Abstract
Erectile difficulties are common after prostate cancer (PCa) treatment and are associated with sexual distress. However, the relationship between erectile function and sexual distress has yet to be carefully examined. This study had three goals: (1) examine the relationship between erectile function and sexual distress; (2) determine groups of men based on erectile function and sexual distress; and (3) examine the psychosexual characteristics of these groups. A cross section of 233 sexually active men after PCa treatment (age M = 64.90 years, SD = 7.50) completed an online survey containing demographic, health, and sexuality and relationship questionnaires. The relationship between erectile function and sexual distress was curvilinear. Four groups of men were found: good erectile function and low sexual distress, poor erectile function and high sexual distress, but also good erectile function yet high sexual distress, and poor erectile function and low sexual distress. Regardless of erectile function, men with greater sexual distress were more depressed, reported additional sexual concerns, placed less value on sex, were less sexually satisfied, and used protective buffering communication more frequently. They were also less likely to be satisfied with their adaptation to sexual changes and less likely to have found a solution to those changes. The relationship between erectile function and sexual distress is complex, characterized by a wide array of responses to erectile function (high and low distress) and multiple correlates of sexual distress. These results broaden the concept of sexual recovery after PCa treatment, which may assist clinicians and researchers to better address sexual problems after PCa treatment.
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References
Arrington, M. I. (2003). I don’t want to be an artificial man: Narrative reconstruction of sexuality among prostate cancer survivors. Sexuality and Culture,7(2), 30–58. https://doi.org/10.1007/s12119-003-1011-9.
Badr, H., & Carmack Taylor, C. L. (2009). Sexual dysfunction and spousal communication in couples coping with prostate cancer. Psycho-Oncology,18(7), 735–746. https://doi.org/10.1002/pon.1449.
Bancroft, J., Loftus, J., & Long, J. S. (2003). Distress about sex: A national survey of women in heterosexual relationships. Archives of Sexual Behavior,32(3), 193–208. https://doi.org/10.1023/A:1023420431760.
Beck, A. M., Robinson, J. W., & Carlson, L. E. (2013). Sexual values as the key to maintaining satisfying sex after prostate cancer treatment: The physical pleasure relational intimacy model of sexual motivation. Archives of Sexual Behavior,42(8), 1637–1647. https://doi.org/10.1007/s10508-013-0168-z.
Benedict, C., Traeger, L., Dahn, J. R., Antoni, M., Zhou, E. S., Bustillo, N., & Penedo, F. J. (2014). Sexual bother in men with advanced prostate cancer undergoing androgen deprivation therapy. Journal of Sexual Medicine,11(10), 2571–2580. https://doi.org/10.1111/jsm.12645.
Brandtstädter, J., & Greve, W. (1994). The aging self: Stabilizing and protective processes. Developmental Review,14(1), 52–80. https://doi.org/10.1006/drev.1994.1003.
Briganti, A., Gallina, A., Suardi, N., Capitanio, U., Tutolo, M., Bianchi, M., … Montorsi, F. (2011). What is the definition of a satisfactory erectile function after bilateral nerve sparing radical prostatectomy? Journal of Sexual Medicine,8(4), 1210–1217. https://doi.org/10.1111/j.1743-6109.2010.02179.x.
Capogrosso, P., Vertosick, E. A., Benfante, N. E., Eastham, J. A., Scardino, P. J., Vickers, A. J., & Mulhall, J. P. (2019). Are we improving erectile function recovery after radical prostatectomy? Analysis of patients treated over the last decade. European Urology, 75, 221–228. https://doi.org/10.1016/j.eururo.2018.08.039.
DeFade, B. D., Carson, C. C., III, & Kennelly, M. J. (2011). Prostatectomy erectile dysfunction: The role of penile rehabilitation. Reviews in Urology,13(1), 6–13. https://doi.org/10.3909/riu0501.
Dennerstein, L., Guthrie, K. A., Hayes, R. D., Derogatis, L., & Lehert, P. (2008). Sexual function, dysfunction and sexual distress in a prospective, population-based sample of mid-aged, Australian-born women. Journal of Sexual Medicine,5, 2291–2299. https://doi.org/10.1111/j.1743-6109.2008.00936.x.
Dowsett, G. W., Lyons, A., Duncan, D., & Wassersug, R. J. (2014). Flexibility in men’s sexual practices in response to iatrogenic erectile dysfunction after prostate cancer treatment. Sexual Medicine,2(3), 115–120. https://doi.org/10.1002/sm2.32.
