In Your Pants with Dr. Susie G - Can You Have a Sex Life After Prostate Cancer?

Starting point is 00:00:00 on this episode what do we want out of sex if we can if the connection is the main point you don't need a firm erection for connection right you can cut you're listening to the in your pants podcast i'm your host dr suzy gronski your penis friendly pelvic health physical therapist sex counselor and educator helping you get in the know down below today we'll be exploring a topic close to many hearts the impact of prostate cancer treatment on a man's sexual function dr marali will be shedding light on the emotional and physical challenges faced by men how partners can offer support the crucial role of communication in maintaining a healthy sexual relationship, available strategies and treatments, and so much

Starting point is 00:00:59 more. Dr. Nazanin Mawali is an internationally recognized ASEC certified psychologist, educator, and the brilliant mind behind the weekly podcast Sexology. Her expertise lies in helping clients overcome eating disorders and navigate the complex world of sexual health. so if you're ready to unravel the mysteries of post-prostate cancer sexual health stay tuned dr moali's insights will leave you informed empowered and ready to engage in open honest conversations about this essential aspect of life and for more information on dr nazanin moali or to explore her podcast sexology where yours truly was featured as a guest check out the show notes, YouTube description below, or my website at drsusieg.com for all the details.

Starting point is 00:01:55 So let's dive into the world of intimate conversations right here on In Your Pants. Dr. Mali, thank you so much for being on the show today. Dr. Susie, I'm very excited about this interview. I've been following your work and I'm a big fan. Thank you. Likewise. So can you please explain to us how prostate cancer treatment impacts a man's sexual function? Well, this is unfortunately very common that many men who go through the treatment, they experience it, but sometimes they don't have enough information about it, they are not well-informed about it, depending on the type of a treatment they choose, whether it's surgery, radiation, hormone therapy, they might experience different type of

Starting point is 00:02:50 side effects. One of the very, very common one is erectile dysfunction. Also, I heard from many of my clients, they experience loss of libido, which we're going to talk about. Part of it, it could be physiological and psychological. Some of my clients kind of struggle with loss of length, like their penis length. That's also something else that they struggle with. And depending on the treatment, some of them experience dry orgasm. It can impact their kind of like quality of their erection. So there are a number of different ways that it may impact men's sexual health. And what are some of the emotional challenges that men face when dealing with sexual changes after prostate cancer treatment? Well, it can definitely impact the man's self-worth,

Starting point is 00:03:47 self-image. Their body can change, as I mentioned earlier. It can change the quality of erection, and it can change their shape and size of their PDS. And some of my clients, their identity is connected with their sexual performance. So completely makes sense that when they're struggling, when they're not able to, quote unquote, perform well in the bedroom, they also feel less of a man, they feel like a failure. Sometimes we see that the communication with the partner is not clear due to the shame, due to the guilt they're feeling, and it created a rift in the relationship.

Starting point is 00:04:31 Like any life-changing condition, many people develop anxiety, depression, which that also can impact their sexual function and also quality of their relationship outside the bedroom, right? So if you're not feeling like yourself, you're not connecting with your partner, it's harder to connect sexually. The other challenge that I see people have is that they kind of feel that their partner is no longer value them. So they can miscommunication is very common in many of my clients because of the changes they've noticed on themselves and the relationship due to the aftermath of the procedures. And I'm glad that you brought up these emotional impacts, because

Starting point is 00:05:26 I don't think a lot of the men have the discussion before prostate cancer treatment, because the initial worry certainly and legitimately is that I have cancer and I need to deal with that. And unfortunately, urologists, doctors are great, but they're not having conversations around how do we support you as a sexual being and also in partnership if that is the situation to reconnect with your sexuality after prostate cancer or even things like how to use a penis pump you know what what to look after as far as like other sexual resources that might be available to them. In your experience, Dr. Ma'ali, what do men often express to you as like the biggest challenge that they're facing, you know, after experiencing prostate cancer and or

Starting point is 00:06:24 treatment with prostate cancer when they make that courageous step to see you? Well, I wanted to highlight what you said earlier that's just so important. We have wonderful urologists, treatment teams, but sometimes they don't emphasize, they don't educate people about the sexual side effects. And I hear from my clients that after going through the procedure, they feel like their expectation wasn't correct when it comes to outcome sexually. They feel that they were not well-informed when they chose the treatment. Some of my clients who are in partnership. They said that I wish my partner also was part of the decision. She was informed about the side effects so we could have an open communication ahead of time. So that's something

Starting point is 00:07:18 that I hear a lot from my clients because there are lots of challenges that someone might face after receiving a treatment. So it can be a lot to sort everything out with kind of emotional challenges, psychosexual issues. So that's something I hear a lot. Like any other medical condition that leads to changes, many of my clients, they go through grief stages. They're just so angry after the procedure, understandably, because they feel that they lost part of themselves. Many of my clients, they had their own challenges, sexual challenges in the relationship in the past prior to the prior to the treatment. And now they feel that they're no longer working for them. So that's also is part of what I hear from many of my clients.

