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 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.
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“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: http://bit.ly/1zboohc
Int J Impot Res January 2015.
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