Dr. Katz provides counseling to patients with a history of cancer who have sexual issues and relationship challenges. She is the immediate past Editor of the journal Oncology Nursing Forum and is the author of 16 books, including Man Cancer Sex, and This Should Not Be Happening: Young Adults with Cancer.
CONQUER magazine asked Dr. Katz to explain the impact of a cancer diagnosis on men’s sexuality.
What Sexual Issues May Men Encounter After Being Diagnosed with Cancer?
The main concern for men diagnosed with cancer is erectile difficulties. Among the many other topics that oncologists don’t talk about are penile shrinkage and the loss of nighttime erections.
Such changes affect men’s body image and sense of masculinity. These changes also carry a big psychological component and have profound emotional and social impacts on men.
Are There Effective Treatments for Men with Such Physical Changes?
The available options are not great. Drugs for erectile dysfunction, such as Viagra and Cialis, can help, but they don’t always work. Part of the difficulty is that men are not educated about how to take these medications properly, because their use has become part of the social discourse. It’s part of jokes.
Doctors send their patients to me all the time, saying that their patient “failed” Viagra. It drives me bonkers! The patient didn’t fail Viagra, the drug failed the patient. This is an important point for doctors and for patients to remember!
With penile shrinkage, there’s some evidence that using an erectile (vacuum) pump may help, but it requires consistent use: it is also very mechanical. There are things like penile injections as well, to help with erection difficulties.
When a treatment doesn’t work once, it can become a self-fulfilling prophecy that it will never work. I never hear my urology colleagues talk about masturbation. Yet it is an easy, cheap, and a familiar way of getting blood flow to the penis.
How Can Patients Get Better Answers Regarding Their Sexual Issues?
Write down your questions in advance. Before your appointment with the oncologist or urologist, tell your nurse that you have some issues you want to discuss with the doctor, and that you’ll need more than 10 minutes. Remind the doctor that you have important questions when he or she walks in. Be a little selfish.
What Are Some of the Common Misconceptions About Male Sexuality?
That sex is easy and mostly physical for men. Many people think of male sexuality as a kind of on–off switch, thinking that women have more of a dial with complex switches and buttons. But men are “supposed” to keep going and going, regardless of the circumstances.
The reality, however, is that male sexuality is complex. Men can have problems with their body image, lack of confidence, and many emotional issues, as a part of normal living.
Can You Contrast Male Sexuality Before and After a Cancer Diagnosis?
Good question. First, I don’t think we talk to men about the impact of cancer surgery on their sexuality. It’s brutal. A colorectal surgeon once told me, “We slash and burn.”
Surgery to the pelvis causes an enormous amount of damage, and often no one tells these men about this. This is a big issue in cancer treatment.
We don’t give men enough details before any surgery for cancer. After the fact, men are often shocked; they are not warned, and they think that sexual problems because of cancer only happen to them.
I think that many men just want things to be the way they were before their cancer treatment. They want a quick fix. Some men only see their sexuality from a mechanical perspective.
Today, there are more people who identify as non-binary. Younger people, I think, are more in touch with their sexuality than older generations. A broader understanding of sexuality is necessary to move forward after damage has been done to your body.
How Can People Develop a Less Stereotypical Notion of Sex and Sexuality?
It’s not easy to change perceptions and beliefs about sex and sexuality. What guides me in counseling men is that beliefs and attitudes about sexuality trump knowledge any day. If someone has a firm belief about what it is to be a man, that’s a hard thing to change.
It’s also a very “male thing” to want to fix it by themselves, whatever the problem is. Some sexual problems can’t be fixed; instead, men have to adapt to those problems. For men, it’s often an all-or-nothing thing; it’s that on–off switch, and that’s tied in with the assumptions about male sexuality.
When it comes to sex, it’s scary to share with someone else what may be going on. But that’s what creates intimacy. Intimacy is based on an emotional connection, which is predicated on vulnerability and a willingness to be vulnerable.
It’s hard to be vulnerable about one’s sexuality, in part because of the tropes of being a man.
How Do You Help Men Who Are in a Relationship to Accept a Less Rigid Notion of Their Sexuality?
Education is key, but I’m not talking about a book or a pamphlet. I mean education via discussions. For men in a relationship, I always ask that their partner be included in our conversations. Without both of them hearing the same information, there’s going to be misinterpretation.
We all make assumptions about what our partner thinks and feels, but often that is not close to reality. A man in his 70s who was after treatment, told me that he wanted to get penile injections so he could start having erections again.
His wife said, “You’ve got to be kidding me! We haven’t had sex in like 20 years, and before that, it wasn’t that great. I was doing it for you, and now you want to do what?!”
What I’ve seen in my 22 years of practicing sexuality counseling is that when a couple is in the presence of an objective, non-judgmental professional, it creates an atmosphere of safety that allows them to talk openly to each other. They start sitting at a 45-degree angle, not facing each other, and half facing me. After I explain what I do and ask a few questions, they move their chairs to face each other and start talking. I’m sitting there, thinking: “Should I check my e-mail? Can I make tea?” Often, I don’t say a word for 30 or 40 minutes. It is something magical that happens.
What About Men Who Are Single?
There is enormous pressure for single people who have had cancer, whether they have a sexual problem or not. They experience a seismic shift in how they see the world. They fear that they’ll be alone forever, wondering, “Who is ever going to want me and accept me?”
Confidence is power, and cancer damages confidence, which is linked to certainty about how life is going to play out physically and emotionally. Men are under enormous pressure to have erections—another trope that men have been led to believe.
The reality is, we all have baggage. The worst thing someone in my position can do is start with platitudes such as, “Oh there’s someone out there for everyone!”
But if a man I’m counseling is worried about being with someone who thinks he is perfect as is, that lack of compassion or empathy is going to catch up to him at some point, about something else.
Opening up to someone about any challenges is scary, and certainly about sex. The fear about being judged is real. But do you want someone who is judgmental in your life?
- Oncologists often don’t talk about the possibility of penile shrinkage and the loss of nighttime erections
- Many people have heard of Viagra and Cialis, but many men are not well-educated on how to take these medications properly
- Single people who have had cancer face an enormous pressure from feeling that they will no longer be wanted or accepted by another person, which can damage confidence
- Getting adequate information before surgery for cancer is important, so that patients aren’t shocked to find their sexual function has changed
American Cancer Society
National Cancer Institute