Starting point is 00:08:13 And sometimes when you are tired, when you're depressed, it's just so much harder to establish a new relationship with a provider, a counselor. So it would be like if you establish a relationship before, as you're going through this journey, it can be more helpful versus like afterward looking to find someone, make an appointment, having your partner coming on board. So those are all the things that I hear from my clients that they wish they knew before they had information about it and they have conversation with partner, their partner about it. Exactly.

Starting point is 00:08:48 And you just named something that I think would be a game changer for many people in in this conversation that we're having is preparing ahead of time, you know, getting your team, your support team in place, having these conversations around sexuality expectations to prepare mentally, to prepare physically. I know as a pelvic therapist myself, I can't tell you how many times I wish men would come in for pre-rehab, right? To get to know their bodies here their pelvic floor muscle memory expectations around urinary incontinence which can significantly impact desire sexual desire libido erectile function how to even again when do i use a penis bone how do i use the penis pump can i hurt myself you know how do i involve my

Starting point is 00:09:39 partner like all of these preparatory important details i think are really are just skipped and And what you're saying is that if we had if they had this preparation and the support during their journey before, during and after, I think it would be a very different experience. I don't know. I'd love to hear more on what you think. Absolutely. Dr. Shuthi, when it comes to sexual functioning, many people, they just don't know about the options out there. even when they don't go through the prostate cancer, because there are so many great options. But in our society, our sexual health is very connected to our identity. So when we're experiencing a challenge in sexual functioning, we think we're defective, we're feeling shame, and that gets in the way of being proactive.

Starting point is 00:10:35 I'm thinking about, okay, this is a setback, and I don't want to minimize it. it's definitely a setback, but what can I do next? Maybe, as you mentioned that before I was using medication, now it's a time to use the pump or I can do surgeries. There's just, if you want to have a healthy connecting sexual life, there are going to be some challenges, but you'll be able to do it. My invitation for people is to have their partner, if they have a partner as part of their kind of decision making for their prostate cancer treatment that they're choosing and ask from their provider or do research, what are the sexual side effects, the setbacks that might come up with each treatment and proactively talk to your partner about how

Starting point is 00:11:25 are you guys going to remain connected after the treatment? I understand for some people it's not a priority, but for many people it is, and they just feel like they don't have the ability to have those open conversations. They feel bad about it. So if it's a joint decision, then you guys can talk about, okay, if there is an erectile dysfunction, what are some of the steps that we're willing to take? For example, I know that some of my clients, they choose to use injections. they choose to they choose to do like things that requires a little bit of a preparation

Starting point is 00:12:03 and they feel that takes away that them being the couple being spontaneous right and they feel it's awkward that if I go to grab something then to do the injection right but if you're talking about it with your partner then you don't need to struggle with in that moment as much about what my partner thinks. The other thing is that in our social experiences, sometimes we're feeding off each other's energy, right? So if I'm having, and I'm having experiences with my partner, he's not experiencing an erection, then sometimes the partner feels that I'm not, they don't find me desirable. We're not able to have a sexual connection anymore. Versus if we know about the options, we know that there needs to be some adjustment that we need to make in

Starting point is 00:12:50 order to have the quality of sexual experiences we want. So definitely invite people to establish their own counseling if they have partner counseling. And as they're going through this process, work with a couple's therapist that they have some expertise on sexual health. So they can help you to have these open communications, talking about different options. What's the meaning of sex for the couple? Because sometimes we get into this space of mind reading. We're thinking that maybe our partner is not interested in having sex anymore. Or maybe my partner, if I don't have a rock hard erection, they don't want to be intimate anymore. So it's really important to, if it's hard to have this conversation on your own, have a therapist as your ally.

