Both members of a couple can experience diminished sexual function after a man has prostate cancer surgery, Swiss researchers find, suggesting that treatment should include sex counseling for men and their partners.
The researchers studied sexual function and satisfaction after men had a type of cancer surgery designed to remove the entire prostate, including semen glands, but protect nearby nerves that are involved in erections.
“Typically, even with nerve sparing, a man may have difficulties for months before he gets back to a more normal erectile function, and then he will have an orgasm that doesn’t include ejaculation,” said Dr. Vincent Laudone, a urologic surgeon at Memorial Sloan Kettering Cancer Center in New York who wasn’t involved in the study.
“Any treatment that doesn’t involve an up front, detailed discussion with both members of a couple is lacking,” Dr. Laudone said.
Dr. Christophe Iselin, with the division of urologic surgery at Geneva University Hospital in Switzerland, and colleagues write in the International Journal of Impotence Research that screening is leading to more men, and younger men being treated for prostate cancer.
To assess the effect this may be having on couples’ sexual health, they analyzed data on 21 couples who completed questionnaires about sex before the men had prostate cancer surgery and again six months after the procedure.
The average age of the study participants was 62.4 for men and 60.7 for women.
Bilateral nerve sparing, the most effective at preserving erectile function, was done in 12 procedures. The remaining nine operations involved nerve sparing on just one side.
As typically happens with prostate surgery, the men reported decreased erectile function after the fact, with a steeper decline after unilateral nerve sparing.
But the women also reported decreased sexual function after the men had surgery, with declines in desire, arousal, lubrication, orgasm and satisfaction.
“The stress of cancer treatment and the disruption in the couple’s usual pattern of intimacy can leave both partners feeling less interested in sexual activity,” said Dr. Andrea Bradford, an assistant professor of gynecologic oncology and reproductive medicine at The University of Texas MD Anderson Cancer Center in Houston.
Even though women aren’t the ones having surgery, the disruption of their regular sex life in the weeks or months immediately after the man’s operation can make sex more painful when relations resume, said Dr. Bradford, who wasn’t involved in the study.
“The female partners in this study were in mid-life or older, which means most of them were postmenopausal,” Dr. Bradford said. “Regular sexual activity can help prevent or slow the normal vaginal changes that occur after menopause, but after a long period of sexual abstinence women may be surprised to find that they have more difficulties than before with lubrication or genital pain.”
Limitations of the study include the small sample, taken only from couples who agreed to sexual assessments, and the short six-month follow-up period for a procedure that can inhibit erectile function for as long as two to three years, the researchers point out in their report.
Going beyond the mechanics of sexual function, the study team also looked at how satisfied couples were with their relationships. The couples reported a dip in satisfaction six months after surgery, but the decline wasn’t statistically significant.
While other studies have found that relationships aren’t affected in those first months, longer-term studies have shown declines in sexual and emotional intimacy as well as relationship satisfaction, said Dr. Daniela Whittmann, a clinical assistant professor of urology at the University of Michigan in Ann Arbor.
“Partners are still not sufficiently included in discussions surrounding prostate cancer treatment,” said Dr. Whittmann, who wasn’t involved in the study.
Even with other forms of cancer, treatment can affect sexual function and relationships, she said.
“We’re talking about fatigue, nausea, baldness, changes of the mucous membranes, poor blood flow, loss of body parts, etcetera,” Dr. Whittmann said. “All of these affect sexual health. Couples need preparation for sexual changes which they have to manage not only physically, but also emotionally.”
SOURCE: bit.ly/1zboohc
Int J Impot Res January 2015.