Orgasmic function is not the same as sexual function: what are we really being told?

We are having a hard time with a media release issued yesterday by BJU International in relation to a study just published in that journal by Tewari et al. (Actually, we are having a hard time with the results of the study itself too.)

The paper by Tewari and his colleagues offers data from a series of 708 patients given a robot-assisted laparoscopic prostatectomy (RALP) at their institution between January 2005 and June 2007, among whom 408  “were potent, able to achieve orgasm preoperatively and available for follow-up.”

From their analysis of data exclusive to these 408 men, Tewari et al. offer the following results:

  • 198/224 men aged ≤ 60 years (88.4 percent) “were able to achieve orgasm postoperatively.”
  • 152/184 men aged > 60 years (82.6 percent) were also able to achieve orgasm postoperatively.
  • 273/301 men (90.7 percent) who received bilateral nerve sparing were able to achieve orgasm postoperatively.
  • 46/56 men (82.1 percent) who received unilateral nerve sparing were able to achieve orgasm postoperatively.
  • 31/51 men (60.8 percent) who received non-nerve-sparing surgery were able to achieve orgasm postoperatively.
  • “Decreased sensation of orgasm” was reported by just 3.2 percent of men ≤ 60 years who underwent bilateral nerve sparing.
  • In the men who underwent bilateral nerve sparing and were ≤ 60 years of age, postoperative orgasmic rates were significantly better than those of
    • Men ≤ 60 years who underwent unilateral nerve sparing (92.9 vs 83.3 percent)
    • Men ≤ 60 years who had no nerve sparing (92.9 vs 65.4 percent)
  • Potency rates were also significantly higher in men ≤ 60 years and in those who underwent bilateral nerve sparing.

Now these results certainly sound so much better than any results ever previously reported that one has to wonder what the authors are actually saying.

Let’s point out up front that being able to have an orgasm is not the same as being potent. You can have an orgasm even if you can’t achieve an erection.

Let’s also be clear that younger men who have a nerve-sparing radical prostatectomy are most certainly more likely to be able to recover complete or near to complete sexual function than older patients. However, …

Is Dr. Tewari seriously trying to advise us that

  • > 60 percent of his patients who had non-nerve-sparing surgery were fully sexually functional after some period of follow-up?
  • > 90 percent of his patients who were 60 years of age and younger and who had bilateral nerve sparing were fully sexually funtional after some period of follow-up?
  • Men ≤60 years old who have a bilateral nerve-sparing RALP (in his hands) can normally be expected to maintain full pre-surgical sexual function?

Such claims appear — at face value — to be not only unlikely but improbable in the extreme.

In truth this can not be what Dr. Tewari is claiming. In one bullet point in the media release it states clearly that, “85% of the men under 60 and 77% of the men aged 60 plus were able to have sexual intercourse after surgery and this rose to 90.5% and 82% respectively in those who had bilateral nerve sparing.” The ability to “have sexual intercourse” is hardly the same as full sexual functionality. How did the partners feel about all of this, for example?

Interestingly, the final sentence of the media release states simply that, “Our study shows that men under the age of 60 and those who underwent bilateral nerve sparing surgery were more likely to recover the same orgasmic function they enjoyed before surgery than older men and those with no nerve sparing.”

Now that claim is perhaps a reasonable one (but it clearly doesn’t mean that these patients were fully sexually functional; it just means they could have an orgasm), so what is Dr. Tewari really claiming? Unfortunately we don’t have access to the entire text of ther article to check, but the language used in the material that is available appears to be misleading at best.

4 Responses

  1. PLEASE NOTE: We have just discovered that the full text of this article is available on line on the web site of Dr. Tewari’s institution. A careful reading of the full paper makes it clear that sexual potency was being defined as “the ability to have sexual intercourse” as opposed to the ability to have a high level of sexual perfomance.

    Indeed, the authors claim to have “calculated” the patients’ level of sexual satisfaction.

  2. I would love to hear the authors of this study and the low-dose brachytherapy study respond to the Health Affairs lying article referenced earlier this week.

    Again, one wouldn’t expect a sociologist or psychologist to provide valid counsel on treatment of prostate cancer, so why in the world would urologists imagine themselves skilled in measurement of human perception. “Calculated” patients’ level of sexual satisfaction indeed!

  3. Have you any information on high-dosage brachytherapy (HDR), given as part treatment instead of the usual 40 or 50 radiation treatments (EBRT).

    In my case the last remaining 25 radiation sessions were substituted by HDR administered over 36 hours (three 5 or 10 minutes sessions); that was the end of my treatment except for continuation of ADT, i.e., Prostap 3 every 3 months for a total of 2 years. I finished that ADT nearly 18 months ago. I have experienced a PSA level of 0.3 ng/ml for the last six 3-monthly tests; it seems to have stabilised there as it was only 0.1 ng/ml during and immediately after my radiation treatment. I originally had clinical stage III/T3b, Gleason 8 prostate cancer and I am now 68 years old.

    I have lost all capacity for sexual function and this includes psychologically as well as physically. How long is this remission likely to last? Have I just been lucky to have got this far or is this fairly normal?

  4. Dear Mike:

    The combination of external beam radiation therapy with HDR and ADT is a perfectly normal and regularly used form of radiation/hormonal treatment for high-risk prostate cancer like yours in men of your age. You may well be cured of your cancer, but it may also take a good while before all the effects of the ADT wear off.

    If your energy levels seem low to you, you might want to ask your doctor to check your serum testosterone level at the time of your next PSA test, and see if that has started to recover or if it is still low too. If your serum testosterone level is still low, you could ask your doctor about the risks and benefits of testosterone supplementation. There are significant potential risks to this as well as the potential benefit of greater vigor. However, you are unlikely at this time to recover meaningful sexual function without pharmacological and physical assistance.

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