Erectile function, motivation, sex, and satisfaction post-surgery

A recent article offers data from an initial investigation of the impact of sexual motivation on the sexual health and satisfaction of men treated by radical prostatectomy (RP) for localized prostate cancer.

This study by Messaoudi et al. was based on a cohort of 63 consecutive French patients who described themselves as having either high or lower levels of sexual motivation. All patients were asked to complete a self-administered questionnaire. 

The data collected from this questionnaire were as follows:

  • The average (mean) age of the patients was 63.9 years.
  • 50/63 men (74.9 percent) were being treated for erectile dysfunction (ED).
  • Following their RP, the patients reported
    • Lower sexual desire (33/63, 52.4 percent)
    • Lower frequency of intercourse (50/63, 79.4 percent)
    • Anorgasmia, i.e., the failure to achieve orgasm (25/63, 39.7 percent)
    • Less satisfaction with orgasm (24/63, 38.1 percent)
    • Climacturia, i.e., expulsion of urine at orgasm (16/63, 25.4 percent)
    • Significant personal distress about sexual function (43/63, 68.3 percent)
    • Lower partner satisfaction (56.5 percent)
  • Among the more sexually motivated set of patients
    • 76.0 percent reported loss of masculine identity
    • 52.0 percent reported loss of self-esteem.
    • 36.0 percent reported anxiety about performance.
  • Among the less sexually motivated set of patients
    • 52.6 percent reported loss of masculine identity.
    • 28.9 percent reported loss of self-esteem.
    • 18.4 percent reported anxiety about performance.
  • The average (mean) overall satisfaction score was 4.8 ± 2.9.
    • Among the more sexually motivated set of patients this score was 3.4.
    • Among the less sexually motivated set of patients this score was 5.8.

Unsurprisingly, the authors conclude that RP adversely affected erectile and orgasmic functions as well as sexual desire, self-esteem, and masculinity. The more sexually motivated patients experienced greater distress and were less satisfied.

As patients have gradually been diagnosed earlier and younger with localized prostate cancer since the widespread use of the PSA test, the impact of sexual dysfunction on quality of life after radical prostatectomy (and after other forms of treatment too) has become an increasingly critical complication of treatment. This is particularly a factor that needs to be addressed in light of the inherent risk of over-treatment of men with potentially indolent forms of low-risk prostate cancer.

The “New” Prostate Cancer InfoLink considers that this article helps to make a strong case for heightened levels of clarity and honesty on the part of the treating community about the risks for ED after surgery (and after other forms of treatment) for localized prostate cancer. It has been evident for some time that all too many patients go into surgery believing that a high percentage of men recover good sexual function after surgery if they have a nerve-sparing operation. We know that this is not, in fact, the case.

Since many more men today are being diagnosed with early stage, low-risk, potentially indolent prostate cancer that comes with significant risk for over-treatment, this is an increasingly important issue in the discussion of the complications of surgery and other forms of treatment for localized prostate cancer.

It would be better for all concerned, and a great deal more honest, if men were given a very clear message that the majority of surgical patients have significant loss of sexual function after RP — even with the assistance of drugs like Viagra and Cialis. While there is certainly a subset of (usually younger) men who do have good recovery of sexual function post-treatment, this is not the norm. The treating community, the prostate cancer support community, and the primary care community all need to send this message to newly diagnosed patients with a great deal of clarity.

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