Helping a PCa man with intimacy:
TEN POINTERS FOR WOMEN
[This was posted by PD to a list on 9/3/00.]
From a man's perspective, I'd like to offer some words of encouragement to women in helping with their partners and with intimacy.
It's been 14 months since my RP, and getting back physical intimacy has been a real test for my wife and me. The issues depend greatly on the nature of the physical relationship before surgery, and some couples will cope easily, while others will be at nearly a complete loss as to what to do.
Ten pointers for women:
1. Don't gauge interest by how often you are now approached for sex or intimacy. Men are used to having a physical feedback loop -- feel a little horny, get a twinge of an erection, feel a little hornier, get more of an erection, etc. Now that the feedback loop has been truncated, its easy for a man to misjudge his own level of interest, or difficult to proceed to intimacy without the usual internal signals.
2. Don't wait for him to be "ready" post-treatment. During the recovery process, expect to be THE instigator of physical relations. This is a role that many women are unaccustomed to, and it might take what seems like an unnatural force of will to adopt sexual aggressiveness. Some women will wait for months for signs of renewed interest from their husbands. Instead, jump in and take the lead for a while.
3. Men who are struggling with ED will need a lot of imaginative and DIRECT stimulation. Many women are used to being able to cuddle flirtatiously, kiss passionately, or caress their partners in general areas, and have the man be ready with an erection. This is likely no longer the case. Using your hands and mouth on his penis might become a necessary part of foreplay (or, for that matter, play itself.)
4. Don't make the erection and penetration the center of activity, or even the goal. It might even be that an erection happens and the opportunity is seized briefly, the erection is lost, play resumes, an erection is regained, the moment enjoyed, the erection lost, more play, etc., during a single lovemaking session. The erection of his penis is no more essential to lovemaking than the erection of your nipples is.
5. Prostate cancer affects men's sense of masculinity in any number of ways. It can affect their general stamina and sense of worthiness at work (which for many men is a key aspect of their masculinity), incontinence is by definition a loss of self-control (another key element of masculinity), fear of death erodes a man's confidence in being able to care for his family, and of course impotence is a tremendous blow. (Heck, men even mourn the loss of ejaculate during orgasm. Sure it's part of the pleasurable sensation, but it also is a celebration of procreative power; there's a reason why erotic films place a lot of focus on the "money shot.") The point is that there is a web of masculinity issues here, all interconnected, and often having psychological offshoots and unexpected side-effects. None can be neglected, and lack of progress or treatment in one area can affect positive results in another area.
6. Become aware of your own needs. Many women find themselves depressed and feeling unappreciated and unloved and lacking emotional support as well as physical support during these days. Some women will lie to themselves that they can do without the sexual relationship as long as they have a strong relationship in other aspects. (For some couples, this may in fact be true.) However, for many women, the physical and emotional relationships go hand in hand, and ignoring one causes unaccountable losses in the other.
7. Men are used to being the Kings of Spontaneity. Women typically take a little while longer to get fully in the mood, but once a woman signals receptivity, men are used to being able to say, "Hey, babe, I'm there!" This is no longer the case. Men will likely need as much romancing, as much lead-up, as much seduction as a woman might, or even more. This takes some getting used to by both partners. On top of that, many ED treatments (Viagra, injections, VED) require lead-times ranging from 10 to 60 minutes.
8. Be patient with progress, and encourage patience in your partner. Men will often see the same thing with impotency that they experience with incontinence -- long periods of stasis, followed by seemingly spontaneous improvements. Also, celebrate incremental improvements, even if the return to former function isn't complete. Better is better, even if it doesn't get any further better.
9. Be prepared, and allow yourself, to lose the mood. It's OK to take a $10 Viagra tablet and then not make love. It's OK to wait 10 minutes for him to inject himself in the bathroom (for most couples, it's hard to make a needle a foreplay game), and lose interest in that time, even if he's walking around stiff as a board for two hours. It's OK to have foreplay for a while and find out you're just not getting your heart rate up.
10. Don't wait for him to talk about it. If you are the initiator of conversations about sex and what's going on with his body and heart and head, and what's going on with yours, then he knows you're interested. If he knows you're interested, that's a feedback loop to his interest.