Sex Therapy for Couples Affected by Prostate Cancer
When Robert and Linda first came to my office, they sat on opposite ends of the couch. Married for 32 years, they now struggled to make eye contact. Six months after Robert’s prostate cancer treatment, their once-vibrant intimate life had disappeared—and with it, a fundamental connection in their relationship.
“We love each other deeply,” Linda explained, “but we’ve lost our way as lovers. We don’t even know how to talk about it anymore.”
Their story is remarkably common. Up to 85% of men who undergo radical prostatectomy report erectile dysfunction, at least temporarily. Radiation therapy affects approximately 50% of patients, while hormone therapy can dramatically reduce libido and sexual function.
But here’s the good news: specialized sex therapy can help couples like Robert and Linda reclaim intimacy, pleasure, and connection—even when traditional sexual function has changed. This article explores how sex therapy works for couples affected by prostate cancer and offers insights into the healing journey.
Understanding the Challenge: How Prostate Cancer Affects Intimacy
Before exploring therapeutic approaches, it’s important to understand the multifaceted ways prostate cancer treatment impacts sexuality:
Physical Changes
- Erectile dysfunction: Difficulty achieving or maintaining erections
- Dry orgasms: Orgasm without ejaculation after prostate removal
- Reduced libido: Particularly during hormone therapy
- Penile shortening: Can occur after surgery
- Urinary incontinence: May happen during sexual activity
- Pain or discomfort: During arousal or orgasm
Psychological Impact
- Identity challenges: Many men tie masculinity to sexual performance
- Fear of disappointing partners: Leading to avoidance of intimacy
- Grief over lost function: Similar to grieving other significant losses
- Anxiety about performance: Creating a cycle that further impedes function
- Depression: Common after cancer treatment, further affecting desire
Relationship Effects
- Communication barriers: Difficulty discussing sensitive sexual changes
- Mismatched expectations: Partners may have different priorities
- Role adjustments: Changes in who initiates or how intimacy occurs
- Withdrawal: Physical and emotional distancing to avoid disappointment
Dr. Anne Katz, a certified sexuality counselor who specializes in cancer-related intimacy issues, explains: “Prostate cancer is really a couple’s disease when it comes to intimacy. Both partners experience the loss and both need to be involved in the recovery.”
What Is Sex Therapy and How Can It Help?
Sex therapy is a specialized form of counseling that addresses sexual concerns within a therapeutic relationship. For couples affected by prostate cancer, it offers several unique benefits:
Goals of Sex Therapy After Prostate Cancer
- Expanding the definition of sexuality beyond erection-based intercourse
- Improving communication about desires, boundaries, and possibilities
- Reducing anxiety around sexual performance
- Developing new approaches to pleasure and intimacy
- Processing grief and loss related to sexual changes
- Building confidence in exploring adapted sexual expression
“Sex therapy gave us permission to start over,” shares Michael, 68, who underwent radiation therapy. “We learned that sexuality is much broader than we’d been taught, and that opened up new possibilities for us.”
Evidence for Effectiveness
Research supports the value of specialized therapy for couples facing prostate cancer-related sexual challenges:
- A study at MD Anderson Cancer Center found that couples who received sexual counseling showed significant improvements in erectile function, orgasmic function, and overall sexual satisfaction
- Both face-to-face and internet-based counseling proved equally effective
- Partners also reported improved sexual satisfaction after therapy
- Benefits were maintained at one-year follow-up
What Happens in Sex Therapy?
Many couples hesitate to seek sex therapy because they’re unsure what to expect. While approaches vary based on the therapist and the couple’s specific needs, here’s a general overview:
Initial Assessment
The first few sessions typically involve:
- Comprehensive sexual history from both partners
- Medical history related to prostate cancer and treatment
- Current sexual function, concerns, and goals
- Relationship dynamics and communication patterns
- Expectations and hopes for therapy
“I was nervous about sharing such personal details,” admits Thomas, 72. “But our therapist’s professional approach put us at ease quickly. It felt like talking to a knowledgeable medical professional, not awkward at all.”
Education and Normalization
A crucial early component involves:
- Information about typical sexual changes after prostate cancer
- Explanation of how anxiety affects sexual response
- Broadening understanding of what constitutes “normal” sexuality
- Challenging myths about aging, cancer, and sexuality
Communication Training
Most couples benefit from structured approaches to discussing intimacy:
- “I” statement practice: “I feel…” rather than “You never…”
- Active listening techniques
- Vocabulary development for discussing sensitive topics
- Boundary-setting and consent conversations
Sensate Focus Exercises
This cornerstone technique of sex therapy involves structured touching exercises:
- Begins with non-sexual touching to rebuild comfort with physical connection
- Gradually progresses to more intimate touching
- Focuses on sensation rather than performance
- Removes pressure for arousal or orgasm initially
- Practiced at home between sessions
“The sensate focus exercises were transformative,” shares Linda, whom we met at the beginning. “They helped us slow down and really pay attention to pleasure again, without Robert feeling pressured to ‘perform.'”
