along and once mastered, can be a powerful healing process, especially towards peace of mind. There are books and DVDs and tapes widely available. This could be a new hobby to explore. Often meditation can improve pain tolerance and induce better sleep habits. Going to bed too early often causes the 4am wide awake syndrome. Better to go to bed later and sleep well. An afternoon short nap can boost energy levels.

6. Good Lovers: It is the couples who never stop courting each other who share a complete relationship together. Illness is a huge challenge. "For better or for worse" takes on its true meaning. For those still interested in sex, they say a good lover gives and takes sexual pleasure. Successful female same sex relationships confirm that one does not even need to have a male organ to be able to do this... This alone indicates that a heterosexual couple CAN diversify if they want to.

Age and mental adjustment are two influencing factors when a man suffers erectile dysfunction. There is no reason for a man to give up being positive through this experience, especially if he has an enthusiastic and interested partner but quite a few do really struggle at the beginning.

Depending on his personal attitude, if a man is not happy with his erections, some months after treatment, he is able to have prescribed Viagra type pills which often help, or apply tiny injections which are designed to improve them, and another choice is an operation which can usually assure an erection at the press of a button, with a release valve for when it is no longer required. The writer met a couple at a prostate cancer conference who were boasting proudly about the great success of this implant system. Like any implants, there are risks involved. Again one needs to find out all the facts and research the many choices available.

Some men would not even consider this type of procedure and would prefer to learn about more simple, natural methods, such as using other parts of their body or applying battery or electrically operated gadgets. This is easier for the man who is already an innovative lover who has explored a variety of possibilities in the bedroom since becoming an adult. All it takes at any age, is the will to explore and experiment. Possibly something some men or women may never have had to do before - because there was never the need.

Besides all the different ways to make love that one can read and learn about in books, we live in a world of sex aids in all shapes and forms which to some without an uninhibited outlook might seem 'dirty'. However, most of these have been carefully developed and manufactured to give people the utmost fulfilment in their sex lives without exceeding normal boundaries. These gadgets are inexpensive and easy to find, and make a sex life varied and interesting. One can make a discreet appointment with the Manager of an adult shop - they are trained to help people with sexual problems- and be shown what is available, or order from a catalogue. Then it is a case of experimenting with a partner, or alone. Remember younger times when it had been a long busy day, the children were at last in bed and you were both really needing sex but were too tired? Well these days, there are some excellent vibrators and other adult gadgets that soon speed up foreplay and make the process more diverse, and more fun! There seems to be no harm in more seasoned adults taking an interest in these inventions, if they still have the urge to do so. This website [www.figleafproducts.com] has lists of the various items on sale, to which can be discreetly ordered and delivered. The most basic, more clinical sexual aids on this part of the site are very inexpensive and can work just as well as the expensive ones with all the bells and whistles!

It may feel strange at first, if one has never tried these items before, and it may take time to introduce them to your partner. Sometimes only one partner is keen to experiment and the interested partner is left to experiment alone. In many cases, with practice, this stimulating new interest can become a most enjoyable part of bedroom life...

Vibrators I read somewhere that vibrators were invented in Victorian times to treat women suffering from depression. Those Victorians were well ahead of their time with a few things!

Vibrators are only recently publically talked about and are now becoming popular and fashionable. They work very well for men as well as women. The penis requires to be at least slightly semi-erect. This can usually be achieved by holding the base of the penis quite tightly and squeezing the blood into the area, making the glans quite firm. Satisfactory orgasms are usually achievable when a strong vibrator is applied to the glans, at the base of the head of the penis, at the right speed. There is pleasure in store for those who have an interest in these products. The surgeon will give guidance as to when it is best to start sexual activity after treatment. Usually, the body tells the mind that it has healed enough and it soon objects by indicating pain, if it is too soon to start.

