Patient Reported Sexual Adaptation Following Prostate Cancer Treatment: An Analysis of Related Variables and Sexual Outcomes Associated with Sexual Adaptation Styles

Abstract

Sexual concerns after prostate cancer (PCa) treatment are high. Flexible coping is a crucial element to maintaining sexual activity after PCa and improves adaptation outcomes. We aimed to identify potential sexual adaptation styles reported by men following PCa treatment, and to assess relationships among associated variables and outcomes. Individuals (n = 223) with PCa treatment history (e.g., radical prostatectomy [n = 165, 74.0%], external beam radiation [n = 83, 37.2%], hormone/androgen deprivation therapy [n = 83, 37.2%]), completed an online survey assessing sexual variables and processes of sexual adaptation. Using a combination of inductive and deductive coding, open-ended responses were thematically analyzed and grouped into sexual adaptation styles. Factors potentially associated with sexual adaptation styles (e.g., age, perceived partner involvement, co-morbidities, relationship duration, time since PCa treatment, desire for physical affection, depression, relationship adjustment) were tested using multinomial logistic regression. Outcomes of sexual well-being (sexual distress, sexual bother, sexual satisfaction) and relationship adjustment were compared against each sexual adaptation style using a multivariate analysis of variance. Sexual activity status and satisfaction with the adaptation process was assessed across the sexual adaptation styles using a chi-square analysis and post-hoc tests. Two distinct categories were identified: those who had Adapted (n = 185) and those who had Not Adapted (n = 38). Four sexual adaptation styles emerged in the adapted category: Relationship Renegotiation (n = 53) and Sexual Renegotiation (n = 47), which were couples-focused styles, and Acceptance/Resignation (n = 34) and Masturbation/Erection (n = 48), which were individual-focused styles. Participants who could not be categorized as one style, but rather met several, were identified as Mixed (n = 3). Higher rates of depression, lower relationship adjustment, lack of sexual activity, and greater dissatisfaction with the adaptation process were observed for Not Adapted participants. Participants engaged in any type of adaptation style fared better than those who had Not Adapted. Couples-focused styles tended to emphasize renegotiation, including a changed perspective on the expression of the relationship. Perceived direct engagement of the partner facilitated adaptation and emphasized engagement with flexible coping, either through redefining priorities or ways of being sexual. Individual-focused styles emphasized pre-cancer erectile function, and either aimed to return to capacity for penetrative sexual activity or accepted its inaccessibility and largely an abandonment of partnered sexual activity.

Appendices

Appendix 1: Questions Designed or Adapted for Study

Perception of Partners Involvement

Participants perception of partners involvement was assessed using two questions, created specifically for this study. Due to these two items being highly correlated, scores on these two questions were added together and averaged; Higher scores indicate greater levels of partner involvement (α = 0.90) (Walker & Santos-Iglesias, 2020).

• (1) My partner would be interested in maintaining a sexual relationship (1 = not at all confident, 5 = very confident)

• (2) My partner would be supportive to me in helping me find a solution to my erectile dysfunction (1 = not at all confident, 5 = very confident)

Desire for Physical Affection

Desire for physical affection was assessed using a single item from the Sexual Interest and Desire Inventory-Female (Clayton et al., 2006):

“Over the past month, how often have you wanted physical affection other than sex (e.g., touching, holding, kissing)?” (1 = never, 2 = less than once a week, 3 = more than once a week, 4 = daily).

Satisfaction with Sexual Adaptation

Participants’ satisfaction with sexual adaptation was assessed using the following forced choice question:

“If you had to choose, would you describe yourself as more satisfied or dissatisfied with your adaptation to sexual changes.” (more satisfied than dissatisfied, more dissatisfied than satisfied).

Sexual Adaptation Style

A series of open-ended questions queried participants adaptation to PCa treatment-related sexual changes. Participants were asked to reflect on their own perceptions when responding to survey questions and to complete the study privately (in the absence of their partner). Therefore, patients reported on their perceptions of factors both personally and as a couple.

Participants were given a prompt and then asked a series of two open-ended questions. Following this prompt, the first question contained two parts (personal vs. couple) and asked about facilitators to adaptation, the second question contained the same two parts (personal vs. couple) and queried barriers to adaptation.

• 1. “We’d like to know what has helped as well as what has made it more difficult for you to adapt, personally and as a couple. (Please take the time to write a few sentences for each question).”

• 2. “What has helped you the most in adapting to those sexual changes…(a) Personally? and (b) As a couple?”

• 3. “What has made it difficult to adapt to those sexual changes…a) Personally? and b) As a couple?”