Sexual function and ways to maintain it while on ADT

An upcoming article in the September issue of the journal Critical Reviews in Oncology/Hematology addresses issues related to the maintenance of sexual function for men with prostate cancer on androgen deprivation therapy (ADT).

This article by Duthie et al. (see below for link) covers detailed information about a spectrum of factors that may influence the ability of patients on ADT to remain sexually active (to some degree), including neurobiological factors, intermittent ADT, sex aids, exercise, sleep, partner factors, masculinity, non-penetrative intimacy, depressive symptoms, and access to counseling or patient education programs.

We want to make it clear to readers that some of the issues discussed in this article may be considered to be very sexually explicit, and not all readers are necessarily going to find all the content of this article to be “tasteful”. We are therefore not going to get into the details of this review in this commentary. However, at the other end of the scale, this article may be extremely helpful for individual patients and their partners, as well as for people like support group leaders, prostate cancer educators, and others to save to their files for their own edification and for future reference in helping other patients.

This link provides provide access to the full text of this review article through to about the middle of September, after which access will be limited to the abstract alone.

In addition to reviewing current information, the authors also make suggestions about future research that may be helpful in extending understanding in this field. They also recommend that clinicians should discuss options for sexual intimacy after ADT with both patients and their partners, as sexual inactivity is not inevitable for most, and strategies are available for helping maintain sexual intimacy.

Editorial note: We would like to thank Erik Wibowo, PhD, of the University of Otago, New Zealand, for providing us with access to the full text of this paper.

5 Responses

  1. Interesting article. I found this line especially poignant,

    “Being intimate in the broader sense can help couples stay as co-supportive partners, and not devolve to a patient-caregiver dynamic”

    as that perfectly describes the relationship I had with my husband during the brief time we tried to maintain sexual relations. It felt like somehow it was up to me to not only initiate all the sex, but magically make it satisfying too. (We were relatively young when he had his prostate removed, and while no ADT, we have not had any sex since 2012.) One (more) thing that feels unfair is that couples who had good sex prior to the cancer will be more likely to have some sex life left after, while those of us who always struggled (especially if it was the husband who didn’t care about sex as much) have it even tougher after cancer. I wish the younger couples in these situations were given more realistic information, so that they could make informed choices about their lives going forward. Unanticipated celibacy can be a terribly depressing way to live.

  2. Mike, you are such a brit! LOL!

    I am so used to frank discussions of sexual issues in my support groups that it never occurs to me that any adult in 2020 would find it in any way distasteful. In fact, if you shy away from talking about this sort of thing, it gives me insight into why patients may refrain from bringing it up to their doctors, and doctors refrain from initiating discussions with patients. It is no wonder that when I ask the several urologists I know how important sexual issues are, they all say it is not very important. “They almost never bring it up. If it were important they would.” Yet, in my support groups, it is the #1 issue. When I try to convince doctors to do more research about it, they think I am clueless. In the US, there are only two expert clinicians who are actively involved in research I’m aware of: John Mulhall at Memorial Sloan-Kettering and Irwin Goldstein in San Diego. Let’s get this subject out of the closet!

  3. Sorry, but the link does not work.

  4. Dear Allen:

    I don’t think my being originally British has much to do with this! I would note that I grew up in London and at a fairly “wild” university in southern England in the mid to late 1960s and early 1970s. From my perspective, I have long found that it is many Americans who have a hard time actually talking about sex (whether it has anything to do with prostate cancer or not).

    Because the readership of this blog encompasses a very broad spectrum of people, I ensured that it was possible for those who wanted to read the details could and those who preferred not to didn’t have to. That’s all. With regard to bringing “this subject out of the closet”, that’s exactly what I was helping to do … so that people like you could read it and those who simply can’t bring themselves to recognize all the problems didn’t have to have it rammed down their throats!

    With respect to the issue of active research in this area, and the failure or unwillingness of urologists to address these issues in relation to urogenital function, I am in complete agreement with you! And I suspect Erik Wibowo and his colleagues are too!


  5. Dear Guntermann:

    I just checked the link. It was working fine as of 9:00 am this morning Eastern time. It does take a few seconds to go to the full article, however. Maybe you need to give it another try.

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