Of all the difficult
challenges that happen to a man with prostate cancer, and to his
partner, this one is rarely discussed. Hormonal therapy causes personality
changes in men, and this — far more than the hormones' effect on
sexual function — can be devastating for those who love them.
Urologist Karen Boyle, M.D., Director
of Reproductive Medicine and Surgery, has seen this many times.
She gives an example (although the names have been changed, to protect
the couple's privacy): Mr. and Mrs. Taylor, married for half a century.
They have always enjoyed an active sex life. Mr. Taylor, who is
78 years old, has advanced prostate cancer, and began hormonal therapy
in 2003, when his bone scan became positive.
"Although the couple was aware of
the side effects of hormonal therapy, they never anticipated how
the most intimate aspect of their marriage would change," says Boyle.
"Not only did Mr. Taylor's erections completely disappear, but he
became completely indifferent and disinterested in sex, and would
not agree to any aspect of sexual intimacy. His lack of affection
toward his wife has caused her extreme unhappiness and loneliness."
feel as if I no longer know him.
Not only will he not talk about
it, he avoids all discussion of
how this makes me feel. It is
as if he is a stranger.”
Mrs. Taylor recently described some
of what she is feeling in this way: "It is as if there is a stranger
in my bed. I lay in bed at night next to a man whom I have known
for over 50 years, but I feel as if I no longer know him. Not only
will he not talk about it, he avoids all discussion of how this
makes me feel. I'm okay with us not having sex — it's everything
else — being physically close, connected — that I miss the most.
He is now indifferent. It is as if he is a stranger."
Mrs. Taylor's experience is "all
too familiar to other women whose husbands have had hormone therapy,"
notes Boyle. But when many physicians talk about the side effects
of hormonal therapy, the discussion "does not usually extend to
the profound effect it has on the couple's intimacy, and the female
partner," she continues. "The thousands of female partners are ignored,
silently suffering, and are left emotionally and physically abandoned.
Until now, their crying and tears have been very private, often
confined to the very bedrooms in which they feel the indifference
of ‘the stranger' lying next to them at night."
believes that women like Mrs. Taylor shouldn't have to wait until
this happens to them to find out about it. "Confronting this loss
of intimacy proactively, before the therapy begins, would be very
beneficial." However, "many physicians are unfamiliar with dealing
with such complex sexual dysfunction." She recommends "couples counseling"
with a medical professional who is familiar with the hormonal and
physical effects of medical castration. "The challenge is getting
the male partner to recognize the problem and agree to participate
in a treatment plan geared not to optimizing sexual intercourse,
but optimizing intimacy."