Psychosocial perspectives on sexual recovery after prostate cancer treatment

Abstract

Many therapies for erectile dysfunction (ED) after prostate cancer treatment improve erectile firmness, yet, most couples stop using aids within 1-2 years. Patients and partners who expect immediate and complete success with their first ED treatment can be demoralized when they experience treatment failure, which contributes to reticence to explore other ED aids. Comprehensive patient education should improve sustainability and satisfaction with ED treatments. Pre-emptive and realistic information should be provided to couples about the probability of recovering natural erections. Beginning intervention early and using a couple-based approach is ideal. Recommendations are provided about the timing of ED treatment, the order of aid introduction, and combination therapies. Renegotiation of sexual activity is an essential part of sexual adaptation. From the outset of therapy, couples should be encouraged to broaden their sexual repertoire, incorporate erection-independent sexual activities, and continue to be sexual despite ED and reduced libido.

Men's Sexual and Relational Adaptations to Erectile Dysfunction After Prostate Cancer Treatment

“…As such, healthcare professionals should be aware that the failure of men to initiate discussions about sexual performance and practices does not mean that they necessarily lack questions or concerns in that area. Moreover, given the diversity of sexual experience and experimentation reported by respondents in our study, an erection-focused prescription for a phosphodiesterase type 5 inhibitors may simply fail to address the patient's broader needs, when they present with ED as a primary complaint (see Dowsett, 2008;Walker et al, 2015). Men with ED are often left on their own to find alternative ways to be sexual that are not erection-dependent.…”

“…Walker et al (2015) have recently suggested that clinicians working with PCa patients should encourage the men to explore non erection-dependent sexual practices concurrently with ED treatments, rather than ignore or introduce these practices as options of last resort. Our findings endorse that perspective.…”

Sexual Health After Cancer Therapy

“…7 When all ED approaches fail, if penetrative sex is a high priority, discussion about use of an external penile prosthesis may be of interest. 8 However, it is also important to…”

“…Patients often do not spontaneously note problems with their sex life and prefer health care providers to initiate the discussion because of embarrassment, fear, or other reasons. 8 However, health care providers often feel ill-equipped to deal with sexual health issues, are embarrassed themselves, and often lack resources to offer patients and their partners if they do identify a problem. A recent review provides interested clinicians with insight and in-depth guidance on how to promote sexual recovery after treatment of prostate cancer, advice that can reasonably be applied to those with ED related to treatment for any malignancy.…”

“…A recent review provides interested clinicians with insight and in-depth guidance on how to promote sexual recovery after treatment of prostate cancer, advice that can reasonably be applied to those with ED related to treatment for any malignancy. 8 Because of this gap in knowledge and resources, oncologists must play a role in how best to integrate sexual health care into medical education as well as into usual practice. Although it is doubtful that oncologists are able provide this care, they must insist that this expertise be made available to their patients and partners and work collaboratively with sexual health clinicians and others as needed.…”