Elterman, D. S., Petrella, A. R., Van Asseldonk, B., Jamnicky, L., Brock, G. B., Elliott, S., … Matthew, A. (2018). Canadian consensus algorithm for erectile rehabilitation following prostate cancer treatment. Canadian Urological Association Journal, 13, 239–245. https://doi.org/10.5489/cuaj.5653.
Feinauer, L. L., & Steele, W. R. (1992). Caretaker marriages: The impact of chronic pain syndrome on marital adjustment. American Journal of Family Therapy,20(3), 218–226. https://doi.org/10.1080/01926189208250891.
Fode, M., Serefoglu, E. C., Albersen, M., & Sønksen, J. (2017). Sexuality after radical prostatectomy: Is restoration of erectile function enough? Sexual Medicine Reviews,5(1), 110–119. https://doi.org/10.1016/j.sxmr.2016.07.005.
Frey, A., Sonksen, J., Jakobsen, H., & Fode, M. (2014). Prevalence and predicting factors for commonly neglected sexual side effects to radical prostatectomies: Results from a cross-sectional questionnaire-based study. Journal of Sexual Medicine,11(9), 2318–2326. https://doi.org/10.1111/jsm.12624.
Goldstein, I., Chambers, R., Tang, W., Stecher, V., & Hassan, T. (2018). Real-world observational results from a database of 48 million men in the United States: Relationship of cardiovascular disease, diabetes mellitus and depression with age and erectile dysfunction. International Journal of Clinical Practice,72(4), e13078. https://doi.org/10.1111/ijcp.13078.
Hagedoorn, M., Kuijer, R. G., Buunk, B. P., DeJong, G. M., Wobbes, T., & Sanderman, R. (2000). Marital satisfaction in patients with cancer: Does support from intimate partners benefit those who need it the most? Health Psychology,19(3), 274–282. https://doi.org/10.10371/0278-6133.19.3.274.
Helgason, A. R., Adolfsson, J., Dickman, P., Fredrikson, M., Arver, S., & Steineck, G. (1996). Waning sexual function—The most important disease-specific distress for patients with prostate cancer. British Journal of Cancer,73(11), 1417–1421. https://doi.org/10.1038/bjc.1996.268.
Jang, J. W., Drumm, M. R., Efstathiou, J. A., Paly, J. J., Niemierko, A., Ancukiewicz, M., … Zietman, A. L. (2017). Long-term quality of life after definitive treatment for prostate cancer: Patient-reported outcomes in the second posttreatment decade. Cancer Medicine,6(7), 1827–1836. https://doi.org/10.1002/cam4.1103.
Kimura, M., Bañez, L. L., Polascik, T. J., Bernal, R. M., Gerber, L., Robertson, C. N., … Moul, J. W. (2013). Sexual bother and function after radical prostatectomy: Predictors of sexual bother recovery in men despite persistent post-operative sexual dysfunction. Andrology,1(2), 256–261. https://doi.org/10.1111/j.2047-2927.2012.00036.x.
Kool, M. B., Woertman, L., Prins, M. A., Van Middendorp, H., & Geenen, R. (2006). Low relationship satisfaction and high partner involvement predict sexual problems of women with fibromyalgia. Journal of Sex and Marital Therapy,32, 409–423. https://doi.org/10.1080/00926230600835403.
Kuijer, R. G., Ybema, J. F., Buunk, B. P., De Jong, G. M., Thijs-Boer, F., & Sanderman, R. (2000). Active engagement, protective buffering, and overprotection: Three ways of giving support by intimate partners of patients with cancer. Journal of Social and Clinical Psychology,19(2), 256–275. https://doi.org/10.1521/jscp.2000.19.2.256.
Kwan, K. S., Roberts, L. J., & Swalm, D. M. (2005). Sexual dysfunction and chronic pain: The role of psychological variables and impact on quality of life. European Journal of Pain,9(6), 643–652. https://doi.org/10.1016/j.ejpain.2004.12.008.
Lardas, M., Liew, M., van den Bergh, R. C., De Santis, M., Bellmunt, J., Van den Broeck, T., … Bourke, L. (2017). Quality of life outcomes after primary treatment for clinically localised prostate cancer: A systematic review. European Urology,72(6), 869–885. https://doi.org/10.1016/j.eururo.2017.06.035.