Mindfulness Training
Research published in 2021 found that mindfulness-based approaches show promise for couples affected by prostate cancer:
- Techniques to stay present during intimate encounters
- Practices for managing intrusive thoughts or performance anxiety
- Body scan meditations to increase awareness of non-genital pleasure
- Guided imagery for relaxation and arousal
Specific Techniques for Prostate Cancer Recovery
Specialized approaches for post-treatment challenges include:
- Adapting to dry orgasms: Techniques to enhance orgasmic sensation without ejaculation
- Managing incontinence concerns: Practical strategies like timing, emptying the bladder, and using incontinence products
- Exploring alternative erogenous zones: Discovering new areas of pleasure when genital sensation has changed
- Integrating medical treatments: Incorporating devices or medications into intimate play rather than treating them as clinical interruptions
Types of Sex Therapy Approaches
Several therapeutic modalities have shown effectiveness for couples facing prostate cancer-related sexual challenges:
Individual Therapy
Some concerns benefit from one-on-one sessions:
- Processing personal feelings about changed body image
- Addressing individual anxiety or depression
- Exploring sexual history that might impact current adaptation
- Preparing for difficult conversations with partners
Couples Therapy
Joint sessions focus on:
- Relationship dynamics affecting sexual adaptation
- Communication patterns and barriers
- Mutual goal-setting for sexual recovery
- Shared exercises and homework
Group Therapy
Some couples benefit from structured group programs:
- Normalizing experiences through shared stories
- Learning from others further along in recovery
- Building community and reducing isolation
- Often combined with educational components
Online/Telehealth Options
Research shows that internet-based sexual counseling can be as effective as face-to-face therapy:
- Provides access for those in remote areas
- Offers privacy that may feel more comfortable for some couples
- Allows participation from home
- May be more affordable than in-person options
“We live in a rural area two hours from the nearest sex therapist,” explains James, 65. “Online therapy made it possible for us to get help without the burden of travel.”
Finding the Right Therapist
The effectiveness of sex therapy depends significantly on finding the right professional. Look for:
Proper Credentials
Qualified sex therapists typically have:
- Graduate degree in psychology, counseling, social work, or medicine
- Specialized training in sexual health
- Certification from organizations like AASECT (American Association of Sexuality Educators, Counselors and Therapists)
- Experience working with cancer patients
Cancer-Specific Expertise
Not all sex therapists have experience with cancer-related sexual challenges. Ask potential therapists:
- Have you worked with prostate cancer patients before?
- What specific approaches do you use for cancer-related sexual issues?
- Do you collaborate with medical providers?
- How do you address both psychological and physical aspects of sexual recovery?
Personal Comfort
The therapeutic relationship is crucial for success:
- Do you feel comfortable discussing intimate details with this person?
- Does the therapist use language and explanations that make sense to you?
- Do they respect both partners’ perspectives equally?
- Are they LGBTQ+ affirming if relevant to your relationship?
Common Therapeutic Techniques
While therapy is tailored to each couple’s needs, several evidence-based approaches are commonly used:
Cognitive-Behavioral Therapy (CBT)
This approach addresses thought patterns that interfere with sexual adaptation:
- Identifying negative automatic thoughts during intimacy
- Challenging unhelpful beliefs about sexuality and performance
- Developing more flexible thinking about what constitutes “successful” intimacy
- Creating behavioral experiments to test new approaches
Sensate Focus
As mentioned earlier, this structured touching program helps couples:
- Reconnect physically without performance pressure
- Discover new sources of pleasure
- Communicate preferences more effectively
- Gradually rebuild comfort with sexual touch
Mindfulness-Based Interventions
These techniques help couples stay present during intimate encounters:
- Focused attention on physical sensations
- Techniques for gently returning to the moment when distracted
- Body scan practices to increase awareness of pleasure
- Acceptance of changing sensations without judgment
“Learning mindfulness changed everything for us,” shares Robert. “Instead of my mind racing with worry about whether I’d get an erection, I could actually enjoy the sensations of touch and connection.”
