Dr. Erica Marchand is a licensed psychologist specializing in couples therapy and sex therapy in Los Angeles.
Prostatepedia spoke with her about the impact erectile dysfunction after prostate cancer can have on couples.
Why did you become a psychologist?
Dr. Erica Marchand:: I’ve seen plenty of ups and downs in my own life and in the lives of family and friends. I started to be curious about how some people seem to weather life’s ups and downs and always land on their feet, and how other people seem to get worn down and diminished by the hard times. So I became a psychologist in part because I wanted to know how to help people become more resilient to life’s problems.
What is it about working with patients in couples and sex therapy that you find most rewarding?
Dr. Marchand: Intimate relationships are so integral to human life. We’re wired for connection with other people, and in romantic partnerships, part of that connection involves sex. When relationships are going well, they’re a source of happiness, care, and nurturing; when they’re going badly, they can be miserable for everyone involved. People who have satisfying, loving relationships tend to have better long-term physical and mental health outcomes. So I find it incredibly rewarding to help people get back to happiness in their relationships.
I find it particularly rewarding to provide space to talk openly about sex since it’s so often taboo but is such an important part of life, pleasure, and connection for so many people.
What are some of the psychosexual issues that can come up for men with prostate cancer and their partners? How do these issues impact their sex lives and their marriages?
Dr. Marchand: There are several issues that tend to come up. First, the experience of cancer can be pretty scary and life-changing. Even though prostate cancer is usually curable these days, many men and their partners feel fear, worry, sadness, and stress going through the process of diagnosis and treatment. Partners can become caregivers and/or temporarily take on additional roles, which can strain both partners but can also lead to greater closeness, understanding, and strength in the relationship.
Second, some of the most common side effects of prostate cancer treatment involve changes in sexual function. Prostate surgery and radiation can lead to erectile dysfunction and, less commonly, retrograde ejaculation. Androgen-blocking drugs can decrease sexual interest and desire. Those effects can interrupt or change a couple’s sexual relationship, and it can take some communication and effort to re-create a sex life together.
How does therapy for prostate cancer patients work? Just talking about what is going on?
Dr. Marchand: To some extent, yes. There’s plenty of talking in therapy about what is going on. I also tend to work with my clients to come up with strategies to improve things and try them out. For example, if someone is struggling with high stress and anxiety, we might integrate some stress-reducing activities into that person’s life in addition to talking about the problems. If someone is trying to re-create a sex life with their partner, we might identify some activities that feel good and fit into their current sexual functioning.
Does your approach to prostate cancer patients differ from your approach with men without cancer?
Dr. Marchand: There is definitely some overlap in therapy for sexual concerns for men with and without prostate cancer. But with prostate cancer, we’re also talking about all the other concerns that come along with having cancer.
Do you have any advice for men who are about to start prostate cancer treatment and are worried about potential erectile dysfunction? Or for men who are already dealing with erectile dysfunction and related sexual issues post-treatment?
Dr. Marchand: Yes! Talk to your urologist about your concerns and about anything you can do to help restore erectile function after treatment. Ask about the pros and cons of different treatment options for maintaining sexual function. Also, try to have an open, honest discussion with your partner about sex before and after treatment. Try to keep your partner in the loop about your current sexual functioning and interest and any concerns or questions you might have. If you find yourself really struggling to adjust, or have difficulty communicating with your partner about sex, consider scheduling an appointment with a therapist who specializes in sexual concerns to help get you back on track.