Lawrance, K., & Byers, E. S. (1995). Sexual satisfaction in long-term heterosexual relationships: The Interpersonal Exchange Model of Sexual Satisfaction. Personal Relationships,2, 267–285. https://doi.org/10.1111/j.1475-6811.1995.tb00092.x.
Lawrance, K., Byers, E. S., & Cohen, J. N. (2011). Interpersonal Exchange Model of Sexual Satisfaction questionnaire. In T. D. Fisher, C. M. Davis, W. L. Yarber, & S. L. Davis (Eds.), Handbook of sexuality-related measures (3rd ed., pp. 525–530). New York, NY: Routledge.
Le, J. D., Cooperberg, M. R., Sadetsky, N., Hittelman, A. B., Meng, M. V., Cowan, J. E., … CaPSURE Investigators. (2010). Changes in specific domains of sexual function and sexual bother after radical prostatectomy. BJU International,106(7), 1022–1029. https://doi.org/10.1111/j.1464-410X.2010.09231.x.
Lee, J., Hersey, K., Lee, C. T., & Fleshner, N. (2006). Climacturia following radical prostatectomy: Prevalence and risk factors. Journal of Urology,176(6), 2562–2565. https://doi.org/10.1016/j.juro.2006.07.158.
Letts, C., Tamlyn, K., & Byers, E. S. (2010). Exploring the impact of prostate cancer on men’s sexual well-being. Journal of Psychosocial Oncology,28(5), 490–510. https://doi.org/10.1080/07347332.2010.498457.
Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the depression, anxiety, stress scales (2nd ed.). Sydney, Australia: Psychology Foundation.
Manne, S. L., Badr, H., Zaider, T., Nelson, C., & Kissane, D. (2010). Cancer-related communication, relationship intimacy, and psychological distress among couples coping with localized prostate cancer. Journal of Cancer Survivorship,4(1), 74–85. https://doi.org/10.1007/s11764-009-0109-y.
Manne, S. L., Dougherty, J., Veach, S., & Kless, R. (1999). Hiding worries from one’s spouse: Protective buffering among cancer patients and their spouses. Cancer Research Therapy and Control,8, 175–188.
Manne, S. L., Norton, T. R., Ostroff, J. S., Winkel, G., Fox, K., & Grana, G. (2007). Protective buffering and psychological distress among couples coping with breast cancer: The moderating role of relationship satisfaction. Journal of Family Psychology,21(3), 380–388. https://doi.org/10.1037/0893-3200.21.3.380.
Matthew, A. G., Goldman, A., Trachtenberg, J., Robinson, J., Horsburgh, S., Currie, K., & Ritvo, P. (2005). Sexual dysfunction after radical prostatectomy: Prevalence, treatments, restricted use of treatments, and distress. Journal of Urology,174(6), 2105–2110. https://doi.org/10.1097/01.ju.0000181206.16447.e2.
Messaoudi, R., Menard, J., Ripert, T., Parquet, H., & Staerman, F. (2011). Erectile dysfunction and sexual health after radical prostatectomy: Impact of sexual motivation. International Journal of Impotence Research,23(2), 81–86. https://doi.org/10.1038/ijir.2011.8.
Milligan, G. W., & Cooper, M. C. (1988). A study of standardization of variables in cluster analysis. Journal of Classification,5(2), 181–204. https://doi.org/10.1007/BF01897163.
Mulhall, J. (2008). Saving your sex life: A guide for men with prostate cancer. Bethesda, MD: C-I-ACT Publishing.
Nelson, C. J., Choi, J. M., Mulhall, J. P., & Roth, A. J. (2007). Determinants of sexual satisfaction in men with prostate cancer. Journal of Sexual Medicine,4(5), 1422–1427. https://doi.org/10.1111/j.1743-6109.2007.00547.x.
Nelson, C. J., Deveci, S., Stasi, J., Scardino, P. T., & Mulhall, J. P. (2010). Sexual bother following radical prostatectomy. Journal of Sexual Medicine,7, 129–135. https://doi.org/10.1111/j.1743-6109.2009.01546.x.
Penson, D. F., Feng, Z., Kuniyuki, A., McClerran, D., Albertsen, P. C., Deapen, D., … Stanford, J. L. (2003a). General quality of life 2 years following treatment for prostate cancer: What influences outcomes? Results from the prostate cancer outcomes study. Journal of Clinical Oncology,21(6), 1147–1154. https://doi.org/10.1200/jco.2003.07.139.
