title: Loss of masculine identity, marital affection, and sexual bother in men with localized prostate cancer.
abstract: BACKGROUND
  Erectile dysfunction (ED) is one of the most frequent sources of distress after treatment for prostate cancer (PCa), yet evidence suggests that men do not easily adjust to loss of sexual function over time. A hypothesized determinant of men's adaptation to ED is the degree to which they experience a loss of masculine identity in the aftermath of PCa treatment.
  
  
  OBJECTIVE
  The aims of this study were (i) to describe the prevalence of concerns related to diminished masculinity among men treated for localized PCa; (ii) to determine whether diminished masculinity is associated with sexual bother, after controlling for sexual functioning status; and (iii) to determine whether men's marital quality moderates the association between diminished masculinity and sexual bother.
  
  
  METHODS
  We analyzed cross-sectional data provided by 75 men with localized PCa who were treated at one of two cancer centers. Data for this study were provided at a baseline assessment as part of their enrollment in a pilot trial of a couple-based intervention.
  
  
  METHODS
  The sexual bother subscale from the Prostate Health-Related Quality-of-Life Questionnaire and the Masculine Self-Esteem and Marital Affection subscales from Clark et al's PCa-related quality-of-life scale.
  
  
  RESULTS
  Approximately one-third of men felt they had lost a dimension of their masculinity following treatment. Diminished masculinity was the only significant, independent predictor of sexual bother, even after accounting for sexual functioning status. The association between diminished masculinity and sexual bother was strongest for men whose spouses perceived low marital affection.
  
  
  CONCLUSIONS
  Diminished masculinity is a prominent, yet understudied concern for PCa survivors. Regardless of functional status, men who perceive a loss of masculinity following treatment may be more likely to be distressed by their ED. Furthermore, its impact on adjustment in survivorship may rely on the quality of their intimate relationships.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Talia
authors.initials: T
authors.lastname: Zaider
authors.forename: Sharon
authors.initials: S
authors.lastname: Manne
authors.forename: Christian
authors.initials: C
authors.lastname: Nelson
authors.forename: John
authors.initials: J
authors.lastname: Mulhall
authors.forename: David
authors.initials: D
authors.lastname: Kissane
mesh_terms: D000223:Adaptation, Psychological; D003430:Cross-Sectional Studies; D007172:Erectile Dysfunction / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D057228:Masculinity; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000523:psychology* / Q000601:surgery*; D011788:Quality of Life; D012725:Sexual Behavior / Q000523:psychology*; D011795:Surveys and Questionnaires