Couples Counseling Boosts Sex Lives After Prostate
MONDAY, Sept. 26 (HealthDay News) -- The side effects of
prostate cancer treatments, including surgery and radiation, can
seriously disrupt a couple's sex life.
But a new study finds that counseling helped married men and
women figure out what sorts of treatments for erectile dysfunction
worked for them and how to incorporate those methods during sex. In
doing so, they returned some luster to their love lives.
Researchers enrolled more than 200 men who'd been treated for
prostate cancer and their wives into one of three groups: one
received three face-to-face counseling sessions; the other was
offered Internet-based counseling; and the third was put on a wait
At a six-month follow-up (about three months after counseling),
men who received either the face-to-face or web-based counseling
reported an improvement in sexual function and satisfaction with
sex. When the man reported his sexual function improved, his wife's
reports of sexual function and satisfaction did as well.
Those in the wait-listed group experienced no improvements,
suggesting that "time alone doesn't heal the issues," said study
author Leslie Schover, a professor of behavioral science and a
clinical psychologist at the University of Texas M.D. Anderson
Cancer Center in Houston.
The study is published in the Sept. 26 online issue of
Despite nerve-sparing surgery, prostate cancer treatment still
causes significant erectile dysfunction, experts say. Other
problems may include difficulty reaching orgasm; decreased
intensity of orgasm; pain and leaking urine at orgasm.
Many men who have prostate cancer are older, and their erectile
function may have already been compromised due to the cancer itself
or other underlying vascular or nerve disease, explained Dr. Bruce
Gilbert, director of reproductive and sexual medicine at North
Shore-Long Island Jewish Health System's Smith Institute for
"Before nerve-sparing prostatectomy [surgical removal of the prostate], 100 percent of men would have erectile dysfunction afterward," Gilbert said. "That has come down quite a bit. But you are dealing with a population of men who are generally not 30 or 40 years old. They're older and may already have an underlying problem with erectile dysfunction."
Most men have some level of erection difficulties after prostate
cancer surgery, experts said.
In addition to dealing with that, "the counseling program
focused on the woman's right to pleasure in sex and on fixing
problems like postmenopausal vaginal dryness or loss of desire
related to poor sexual communication," Schover said.
"We educated both partners about available treatments to restore erections and had them complete a 'decision aid' to figure out what treatment to try, based on mutual opinions," she said. "If that treatment did not work well for them, we encouraged them to try another choice."
After prostrate cancer, many men try pills for erectile
dysfunction, experts said. But those may not be enough. Other
options include penile injections, vacuum pumps and or penile
implants, but Schover said she suspects many men throw in the towel
when they don't get the results they want and don't pursue the
Men and women were given questionnaires that asked about a wide
variety of measures of sexual function and sexual satisfaction,
including their erectile function (for men), ability to achieve
orgasm and their level of desire.
"Every subscale improved except desire, which we weren't surprised by because very few had low desire to begin with, so there wasn't that far to go on that," Schover said.
Men's ability to achieve "near-normal" erections also improved
after counseling. Before counseling, about 12 percent to 15 percent
of men reported few erection difficulties. That increased to
between 36 percent and 44 percent for those who underwent
At one year, men who reported that they found a successful
erectile dysfunction treatment had scores on the sexual function
and satisfaction scale that were about the same as healthy men.
One limitation of the study is that about 34 percent of couples
enrolled in the counseling dropped out for unknown reasons, said
Dr. Bruce Gilbert, director of reproductive and sexual medicine at
the Smith Institute for Urology at North Shore LIJ Health
Still, he added, "a study like this is very important and
highlights that there is a lot that happens if you engage couples
or the patient in some type of counseling," Gilbert said.
Couples and physicians should also never forget that while
prostate cancer is frightening, so is the worry that even if it's
cured, "they may not be the same after a procedure than before,"
Gilbert said. "That's a real fear for men."
Ideally, patients should start "penile rehabilitation" even
prior to having the treatment, which has been shown to improve
Urologists should be able to suggest methods of improving
erectile function, experts noted. They suggested that if you're not
getting all the help you need from your urologist, ask for a
referral to a urologist that specializes in sexual medicine, or a
mental health professional that treats issues related to cancer
treatment, often found at large teaching hospitals in major
Dr. Elizabeth Kavaler, a urologist at Lenox Hill Hospital in New
York City, said "the idea of providing Internet-based counseling to
couples experiencing sexual dysfunction after prostate surgery is
"This study proves that patients and their partners respond to instructive sex therapy. Since insurance coverage for psychotherapy is sparse, it is encouraging to know that web-based help is available to these couples," Kavaler said.
U.S. National Kidney & Urologic Diseases
Inform...on Clearinghouse has more on erectile dysfunction.
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