Penson, D. F., Latini, D. M., Lubeck, D. P., Wallace, K., Henning, J. M., & Lue, T. O. M. (2003b). Is quality of life different for men with erectile dysfunction and prostate cancer compared to men with erectile dysfunction due to other causes? Results from the ExCEED data base. Journal of Urology,169(4), 1458–1461. https://doi.org/10.1097/01.ju.0000054462.88306.43.
Penson, D. F., McLerran, D., Feng, Z., Li, L., Albertsen, P. C., Gilliland, F. D., … Stanford, J. L. (2005). 5-Year urinary and sexual outcomes after radical prostatectomy: Results from the prostate cancer outcomes study. Journal of Urology,173(5), 1701–1705. https://doi.org/10.1097/01.ju.0000154637.38262.3a.
Punnen, S., Cowan, J. E., Dunn, L. B., Shumay, D. M., Carroll, P. R., & Cooperberg, M. R. (2013). A longitudinal study of anxiety, depression and distress as predictors of sexual and urinary quality of life in men with prostate cancer. BJU International,112(2), E67–E75. https://doi.org/10.1111/bju.12209.
Rabbani, F., Patel, M. I., & Scardino, P. T. (2004). 1178: Time course of recovery of potency after bilateral nerve sparing radical prostatectomy. Journal of Urology,171(4), 310–311. https://doi.org/10.1016/S0022-5347(18)38415-5.
Rabbani, F., Schiff, J., Piecuch, M., Yunis, L. H., Eastham, J. A., Scardino, P. T., & Mulhall, J. P. (2010). Time course of recovery of erectile function after radical retropubic prostatectomy: does anyone recover after 2 years? Journal of Sexual Medicine,7(12), 3984–3990. https://doi.org/10.1111/j.1743-6109.2010.01969.x.
Robertson, J., McNamee, P., Molloy, G., Hubbard, G., McNeill, A., Bollina, P., … Forbat, L. (2016). Couple-based psychosexual support following prostate cancer surgery: Results of a feasibility pilot randomized control trial. Journal of Sexual Medicine,13(8), 1233–1242. https://doi.org/10.1016/j.jsxm.2016.05.013.
Rosen, R. C., Riley, A., Wagner, G., Osterloh, I. H., Kirkpatrick, J., & Mishra, A. (1997). The International Index of Erectile Function (IIEF): A multidimensional scale for assessment of erectile dysfunction. Urology,49, 822–830. https://doi.org/10.1016/S0090-4295(97)00238-0.
Rossi, M. S., Moschini, M., Bianchi, M., Gandaglia, G., Fossati, N., Dell’Oglio, P., … Briganti, A. (2016). Erectile function recovery after nerve-sparing radical prostatectomy for prostate cancer: Is back to baseline status enough for patient satisfaction? Journal of Sexual Medicine,13(4), 669–678. https://doi.org/10.1016/j.jsxm.2016.02.160.
Santos-Iglesias, P., Bergeron, S., Brotto, L. A., Rosen, N. O., & Walker, L. M. (2019). 032 proposal and initial validation of the Sexual Distress Scale-Short Form in male and female samples. Journal of Sexual Medicine,16(6), S15. https://doi.org/10.1016/j.jsxm.2019.03.489.
Santos-Iglesias, P., Byers, E. S., & Moglia, R. (2016). Sexual well-being of older men and women. Canadian Journal of Human Sexuality,25(2), 86–98. https://doi.org/10.3138/cjhs.252-A4.
Santos-Iglesias, P., & Walker, L. M. (2018). Psychometric validation of the Sexual Distress Scale in men with prostate cancer. Journal of Sexual Medicine,15(7), 1010–1020. https://doi.org/10.1016/j.jsxm.2018.05.015.
Schauer, I., Keller, E., Müller, A., & Madersbacher, S. (2015). Have rates of erectile dysfunction improved within the past 17 years after radical prostatectomy? A systematic analysis of the control arms of prospective randomized trials on penile rehabilitation. Andrology,3(4), 661–665. https://doi.org/10.1111/andr.12060.
Seftel, A. D., Sun, P., & Swindle, R. (2004). The prevalence of hypertension, hyperlipidemia, diabetes mellitus and depression in men with erectile dysfunction. Journal of Urology,171(6 Pt 1), 2341–2345.
Shabsigh, R., Klein, L. T., Seidman, S., Kaplan, S. A., Lehrhoff, B. J., & Ritter, J. S. (1998). Increased incidence of depressive symptoms in men with erectile dysfunction. Urology,52(5), 848–852.
