Sexual dysfunction after radical prostatectomy: prevalence, treatments, restricted use of treatments and distress.
OBJECTIVE
Cancer of the prostate (CAP) is one of the most common malignancies affecting North American men with about 215,000 new cases and 35,800 CAP related deaths annually. The most prevalent intervention for localized CAP is radical prostatectomy (RP) with 10-year survival rates approaching 90%. Studies of men in post-RP recovery indicate that 44% to 75% experience sexual dysfunction and more than 60% experience distress in reaction to sexual dysfunction problems. These findings are increasingly significant as prostate specific antigen testing continues to increase CAP detection rates, resulting in more and younger post-RP patients confronting sexual dysfunction.


METHODS
A MEDLINE database search was performed for articles published from 1966 to September 2004.


RESULTS
Despite effectiveness 30% to 50% of patients who turn to sexually assistive aids after RP discontinue use within a year. This suggests that the achievement of physical responsiveness to an aid is necessary but it is not a sufficient factor in long-term sexual adaptation. Current research exploring this gap between effectiveness and ongoing use supports a broader perspective of sexual dysfunction emphasizing several factors, including perceptions of inadequacy, anxieties in regard to performance and depression in each member of the couple, overly enthusiastic expectations, partner physical/emotional readiness to resume active sex, the meaning to the couple of using a sexual aid and the quality of the nonsexual relationship of the couple.


CONCLUSIONS
Our findings reveal the need to explore broader strategies for improving patient coping ability and adaptation. They also point to the need to explore the role of resumed satisfying sexuality in overall quality of life following treatment.
Matthew
Andrew G
AG
Department of Surgical Oncology, Princess Margaret Hospital, The Prostate Centre 4-922, 620 University Avenue, Toronto, Ontario, Canada M5G 2M9. andrew.matthew@uhn.on.ca
Goldman
Adam
A
Trachtenberg
John
J
Robinson
John
J
Horsburgh
Sheri
S
Currie
Kristen
K
Ritvo
Paul
P
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000527:Alprostadil / Q000627:therapeutic use; D007172:Erectile Dysfunction / Q000188:drug therapy / Q000209:etiology / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015917:Penile Prosthesis; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D010879:Piperazines / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015995:Prevalence; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011471:Prostatic Neoplasms / Q000601:surgery; D011687:Purines; D012307:Risk Factors; D000068677:Sildenafil Citrate; D013315:Stress, Psychological / Q000209:etiology* / Q000517:prevention & control; D013450:Sulfones; D014619:Vacuum Curettage
D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate; D000527:Alprostadil