Starting point is 00:13:40 and what would you say to the partners like how can partners support men who are impacted by the physical and emotional effects of prostate cancer treatment you you definitely mentioning communication turning towards your partner being part of the decision-making process but is there any other tips or supportive advice that you can offer to partners Absolutely. I think the first thing is that have a kind of like an honest self-reflection, thinking about how important sex is for your relationship, for yourself, because sometimes partners feel guilty or they feel bad that, okay, my partner just went through this surgery, life transitioning situation, and now I put the pressure on them wanting sex. So it's important to think about, OK, how important sex is for me and what is the meaning of sex for our relationship? Is it about connection? Is it about intimacy? Is it about kind of like building excitement? So it's really important to have that thought on your own and have a conversation with your partner of thinking about how you can support them.

Starting point is 00:14:57 tell them like using I statement that this is what I feel and how can we move forward with this? How can I support you? One thing that's really important for couples to see this as a team approach. It's not you're failing or I'm selfish. As a team, what can we do to make sure both of our needs are getting met? It could be meaning like, okay, we're talking about getting creative, right? That talking to our partner about what do we want out of sex? If the connection is the main point, you don't need a firm erection for connection, right? You can cuddle, you can do erotic massages, different things to do in order to feel that connection. If for a partner, penetration is really important, then as we talked about, there are so many different interventions

Starting point is 00:15:51 like ED medication, like the vacuum, like a surgery, like pump, there's just so many things people can do. But even with those, it's as you mentioned, it's really important for people to know the right usage, right? That for example, if you're taking the medication, you're very, very anxious, because you have performance anxiety, the medication might not work. So it's really important for people to educate themselves on how can they choose the best treatment and how can they maximize their approach and educate the partner about what can be helpful for them so maybe they're because of the anxiety uh it's harder for them to get an erection then we can talk about with the partner what can we do beforehand to kind of reduce our anxiety

Starting point is 00:16:41 we can do tantra practices like eye gazing a rhythmic breathing we can do uh deep breathing together, so we both feel more grounded. So I think that that is also something important. And kind of getting creative, thinking about it's really, really important for anyone to be flexible around their sexual script. Sometimes we have such a linear story in our mind about what sex could and is supposed to be, like if it's a heterosexual couple, vaginal, penile erection leading to both orgasms right but kind of thinking about how can we get the emotions that we want using the tools that we have right now I sometimes think about it like you want to make a cuisine you want to make Italian food right these are the ingredients you have right so there's just so

Starting point is 00:17:34 many different ways that you can make that ingredient so kind of but then it could be use of sex toy master mutual masturbation sensual massages those are all very very helpful what invitation i have for people if you are planning to use a sex toy they can be your ally it can make the experience so much more fun but it's important to have a conversation beforehand with your partner right don't surprise them with sex toys and maybe that could be part of that erotic exchange that you guys having maybe you can open a new chapter with incorporating these toys and toys are not your competition they're just enhancement of uh what you already have so I often hear people like kind of like they feel like using this new kind of updated

Starting point is 00:18:25 script their sex life even got so much better and I think for partners also it's important for them to let themselves feel the grief there is a oftentimes grieving period because your your sex life maybe is changing drastically or for at least temporarily. And it's okay to let yourself feel the emotion. So I don't want people to jump into only a caregiver mode, which is wonderful, but also give yourself opportunity to feel the emotion, process it before talking to your partner. Absolutely. And I really would, I don't need a fervor erection for connection that needs to be on a shirt somewhere. I think, I think that's some new merch for you, Dr. Molly. Thank you. I'm loving it. I'm loving it. But yes, I mean, you're, you're kind of diving into the,

Starting point is 00:19:22 the, the treatment and strategy question that I have, you know, what are some of these ingredients and your experience working with people, what helps, you know, what helps to manage or even enhance and optimize sexuality and work with these sexual difficulties that might present themselves after a prostate cancer treatment? Well, kind of going back to the recipe piece. So for most people, in order for them to have a good sexual experience, there is a psychological arousal that needs to happen and there is some physiological arousal. Having a conversation with your partner about, again, what is the meaning of the sex and what are some of the ingredients we can add for psychological arousal and what are some

Starting point is 00:20:09 of the updates we can make to a physiological arousal, right? So sometimes as we're going back to the kind of like that loop of excitement of your partner many women they kind of when their partner ejaculate it's part of like the firework or they're like a finishing like a finishing act and they might feel disappointed or not know what's happening first step is like for people to educate themselves okay what are some of the challenges and issues we have around physiological arousal now and what are some of the pros that like tools that we have for psychological arousal and what are some of the things we don't have.