Shifren, J. L., Monz, B. U., Russo, P. A., Segreti, A., & Johannes, C. B. (2008). Sexual problems and distress in United States women. Obstetrics and Gynecology,112(5), 970–978. https://doi.org/10.1097/AOG.0b013e3181898cdb.
Steinsvik, A., Axcrona, K., Dahl, A. A., Eri, L. M., Stensvold, A., & Fossa, S. D. (2012). Can sexual bother after radical prostatectomy be predicted preoperatively? Findings from a prospective national study of the relation between sexual function, activity and bother. BJU International,109, 1366–1374. https://doi.org/10.1111/j.1464-410X.2011.10598.x.
Stephenson, K. R., & Meston, C. M. (2010). Differentiating components of sexual well-being in women: are sexual satisfaction and sexual distress independent constructs? Journal of Sexual Medicine,7, 2458–2468. https://doi.org/10.1111/j.1743-6109.2010.01836.x.
Terrier, J. E., Masterson, M., Mulhall, J. P., & Nelson, C. J. (2018). Decrease in intercourse satisfaction in men who recover erections after radical prostatectomy. Journal of Sexual Medicine,15(8), 1133–1139. https://doi.org/10.1016/j.jsxm.2018.05.020.
Ussher, J. M., Perz, J., Gilbert, E., Wong, W. K. T., & Hobbs, K. (2013). Renegotiating sex and intimacy after cancer: Resisting the coital imperative. Cancer Nursing,36(6), 454–462. https://doi.org/10.1097/NCC.0b013e3182759e21.
Ussher, J. M., Perz, J., Kellett, A., Chambers, S., Latini, D., Davis, I. D., … Williams, S. (2016). Health-related quality of life, psychological distress, and sexual changes following prostate cancer: A comparison of gay and bisexual men with heterosexual men. Journal of Sexual Medicine,13(3), 425–434. https://doi.org/10.1016/j.jsxm.2015.12.026.
Walker, L. M., & Robinson, J. W. (2011). A description of heterosexual couples’ sexual adjustment to androgen deprivation therapy for prostate cancer. Psycho-Oncology,20(8), 880–888. https://doi.org/10.1002/pon.1794.
Walker, L. M., Wassersug, R. J., & Robinson, J. W. (2015). Psychosocial perspectives on sexual recovery after prostate cancer treatment. Nature Reviews Urology,12(3), 167–176. https://doi.org/10.1038/nrurol.2015.29.
Wittmann, D., Carolan, M., Given, B., Skolarus, T. A., An, L., Palapattu, G., & Montie, J. E. (2014). Exploring the role of the partner in couples’ sexual recovery after surgery for prostate cancer. Supportive Care in Cancer,22(9), 2509–2515. https://doi.org/10.1007/s00520-014-2244-x.
Wittmann, D., Carolan, M., Given, B., Skolarus, T. A., Crossley, H., An, L., … Montie, J. E. (2015). What couples say about their recovery of sexual intimacy after prostatectomy: toward the development of a conceptual model of couples’ sexual recovery after surgery for prostate cancer. Journal of Sexual Medicine,12(2), 494–504. https://doi.org/10.1111/jsm.12732.
Yang, L., Kibel, A. S., Colditz, G. A., Pakpahan, R., Imm, K. R., Izadi, S., … Sutcliffe, S. (2017). Caution with use of the EPIC-50 urinary bother scale: How voiding dysfunction modifies its performance. The Journal of Urology,198, 1397–1403. https://doi.org/10.1016/j.juro.2017.07.041.
Zaider, T., Manne, S., Nelson, C., Mulhall, J., & Kissane, D. (2012). Loss of masculine identity, marital affection, and sexual bother in men with localized prostate cancer. Journal of Sexual Medicine,9(10), 2724–2732. https://doi.org/10.1111/j.1743-6109.2012.02897.x.
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Authors would like to thank Madiha Rana for her assistance with the ethics application and literature review for this study.
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This research was funded by a Prostate Cancer Canada Grant (RS2015-03) for Dr. Lauren M. Walker.
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Walker, L.M., Santos-Iglesias, P. On the Relationship Between Erectile Function and Sexual Distress in Men with Prostate Cancer. Arch Sex Behav 49, 1575–1588 (2020). https://doi.org/10.1007/s10508-019-01603-y
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DOI: https://doi.org/10.1007/s10508-019-01603-y