Communication Exercises
Structured approaches to improve intimate conversations include:
- Scheduled check-ins about sexual needs and experiences
- “Speaker-listener” techniques to ensure both partners feel heard
- Vocabulary building for discussing sensitive topics
- Role-playing difficult conversations
Integrating Medical and Psychological Approaches
Effective sexual recovery after prostate cancer often combines medical interventions with psychological approaches:
Coordinated Care
The best outcomes typically occur when:
- Sex therapists collaborate with urologists and oncologists
- Medical treatments for erectile dysfunction are integrated with psychological approaches
- Partners are included in medical appointments when appropriate
- All providers share a biopsychosocial understanding of sexual health
Penile Rehabilitation
This approach combines medical and psychological elements:
- Early intervention after treatment to maintain penile health
- Regular use of vacuum devices or medications to promote blood flow
- Gradual reintroduction of sexual activity with modified expectations
- Psychological support throughout the process
Medication and Device Integration
Sex therapy can help couples incorporate medical interventions into intimate play:
- Reframing ED medications as enhancers rather than “fixes”
- Incorporating device use into foreplay
- Managing timing expectations with different interventions
- Addressing feelings about reliance on assistance
Special Considerations for Different Relationships
Sex therapy approaches may vary based on relationship dynamics:
LGBTQ+ Couples
Gay, bisexual, and transgender individuals may face unique challenges:
- Different sexual practices may be affected differently by treatment
- Finding therapists with both cancer and LGBTQ+ expertise can be challenging
- Some may face additional stigma or lack of understanding from healthcare providers
- Specific concerns like changes in receptive anal intercourse after treatment
Older Couples
Couples in long-term relationships or of advanced age may benefit from:
- Addressing generational attitudes about discussing sexuality
- Navigating concurrent age-related sexual changes
- Adapting to multiple health conditions that affect intimacy
- Exploring evolving definitions of sexuality in later life
New or Dating Relationships
Those not in established partnerships face different challenges:
- When and how to disclose sexual changes to new partners
- Building confidence in dating after treatment
- Managing anxiety about rejection
- Establishing new sexual patterns without a previous baseline
Success Stories: Reclaiming Intimacy
While every couple’s journey is unique, many find meaningful ways to reclaim intimacy after prostate cancer:
“Six months into therapy, we realized we were having better sex than before cancer,” shares Miguel, 58. “Not the same kind of sex—but more connected, more creative, and in some ways more satisfying because we’re really paying attention to each other now.”
“I thought our sex life was over,” admits Patricia, whose husband underwent prostatectomy and radiation. “Sex therapy helped us understand that sexuality is about so much more than just intercourse. We’ve discovered new ways of being intimate that work for both of us.”
“The most important outcome wasn’t even physical,” reflects David, 70. “It was learning to talk openly about our needs and feelings. That skill has improved our whole relationship, not just our sex life.”
Getting Started: First Steps
If you’re considering sex therapy after prostate cancer, here are practical first steps:
Talk With Your Partner
- Choose a private, relaxed time to discuss seeking help
- Use “we” language: “I think we could benefit from some guidance”
- Focus on positive goals rather than current problems
- Be prepared for initial hesitation or discomfort
Consult Your Medical Team
- Ask your urologist or oncologist for referrals to qualified sex therapists
- Discuss any medical interventions that might complement therapy
- Ensure your medical providers know you’re pursuing this aspect of recovery
- Request that records be shared with your therapist (with appropriate consent)
Research Options
- Check credentials and specialization in cancer-related sexual issues
- Consider practical factors like location, cost, and insurance coverage
- Explore both individual therapists and hospital-based sexual health programs
- Look into telehealth options if in-person therapy isn’t accessible
Prepare for Your First Appointment
- Discuss with your partner what you both hope to achieve
- Make notes about specific concerns or questions
- Bring relevant medical information about your cancer treatment
- Remember that the first session is often assessment-focused
Resources for Further Support
Beyond formal therapy, several resources can support couples’ sexual recovery:
Organizations and Support Groups
- American Association of Sexuality Educators, Counselors and Therapists (AASECT) – Find certified sex therapists
- ZERO – The End of Prostate Cancer – Support groups and resources
- Us TOO International – Peer-to-peer support network
- Cancer Support Community – Free counseling and support groups
Books and Educational Materials
- “Saving Your Sex Life: A Guide for Men with Prostate Cancer” by John P. Mulhall, MD
- “Man Cancer Sex” by Anne Katz, RN, PhD
- “Intimacy with Impotence: The Couple’s Guide to Better Sex After Prostate Disease” by Ralph and Barbara Alterowitz
Conclusion: A New Chapter of Intimacy
Sex therapy offers couples affected by prostate cancer a pathway to reclaiming intimacy, connection, and sexual satisfaction—even when traditional sexual function has changed. By expanding definitions of sexuality, improving communication, and exploring new approaches to pleasure, many couples discover a new chapter in their intimate lives that can be fulfilling and meaningful.
As for Robert and Linda, whom we met at the beginning? After six months of therapy, they sat close together on my office couch, occasionally touching hands as they spoke.
“We’re not the same as before cancer,” Linda reflected. “But in some ways, we’re better. We talk more openly now. We pay more attention to each other’s needs. And we’ve discovered forms of intimacy we never explored in 32 years of marriage.”
Robert nodded in agreement. “Cancer took some things from us, but therapy helped us find new possibilities. I never thought I’d say this, but our intimate life now is more creative, more mindful, and in many ways, more satisfying than before.”
Their story reminds us that while prostate cancer changes sexuality, it doesn’t have to end it. With proper support, couples can write new chapters of intimacy that honor both what’s been lost and what remains possible.
This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment of any medical condition.