Bringing back sexual spark after prostate surgery
Rob and Diane Kikkert have had to learn a few new tricks since Rob’s surgery to remove a cancerous prostate gland, a procedure that left him struggling with incontinence and erectile dysfunction.
“You just have to learn a new way to do it,” said Diane. Through couples mindfulness training, they have rekindled their intimate relationship.
That doesn’t mean it was easy. Most men who have their prostate removed suffer damage to blood vessels, irreversible erectile dysfunction, and loss of sensation due to nerve damage.
The former high school sweethearts — in their 47th year of marriage — were sexually active before the surgery almost two years ago and now live in a post-erectile reality.
“They say you can feel depressed, but it’s more like a grieving process,” said Rob, who had been watching his PSA (prostate-specific antigen) scores rise for years before his surgeon — University of B.C. professor Larry Goldenberg — finally said “Let’s get that sucker out of there.”
Goldenberg’s book The Intelligent Patient’s Guide to Prostate Cancer helped Rob prepare for his treatment.
Rob knew the odds were against a return to full sexual function. About 70 per cent of men can’t get an erection firm enough for intercourse after surgery five years later and it seldom gets better with time. Even Viagra doesn’t help much.
Other treatment options, such as radiation and brachytherapy, may also do damage to blood vessels and nerves.
“They give you a lot of statistics, but when it’s your turn you tend to think that some percentage have ... a pretty good outcome and I preferred to think I would have the best outcome,” he said.
“But the odds are stacked against you.”
The strong likelihood of profound disruption to their sex lives is not something that cancer doctors dwell on with their patients when discussing treatment options out of fear they might avoid life-saving treatment, according to Lori Brotto, director of the UBC Sexual Health Laboratory.
“Doctors are in the business of curing the cancer,” she said. “Their goal is to send you back cancerfree.”
But for men who place a high value on sexual performance and who see sex as an integral part of their quality of life, loss of sexual function is emotionally devastating, often leading to depression and disruption in their relationships.
Brotto and a team of researchers in male and female reproductive health at UBC are co-operating on a clinical trial to compare two different approaches to sexual reeducation — mindfulness and cognitive behavioural therapy.
With a grant from Prostate Cancer Canada, 240 men and their partners will be divided into groups employing different strategies.
The Kikkerts participated in a pilot study on mindfulness.
“Many men can learn to be sexual again,” said Brotto. “"There’s still sensation there and, for some, a level of erectile response.”
After surgery, men can learn to experience their bodies and sensation differently, in ways that introduce them to a “smorgasbord” of sexual behaviours that don’t involve the penis. And for many men — even though the penis may never be erect enough for vaginal intercourse — orgasm is still possible.
Over the past 40 years, mindfulness has made its way into western medical practice, especially for chronic pain and depression.
“Mindfulness involves paying attention non-judgmentally and in the moment,” said Brotto, who has studied female sexuality for more than two decades.
“We can teach people through exercises to notice different sensations, temperature and pressure.”
“Research over the past 15 years or so has shown that this had been very effective with women, and so we are adapting it to men,” she said.
To participate in the study, visit the Brotto Lab web page at brottolab.med.ubc.ca or email Chris Pang at cpang@prostatecentre.com.