Above-the-Belt Relationship Changes That Can Come with Prostate Cancer
by Arnold Melman, MD, and Rosemary E. Newnham
Although many men see their temporary or permanent loss of erectile function as the chief change that affects their relationships post-treatment, most researchers would argue that the bigger changes happen – and need to happen – above the belt buckle: in the brain and in the heart.
Changing Views of Yourself
Before you were diagnosed with prostate cancer, there were many roles you played in life: roles related to your work (engineer, teacher, regional manager), your family (son, husband, father, uncle), and maybe your hobbies (baseball fan, photographer, runner). Along with a cancer diagnosis, you are handed a whole new role to play: that of a cancer patient. Especially if you haven’t gone through a major illness before, this is a difficult adjustment. Part of your new role involves unpleasant things like getting poked and prodded and talking about genitals and continence issues, all while wearing a skimpy paper gown in a dreary examining room. Anyone would feel a little vulnerable in that position.
No matter how easily your treatments have proceeded, there will be times when your spouse will need to assume a caretaking role.
There are several other factors that can change the way you view yourself. One is the actual physical problems (urinary incontinence, erectile dysfunction, and possible rectal issues) that make you feel as if you have lost control of your own body. Wetting yourself can be demoralizing and can make you feel infantilized. Erectile dysfunction may mean a loss of spontaneous sex or even the end of sexual intercourse all together. Even if he’s not currently in a relationship, a man may feel like less of a man with the loss of his erections. Masculinity in most cultures is associated very much with virility and with the phallus, which is a powerful symbol of strength and even life itself. Without such tangible evidence as hard, spontaneous erections or the ability to control basic bodily functions, some men may find themselves questioning, what does it mean to be a man? This questioning and vulnerability can change the way you behave in general, and toward your partner in particular.
Changes Caused by Aging
Layered on top of any perceived losses of power and manhood are changes in other areas that might be happening simultaneously for many men with prostate cancer. This disease is often diagnosed around the same time a man starts feeling the effects of aging, such as diminished muscle strength and increased pants size. Other obvious signs of age like hair loss or grey hair and wrinkles can add to the feeling that you are losing your virility.
Given that most men are diagnosed with prostate cancer in their 60s, it is likely to hit a man as he winds down his professional life. Work helps give our lives meaning. Life without work can lower your confidence in yourself and may even bring on an identity crisis: Who am I if I’m not an engineer/ teacher/salesman? What will I do with my life? It may seem as if you are less important to the world, but there is at least one person to whom you are still very important: your spouse.
No matter how easily your treatments have proceeded, there will be times, either during or afterward, when your spouse will need to assume a caretaking role. Caretaking can take many forms: providing emotional support after diagnosis, changing dressings after surgery, buying incontinence pads at the store.
The business of caretaking can upset the balance of a relationship and sometimes make it difficult to continue the usual activities of daily living. The more flexible a couple can be in terms of the roles they take with each other, the better; for example, do both feel comfortable being the giver and the taker? In relationships where the roles are more rigid, it can be more difficult to adjust to stressful shifts in the relationship.
If the caretaking responsibilities begin to seem onerous, then you will need to address the issue. Perhaps there is someone else, a relative or a friend, who you could ask to help. Can you and your spouse arrange it so that you both have time to yourselves – either with friends or on your own – so that you can come back to each other more refreshed? Compromises may need to be made on both sides. Even a small gesture of compromise (maybe you feel too tired to cook but can still peel the carrots) can make the other person feel more appreciated. The person who needs the care might consider little things he could do – fixing a leaky faucet or a cup of tea – to make the caretaker feel cared for, too.
Tension Over Treatment Involvement
Sometimes a man and his spouse can have different priorities for cancer treatment. Research has found that men with prostate cancer might compromise their long-term survival rate to maintain potency, whereas their partners value survival over everything else. Tensions can rise when fears – for loss of life or loss of manhood – collide. Hopefully, you and your spouse communicated about your feelings from the beginning. Spouses not only give emotional support, but they can also provide an extra set of ears and eyes to catch the many important details of medical treatment, such as understanding the medical information, setting up appointments, and following up on test results.
Sometimes the limitations imposed by the disease, or the treatment, can place undue stress on a relationship. For example, the daily radiation treatments could be especially taxing if the treatment center is a long distance from home. Also, complications such as incontinence can result in curtailing a couple’s social life and travel. Talk about how you and your partner see these limitations; how much do they bother you? Together, brainstorm for ways to resume more of your desired activities while still maintaining your dignity. For example, staying in a shortterm rental house or apartment might give you more privacy on vacation than a hotel – and allow you to do laundry if needed. Changing your regular seats at the theater or ballpark to ones closer to the restroom could allow you to keep your season tickets. Initiating new social activities that are more doable but still fun is a great way to broaden your horizons and deepen your bond with your partner. A social worker, support group friend, or your doctor might be able to offer coping strategies as well.
Anxiety and Depression
Multiple studies have shown that partners become emotionally distressed at higher rates than the ones with cancer, and women are more likely than men, in general, to develop depression and anxiety. If you know your partner is feeling anxious and scared about your condition, you may feel you want to protect her by not sharing your own fears. In reality, there can be great comfort for her in knowing that you are together in your fears or losses. Many couples found that by going through every step of the way together, they came through with a closer, more meaningful relationship and were less “down” than they expected because they weren’t alone.
Look for signs that depression or anxiety might be affecting your spouse’s daily life. Has she withdrawn from her own support network of friends and family? Does she express guilt about your condition or her role in your life? Can you encourage her to continue or resume activities that once gave her joy? If you feel that she is slipping into a real depression and could benefit from counseling, present the idea as a solution to problems she sees in her life. For example, “Your boss seems to be really demanding lately. Maybe a therapist would have some ideas about dealing with him so he doesn’t give you such a headache.” Or, “You’ve been saying you have trouble sleeping for weeks now; maybe your doctor would be able to recommend ways to sleep better.” If she seems reluctant to talk to her doctor or go to a therapist, you might suggest going to couples therapy to get your life together back on track. “We’re going through so much right now; it would do us both good to talk these things through.” A good couples counselor should be able to help address her individual anxiety or depression, and it would take you out of the position of having to “police” her state of mind.
You are also at a higher risk for depression and anxiety during your cancer experience, and your state of mind will definitely affect your spouse. The best thing you can do is be honest with yourself and your spouse about what you are feeling. Be vigilant about not taking out any anger or anxiety on your partner. And don’t be too proud to get help when you need it.
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Dr. Arnold Melman is professor of Urology at the Albert Einstein College of Medicine in Bronx, NY. Learn more about Dr. Melman at DrArnoldMelman.com. Rosemary Newnham is the former assistant director of the Oral History Research Office at Columbia University in New York, NY. She works with Columbia’s Narrative Medicine program and is a medical writer.
Excerpted with permission from After Prostate Cancer: A What-Comes-Next Guide to a Safe and Informed Recovery, by Arnold Melman, MD, and Rosemary E. Newnham, copyright © 2011
This article was originally published in Coping® with Cancer magazine, January/February 2013.