After the decision about treatment, however, when the treatments take their toll on men’s sexual functioning, most couples’ communication about their sex life discontinues. But the men were outspoken with the interviewer in their descriptions of impotence. They stated their inability to achieve an erection, their loss of a sexual urge, and that lack of sexual functioning threatened their masculinity. Also, the men’s accounts indicated that their definition of sexuality is intercourse. The men’s inability to achieve an erection caused them to restrain from any type of sexual interactions. Generally, the men described their wives as understanding and accommodating to their loss of sexual functioning. One man told the interviewer that his wife made sexual advances that he could not reciprocate. Many men held the belief that the loss of sexuality had little or no effect on their wives. They portrayed their wives as adapting well to the loss of sexuality, because in men’s opinions women know how to cope with this change. Religiosity was one coping style of wives that men mentioned to the interviewer, “My wife goes to church a lot. She found the Lord, I guess. It don’t bother her much. She don’t act like it does.”
Men’s accounts reveal that there is little knowledge about their wives’ feelings about the sexual loss. Men’s assessment that sexual loss means little to their wives was based on reasoning that it must mean little to them since they are not complaining. As one man put it: “As far as I know [it does not bother her]… Now if she had said something…but if it is, she hasn’t said anything. It could be bothering her, but she hasn’t said anything.”
The importance of sexuality was mostly proclaimed in focus groups with men. Some men confided in the interview situation that their sexuality was diminished before prostate cancer. With increasing age, sex became less frequent. Others admitted to problems with impotence before prostate cancer. One man stated that being with his wife has always been more important than sexual activity. The men’s coping with a lack of sexuality after prostate cancer included avoidance (by putting it out of their minds), as well as through resignation by accepting that sexuality belongs to their past. These coping styles preclude seeking conversations with their wives.
Overwhelmingly, wives are focused on the importance of sexuality for their husbands without ever indicating the importance they give to sexuality. Wives’ reports center on ways of accommodating to the lack of sexual relations. One wife said:
It doesn’t bother me. I just made up my mind that it can’t be, so I just keep it off of my mind. I do other things to keep it off of my mind. I just try to stay active doing other things. It hadn’t bothered me. It used to, it would bother me to hug and kiss him, but now it doesn’t since it is no longer that way. It can’t be. I just made up my mind. Consistently, wives stated how devastating the loss of sex is for their husbands, paying little attention to their own needs. One wife wished her husband could have an erection, because she believed it was crucial for his masculinity. Wives accommodated the lack of sex and made it known that they would never seek sex outside of marriage. Instead, they did everything they could to build up their husband’s self-esteem by reassuring him that his masculinity was not tied to sexual performance. Wives confirmed that there is no sexual activity of any form; one wife even stated that her husband is less caring or romantic since his sexual dysfunction. Another wife reacted surprised to the interviewer raising the possibility of sexual activity. The avoidance of communication about sexuality leaves spouses on their own when adjusting to sexual loss.
Discussion
The focus group interviews with men and some of their wives provided us with insight into couples’ experiences with prostate cancer. Their perspectives contribute toward understanding the implications of prostate cancer on the marital relationship. Our analysis is greatly influenced by the suggestion of previous studies that open communication among spouses is important for a positive adjustment by patients and their spouses.7,8 We find that most of the men are capable of communicating the factual physical changes, while they appear unwilling, or perhaps unable, to communicate with their wives about their feelings regarding these changes.
Limitations
The inclusion of spouses in studies that focus on the well-being of men with prostate cancer is imperative. However, we are aware of the limitations of the wives’ focus group data. In addition to the small number, our study’s focus restricted the interviews with wives mostly to their assessment of their husbands’ well-being. The women had little opportunity to discuss their subjective experiences. Also, the focus groups with wives were conducted by 2 men. One can speculate that discussions of sensitive matters such as sexuality may be constrained when the interviewers are of the opposite sex. The same-sex environment of the men’s focus groups, however, may have elicited frank and honest accounts. Our limited sample prevents us from exploring specific cultural differences in couples of different racial or ethnic background. The conclusions we reached were affected by the preliminary nature of our study. In particular, we have no information about the couples’ marital relationship and communication styles before the diagnosis of prostate cancer. Other research indicates that couples’ communication patterns after a diagnosis are similar to the style they had before the diagnosis.8 Also, our study’s findings may be affected by the stage of disease. Future prospective studies that measure psychological well-being of patients with prostate cancer and their partners need to consider the important issues raised by our study. In particular, the apparent contradiction of not communicating about fears and death while claiming marital satisfaction warrants further research. Larger studies will have to demonstrate the benefits of disclosure of feelings on adjustment before care providers are asked to contribute to open communication between spouses. Nevertheless, the findings of our research indicate that the inclusion of spouses in research expands our understanding of the effects of prostate cancer on well-being.