'My husband can't get an erection after having surgery'

My husband had a prostatectomy to treat his cancer. Now he can’t get an erection. He has become withdrawn and unhappy. He avoids any kind of sex, he won’t let me see him naked, and he dodges hugs.  We’ve always been a close couple that enjoys sex and cuddles, so this is a big change. I haven’t really tried talking, as I’m scared it’ll upset him more. The closest I’ve got from him is he says he feels he’s longer a ‘real man’. When it first became obvious he can’t get erections, he cried and begged me not to leave him. Although today he said he wouldn’t blame me if I did. We’re both still young. I have no intention of leaving. I love him. I was afraid I’d lose him to cancer, but now feel I’ve lost him anyway. I want my husband back.

I’m sorry to hear about what your husband and you are going through.  You say you’ve not really talked to him, and I wonder if you could change that by telling him what you told me?

The last part of your message is particularly powerful, and I think it would do him good to hear that you love him, you are not leaving, and you want to help.

Reactions to surgery

Men can respond differently to prostate surgery based on how invasive it was. Depending on nerve damage, some will still be able to get erections even if they aren’t as strong as in the past. Others, like your husband, may lose the ability to get erections completely. And, of course, erectile dysfunction can occur for a number of other reasons, too, which may have nothing to do with surgery.

This is understandably distressing, and shouldn’t be underestimated. Aside from erections being tied to masculinity, the opportunity to get pleasure and be intimate with a partner is important to most men.

Often men and their partners feel conflicted after surgery.  Some think it’s trivial to be distressed about erections when you’re anxious about survival. But are still upset they can’t have sex like they used to. Surgery can also reduce penis length, which may create another anxiety for men.

Some men want to talk over these issues; others want to focus on recovery. Ask your husband what he would prefer.

Coping after illness

Cancer treatment and recovery can be far, far harder than people imagine. There’s often an assumption that, having had surgery or other treatments, life afterwards will instantly be better – because someone’s surviving and thus have much to look forward to.

That can be true for some people, but others are left exhausted, impoverished, and traumatised by their experiences.

Physical and emotional recovery after cancer can take time, and people may not feel like themselves for some while after, if at all. They may need to adjust to a ‘new normal’, and while for some that can include a positive lease of life, for others the daily grind hasn’t gone away and that can take precedence over everything else.

Side effects of treatment and medication can also be difficult to cope with, as your husband has discovered.

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It may be his unhappiness is due to his erection problems, which is understandable. But it may be he is depressed for additional reasons, too. Could you encourage him to speak to his GP about this? His doctor can help in two ways; they can address why he is depressed and, if appropriate, offer treatment for this. And they can discuss solutions for his lack of erections (more on this later).

Both of you, but particularly your husband, may also want to talk to Macmillan and Prostate Cancer UK,who can give practical advice about recovery and reassure your husband.

If your husband feels his identity has changed and is afraid of you leaving, he may not be able to think positively about the future.  For now you may want to focus on restoring the closeness you previously enjoyed, and, in time, return to your plans - or create new ones.  

Therapy may be something that he doesn’t feel up to doing right now, but it may be a positive means for both of you to communicate more effectively and focus how you want to enjoy life together from hereon in. Or useful for him if he’s still frightened about cancer or having flashbacks.

Your GP can help with referring to a counsellor, or you can refer yourselves via It’s Good To Talk.

Addressing your sex life

The model of sex we’re taught is focused on penis in vagina intercourse. Which is a posh way of saying you always need an erect penis to enjoy sex.

It’s also unhelpful because it downplays or misses out lots of other possibilities for pleasure. And, when erection difficulties occur, it leaves men and their partners assuming ‘sex’ is no longer possible.

Knowing this can have two effects. For some people, understanding everything they know about sex is largely wrong can be a revelation. They may feel freed up to try new things and recognise they can still enjoy intimacy – if they want it.

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However, this can also be a frustrating and threatening thing to hear. Either because it is difficult to let go of an ingrained belief. Or because erections are pleasurable and alternative ways to experience intimacy won’t replace those enjoyable feelings.

Men may feel jealous of others who can get erections; sad about the erections they used to enjoy but no longer will; or bitter that the feelings of a full, hard erection and strong ejaculation are denied them.  Again, therapy or being able to speak frankly together is a place to share such feelings if your husband has them.

You can reassure him in the present moment by noting you don’t expect sex at all. That you understand his fears and frustrations, but right now any contact you are making is to show him that you love him. Some men will avoid intimacy at all costs because they don’t want the expectation of having sex when they know they can’t do it. Or because it triggers so many other upsetting emotions.

He may be glad to have the pressure of penetrative sex removed. But equally he may still be frustrated because it’s NOT that he wants to avoid it, he wants to do it, but can’t.

If that’s the case, then he has the options of a penis pump – a suction device that lengthens the penis. The drug Alprostadil can be used in injection (Caverject) or pellet (MUSE) form to induce erections. Or an implant – a bendable or inflatable rod that is put into the penis during surgery and used when intercourse is desired. All of these have advantages and disadvantages and his doctor can explain this to him.

Another non-clinical option is to use a strap-on.  Some people find this is an enjoyable solution, particularly if penetrative sex is important for your pleasure.

Others find it stressful and threatening, a very obvious reminder that they aren’t having erections. A compromise here, if penetration is important for your orgasms, is to use a dildo or other toys yourself  when being intimate with your husband. Or if that is still too upsetting for him, privately on your own.

He may need to try more than one option to discover which works for you both.

I’ve written a longer guide that explains more about erection problems, treatments and ways to experience pleasure. You can download it here.

You can also listen to other men and their partners talking to me about erection problems and how they have coped with them on Radio 4 today.

Adjusting to life after cancer isn’t always easy, and because talking about erections is taboo many men like your husband struggle alone or feel there’s no help available. Knowing there are ways of enjoying relationships and connecting together may be reassuring for the both of you.

‘Impotential’ is on BBC Radio 4, on Monday October 30, at 11am and available to download after.

Petra Boynton is a social psychologist and sex researcher working in International Health Care and studying sex and relationships. She is The Telegraph’s agony aunt. Follow her on Twitter @drpetra.

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