A single, relatively younger man who had opted for prostate surgery, reported that soon after his operation, as well as using a vacuum pump daily, to expand his penis and increase the blood flow, he then used a rubber ring (not too tightly) round the base of the penis and a standard type of vibrator. He was very keen to start dating again. Regular doses of Viagra type pills, prescribed by his GP were also helping. He had investigated certain types of strap on apparatus which fit over the penis and by all accounts feel very similar to the real thing to a female partner. This type of apparatus also never lets a man down ...He was also experimenting with the tiny injections with cause erections, with success. He would read or view stimulating magazines or films beforehand, to get into the right mood before trying the various experiments. This gave him more chance of success. (Couples seem to find this beneficial too). Only six months after the operation, he was positively improving all the time - and confident enough to start dating again.

The above applications all seem to assist towards a balanced and positive recovery from prostate cancer - or are guidelines towards living with it - and men do have the opportunity to take the positive approach and become better lovers and companions post diagnosis. The writer is a certified counsellor with no medical training but has spent more than the last 17 years, often over months in discussion and support with individuals and couples as they go through this uninvited life experience, similar to her own, which started when her husband was first diagnosed with advanced prostate cancer at the age of 57.

It is worth mentioning that if he had not been given a random PSA blood test, which a Rotary club had organised as a community project in a Perth mall, he may have found out too late that he had aggressive prostate cancer. He had been feeling tired but his other symptoms were so minor that he had ignored them, thinking that they were only signs of getting older... A recent rectal examination given as part of an extensive and expensive medical, offered by a medical insurance company in UK, revealed nothing and he was given a clean bill of health! When the PSA test results were received from Rotary by a GP in Perth, the reading was high and the GP sent him directly to a urologist. The surgery was too late - the cancer was already spreading out of the prostate. Consequently, the last 17 years have been much more challenging compared with certain friends, and colleagues, who have been fortunate enough to pick up their diagnosis much earlier. A man who is treated in time and is given the all clear, usually keeps his full sex drive and can live a much more normal life. He does not have to cope with the continual tests and ongoing treatments - or with the accompanying debilitating side effects of the ADT treatment or other treatments for advanced prostate cancer. It is the determination to overcome all these things and to succeed in continuing an almost normal life for as long as possible that is the challenge and the reason for all this research and rewarding success. This information needs to be passed on, so that others can enjoy the benefits too.....

Men in their forties would be wise to consider having both tests on their Birthday every year, if anyone in their family has had prostate cancer. (My husband's Mother died of breast cancer which is also a hormone driven type of cancer). Just ask your doctor for the tests. You and your partner are the ones that have to live out the effects of cancer which is not treated early. Having met and heard the cries of regret of so many men and their partners, who for some reason or other, were put off testing for this particular cancer, I can only say - rather take no chances!

Much of the above has been tested or passed on by others who are on a very similar journey. There is so much information available if one is in need of assistance, which was not available even 5 years ago. One only has to believe that things can be improved and look for help....

7. Comedy and play Adults under stress often tend to forget how wonderful it is to be able to have a good laugh and may hardly recall the freedom and fun of youth. It has always been said that couples who play together, stay together. I have left this point until last because it is probably the most difficult to work at. A good laugh is probably the most healing thing to experience, at least mentally and there is evidence emerging that indicates that it can be of physical benefit too.

Try to watch plenty of comedy and start to look for that comical side of our make up. If you dig deep enough, there is always something to be playful about. One may feel more attracted to the darker and more ironical things to laugh at but this is OK too. Laughing is an outlet and working on it is just another healthy therapy. Look for Michael McIntyre (UK), one of the top current comedians.

Anyone reading this is encouraged to take heart and make the most of this new life challenge. Talk to the person closest to you and communicate often about how you feel . Read and research whatever you can, to become familiar with what you are dealing with. Then you will understand it. Understanding takes much out of the fear of the unknown. Work together to discover ways to make the most of each situation as it evolves. This could possibly be the best way to weather this experience together successfully. I know from experience that it can be done....

Try to forget the bad parts and strive to find even the smallest things to enjoy whenever possible. It is not the experiences we have in life that are as valid as the way in which we handle them. I think that we can be as happy as we make up our minds to be...It all depends how we each prefer our partners and families to recall the time they spend with us, whilst we are in their lives.