Dissociation between patients and their partners in expectations for sexual life after radical prostatectomy

Abstract

Abbreviations & Acronyms COP = cooperative HR-QOL = health-related quality of life NCOP = non-cooperative PDE5-I = phosphodiesterase type 5 inhibitor PSA = prostate-specific antigen RP = radical prostatectomy RRP = retropubic radical prostatectomy SA = sexually active SB = sexual bother SF = sexual function SIA = sexually inactive UCLA-PCI Objective: To analyze expectations for sexual life after radical prostatectomy in patients and their partners, and its influence on sexual motivation and bothers in the postoperative period. Methods: A total of 162 patients who underwent retropubic radical prostatectomy and their partners were evaluated. The patients' sexual function, sexual bother and expectations for postoperative sexual life were assessed prospectively at baseline, and at 1, 3, 6 and 12 months after radical prostatectomy. The partner was asked questions about postoperative sexual life before the operation. Sexual function and sexual bother were evaluated by the University of California Los Angeles Prostate Cancer Index. Expectations for postoperative sexual life were studied using three ad hoc questions. Results: The rate of having sexual intercourse and adequate penile rigidity for vaginal penetration at baseline was 29.0% and 21.6%, respectively. A significantly higher rate of patients considered "sexual life is important" (patient 35.2%, partner 13.0%), hoped for "preservation of erectile function" (patient 66.0%, partner 33.3%) and accepted "use of phosphodiesterase type 5 inhibitor" (patient 65.4%, partner 43.2%) compared with their partners (P < 0.001). Patients who had partners with a negative sexual attitude lost sexual motivation 1 year after operation. However, patients with cooperative partners maintained sexual motivation, although they felt greater sexual bother 1 year after radical prostatectomy. Conclusions: There was a significant dissociation in perspectives of postoperative sexual life between patients undergoing radical prostatectomy and their partners. Partners' low expectations are associated with patients' low sexual bother and motivation. Partners' cooperative attitude might contribute to maintaining patients' sexual desire and motivation.

Sexual Bother in Men with Advanced Prostate Cancer Undergoing Androgen Deprivation Therapy

“…Although most research has been in localized prostate cancer, findings suggest sexual bother may be largely independent of sexual function and uniquely related to QOL outcomes [21–24]. Changes in sexual function occur within the context of other psychosocial and situational factors related to sexuality (e.g., expectations for sexual performance, perceptions of diminished masculinity, having an available partner, and partners' sexual function and interest [18,25,26]). As such, men with the same level of impairment may be more or less bothered or distressed.…”

Predictors of Patient and Partner Satisfaction Following Radical Prostatectomy

“…Patients and partners may certainly have distinct expectations of sexual outcomes following radical prostatectomy, as well as varying attitudes towards the relative importance of recovery of sexual function following cancer treatment. Sato et al evaluated sexual function, sexual bother, and expectations for postoperative sexual life among 162 patients and partners following before and after radical prostatectomy, and found a significant dissociation in perspectives of postoperative sexual life between patients and their partners (19). In particular, patients were more likely to verbalize that sexual life was important, hope for preservation of erectile function, and accept use of phosphodiesterase type 5 inhibitor therapy, compared to their partners (19).…”

“…Ultimately, patients’ acceptance of altered sexual function after RP is highly affected by the attitudes and support provided by their spouses (19, 21). Indeed, patient-perceived partner support is associated with better patient-reported erectile function, and greater relationship satisfaction both before and after prostatectomy (27).…”

Management of erectile dysfunction post-radical prostatectomy

“…As such, the presence of partners in counseling may prevent this from happening, by encouraging the discussion of frustrations. In addition, cooperative partners maintained sexual desire in patients compared with noncooperative ones, who created less sexual motivation in patients post-RP 11,12…”