Starting point is 00:20:50 And you can add to psychological arousal, kind of making sure that, okay, maybe we can watch something exciting together. Maybe we can do a role play. So like, you know, getting creative with that part and kind of talking about with this new challenge with physiological arousal, what kind of a sensation we would like to have

Starting point is 00:21:11 And how can we achieve them? Again, going back to if erection is important, maybe kind of like using one of those strategies that we talked about, consult with a urologist, they kind of understand the pros and cons. And sometimes my experience with my client is that they say that even if they use a sensation like vacuums or surgery, they might not have the sensation they used to have, right? kind of that also requires for people to understand it and kind of like think about maybe I can help it with increasing psychological arousal with adding additional kind of like additional exciting things in our script. And kind of like thinking about kind of having your own toolbox with

Starting point is 00:21:58 managing mood, any challenges that comes with if it's like a depression, anxiety, working through that as I mentioned sex toys can be your ally my invitation for people is to maybe go to an event sex shop kind of sex shop and like kind of like tell them field trip yes yes what kind of a cuisine you're trying to make yeah and kind of see what comes up and then kind of getting even if you don't want to implement it right that can help with adding psychological arousal for people And kind of experiment with it. Many of my clients, they love the strap-on. That's something else that like if their partner wants that more of a firm erection, that sensation is important. It's something they can experiment with. They can experience the pleasure themselves. but it requires a little bit of getting used to, but it's, it is important for people to kind of like let themselves to update their sexual script if they want to continue having

Starting point is 00:23:03 connected sexual experiences. Absolutely. And I'm glad you mentioned the strap-on because there's a really great paper. It's just one, it was a case study about someone who was impacted by prostate cancer was unable to achieve an erection even with you know medications or what have you and this person decided to use a strap-on that was hollow on the inside so he was able to put his penis inside and and have penetrative sex and this individual was like i've had you know their firsthand experience was like great orgasms you know so for for all men out there it's like you know, the erection doesn't equal new orgasm. In fact, you can have orgasm and not have an erection or not ejaculate. So I'm glad that you brought that strap on because I think for a lot of

Starting point is 00:23:57 penis owners, sometimes that could be maybe a really, really broad stretch, you know, to use a strap on. But yeah, there are there are written documented cases of folks really, really enjoying them men really enjoying them with their partners absolutely you can't give your partner experiences and sensation they didn't have but you are the star of this show you are the person the partner want to have this experience and this is just an add-on to kind of kind of enhance the physiological arousal exactly exactly and one yes you know being open-minded to the possibilities of expanding your sexual menu. As you're saying, we're going to stick with the theme of ingredients and meals here, you know, expanding your sexual menu and maybe starting

Starting point is 00:24:48 to explore what that might even look like with your partner. It's like an exciting, it can be an exciting new adventure. It just depends on how, you know, how you're looking at it and your perspective, I think. And the approach of kind of thinking about a team approach. And I even recommend it to many of my clients that they're not struggling with any medical condition, that kind of like expand your menu and make sure you're including non-penetrative approaches in that menu. Because first of all, it helps you to experiment different erogenous zones, different types of experience, and also helps you to have a flexible script when it comes to sexual experiences. Absolutely. Well, Dr. Maali, this is wonderful. All these gems that

Starting point is 00:25:34 you've shared with us. Thank you so much for being on the show. If listeners wanted to connect with you, how can they? Well, thank you so much for your invitation. I loved our conversation. People can find me at my website, sexologypodcast.com or my Instagram sexology podcast. I have a weekly show that I talk about tools and strategies people you can use to enhance their sexual experiences. Thank you so much. And we will definitely be linking all of Dr. Moali's ways to connect with her in the podcast show notes and in the YouTube description below. Again, thank you so much for being on the show today. Thank you. And to all of our listeners and viewers there. Until next time, my friends, this is Dr. Susie Gronski, loving wellness for your pelvis.

Starting point is 00:26:23 Thanks for listening to today's episode. Be sure to visit my website, drsusieg.com, for show notes and related resources on today's topic. If you like what you're hearing, head on over to YouTube and subscribe to my channel. On my YouTube channel, you'll find content related to sex, pelvic health, and expert interviews for men. If you've got a question or a topic that you'd like me to answer on my channel,

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In Your Pants with Dr. Susie G - Can You Have a Sex Life After Prostate Cancer?

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