Rebuilding sexual intimacy after a prostate cancer diagnosis

Intimacy goes beyond the physical act of sex. Use sensual exercises to explore different ways to experience pleasure and connection with your partner.

When you’re looking to adjust to changes in your sex life during and after prostate cancer treatment, it’s easy to forget about other options besides intercourse or penetration. The truth is, there are many ways to think of intimacy, pleasure and connection with your spouse or partner.
In this article, we’ll share a few different thought exercises you can work through, with or without a partner. (If you have a partner, it’s great to do this together and share your answers right after!) We’ll also cover a few key foundations to maintaining intimacy when you're navigating prostate cancer.

How can I maintain intimacy during and after prostate cancer treatment?

Intimacy goes beyond sex. It’s about closeness, being vulnerable, being touched, acceptance, emotional support, and much, much more. Ways to be intimate (without intercourse or penetration) include being affectionate in public, scheduling intimate time, massages, and meditation. These are all great ways to touch, stay connected, and appreciate each other.

Practice good communication with your partner.

Talking to your partner is the first step in preserving closeness and reclaiming sex and intimacy after prostate cancer treatment. Tell your partner about how cancer and treatment have affected you. Talk about how prostate cancer has caused intimacy issues and has affected you sexually. Make a pact to stay connected, be supportive, and work as a team to re-establish an enjoyable sex life.

Avoid making assumptions about your partner’s sexual expectations and needs.

An open and candid discussion about how you two will adapt to changes will help avoid misunderstandings. For example, openly share your ideas on how you can still have sexual contact without intercourse or penetration. Similarly, opening up to each other about the emotional vulnerability you’re experiencing can help bond you together as a team (for example, discussing your fear that you cannot sexually respond to the needs of the other).

Thought exercise: understanding intimacy

Below are some thought exercises to get your wheels turning and help in restoring intimacy during and after prostate cancer treatment. Reflect on these questions on your own or with a partner.

What does intimacy mean to you?

How would you rate your sexual self-esteem?

What do you think intimacy means to your partner?

Where are you now with intimacy versus where you want to be?

Important tips to promote intimacy:

  • Explore other ways to be intimate besides intercourse or penetration.

  • Take sex off the table.

  • Schedule time to be intimate.

  • Have open communication.

  • Think positive, not negative.

  • Don’t try to force intimacy.

  • Kiss and touch often.

Thought exercise: Identifying what excites you sexually

Many sex experts identify 3 key ingredients of good sex:

  1. Mutuality. You are both able, and willing, to give and receive pleasure

  2. Willingness. You both want to be there, not because you feel it’s your “duty”.

  3. Intimacy. When you feel vulnerable but safe, knowing that you are loved, wanted, and won’t be judged

Exercise 1: What is good sex?

How to begin: Grab a piece of paper or something to take notes with. If you’re doing this thought exercise with your partner, each of you will take time to write down what makes sex “good” for you. What are the ingredients of good sex? Think of a time when sex was really good for you. What made it so satisfying?

  • When you were on vacation? What was it about being on vacation that made sex good?

  • After you partner did something that made you feel special? Attractive? Desired? Sexy?

  • After a lengthy period of foreplay? After a short period of foreplay?

  • With the lights on? With the lights off?

  • At night? In the morning?

  • Rushed, and spontaneous? Slow and planned?

  • In the bedroom? In the backseat of the car?

  • Indoors? Outdoors?

  • A favorite sexual position (missionary, on top, on the bottom, standing, lying down)?

Now, take a moment to reflect on your answers. If you have a partner, share your answers with each other and use this time to practice kind and supportive communication about sex and intimacy.

Exercise 2: What do you value about sex?

Generally, the reasons people value sex can be divided into two broad categories:

People who value sex for physical pleasure.

Sex is often described as a release, as physically satisfying, as pleasurable, as a stress release, as a source of physical gratification. The sensations of arousal and orgasm are important. Sex is desired because it feels good physically.

People who value sex for relational intimacy.

Sex is valued because the person feels emotionally close with their partner during sex. People who value sex for relational intimacy often find enjoyment out of the quality of time spent together and connecting on an emotional level. Sex is desired because an individual wants to connect with another person.

Print out 2 copies of the graph below, one for each of you. You can also print out this entire article, if that’s easier.

Blank version of PRISM diagram: two intersecting lines representing physical pleasure and relational intimacy on a gradient from low to high
Physical Pleasure – Relational Intimacy Model of Sexual Motivation (PRISM) diagram
  1. On your own, first think about how much you value sex for physical pleasure. Put an X on the vertical (straight up and down) line to indicate the degree to which you value sex for physical pleasure. If you highly value sex for physical pleasure put your X close to the top of the line. If you don’t value sex for physical pleasure, put your X closer to the bottom of the line.

  2. Do the same thing thinking about how much you value sex for relational intimacy. This time draw your X on the horizontal line (the lines going left to right). If you highly value sex for relational intimacy put your X close to the right end of the line. If you don’t value sex for relational intimacy, put your X closer to the left end of the line of the line.

  3. Draw lines to connect the two lines like the example below and write your name where the two lines intersect.

  4. Now repeat this exercise. Guess how your partner filled out the form and put your partner’s name beside the point.

  5. Share your results with each other. Place the figures side by side and compare. By comparing, you two can gain a better awareness of how you value sex, including similarities and differences.

Intersecting lines on the PRISM diagram showing both people's responses
Completed version of PRISM (Physical Pleasure – Relational Intimacy Model of Sexual Motivation) diagram

It’s OK if your figures don’t match each other—that’s not the goal. Rather, it’s an opportunity to see how each of you value sex and put aside assumptions or misperceptions. By sharing, you can both become more accepting of differences and develop approaches to sex that can satisfy you both.