Sexual Function and Relationships

Psychological and Emotional Impact

Patients diagnosed with prostate cancer face a complex journey that significantly impacts their physical, emotional, and relational well-being, particularly concerning their sexual health (1). The side effects of treatment, such as erectile dysfunction, can deeply affect a man's self-image and self-esteem, sometimes leading to feelings of inadequacy or a sense of having "paid a price" to survive (4). Based on insights from both patients and their partners, relational and sexual counseling, preparation, and guidance are often not commonly offered or emphasized within the standard treatment process (4). This perceived gap in formal support leads many patients to seek understanding and connection through alternative channels, including peer support networks like online forums, social media groups, and one-on-one mentor programs provided by organizations such as ZERO Prostate Cancer and the Prostate Cancer Foundation (12). Peer support is noted to improve mental health outcomes for those affected (12).

  • Erectile dysfunction resulting from treatment can significantly impact men's self-image and self-esteem.

  • Patients may experience feelings of "loss of manhood" and inadequacy.

  • Some patients express feelings of "paying a price" to survive due to treatment side effects like sexual dysfunction.

  • In severe cases, men may experience suicidal ideations related to the impact of the disease and treatment on their sexual function and sense of self.

  • Patients on ADT experience significant declines in overall quality of life and intimate relationships.

  • Patients, like partners, may experience cancer worry, though this was shown to decline substantially over time in one study.

The “Couples Disease”

Prostate cancer and its treatment can have significant physical and emotional impacts that extend beyond the patient and affect their relationships with partners, family, and close friends (1). This impact leads to prostate cancer being referred to as a "couple's disease".

The impact on sexual relationships and intimacy is significant and often distressing for both partners, worsening over time, particularly after surgery (2). While treatment options exist for sexual dysfunction, and peer support networks offer valuable emotional connection, there is a clear need for more integrated professional counseling and guidance specifically focused on the relational and sexual challenges faced by couples navigating prostate cancer (54). The Connect App will go towards filling the gap.

Psychological and Emotional Impact

The occurrence of prostate cancer and its treatment can cause psychological instability and depression, which in turn can decrease sexual function (8). A prostate cancer diagnosis creates fear and anxiety regarding its effects on their lives, leading to an unstable mental status in their sex life and reduced sexual activity (11).

Erectile dysfunction resulting from treatment can impact men's self-image and self-esteem (37). Patients may experience feelings of "loss of manhood," inadequacy, and even suicidal ideations (8).... Some may feel they are "paying a price" to survive (37).

Partners are also significantly impacted emotionally (7). Their anxiety levels can be higher than those of patients and population norms (8). The psychological distress between couples dealing with cancer is interdependent (8). Partners may feel heartbroken or consider divorce due to changes in the relationship and their partner (12).

Managing Treatment-Related Sexual Dysfunction

Several methods are available to help manage sexual dysfunction:

  • PDE5 inhibitors (e.g., sildenafil, vardenafil, tadalafil)16.... These oral medications are commonly used for ED. Studies suggest they may help preserve erectile function recovery after surgery (40).

  • Intracavernosal injections16.... Injections directly into the penis can induce erection and show good results, particularly for post-surgery ED (42).

  • Vacuum constriction devices (16). These devices create a vacuum to draw blood into the penis. While used, evidence for their role in penile rehabilitation is considered insufficient (42).

  • Penile prosthesis (implant) (42). This is generally considered a last resort when other treatments for ED have failed, offering a potential solution for men who still desire sexual activity.

  • Testosterone replacement therapy is also being explored, particularly for hypogonadism and ED after treatment in men with localized disease who have achieved complete recovery, although concerns about prostate cancer recurrence make it controversial and require further validation (42).

Support for Couples and Partners

While some support exists for partners and caregivers through organizations like ZERO Prostate Cancer and the Prostate Cancer Foundation, including online peer support forums, private social media groups, and virtual/local support group meetings, there is a recognized gap in support specifically addressing the relational and sexual challenges.

  • Relational and sexual counseling, preparation, and guidance are not commonly offered or emphasized as part of the standard treatment process.

  • Healthcare practitioners may be able to address psychological distress by targeting psychosocial interventions at the level of the couple. Identifying vulnerable couples who may benefit from counseling or educational tools is suggested.

  • Peer support through communities and groups can improve mental health outcomes for patients and their loved ones, providing a safe space to discuss hardships, emotional impact, and share experiences and advice.

  • Palliative care, which aims to improve quality of life, includes support for the patient's family and friends.

Prostate cancer is often referred to as a "couple's disease" because its impact extends significantly to the patient's partners, family, and close friends1.... This impact involves both physical and emotional challenges that can strain relationships3.... 1 https://www.patientinsights.com/blogs/prostate-cancer-a-couples-disease 2 https://www.patientinsights.com/blogs/prostate-cancer-a-couples-disease 3 https://www.patientinsights.com/blogs/understanding-prostate-cancers-impact-and-support 4 https://www.patientinsights.com/blogs/understanding-prostate-cancers-impact-and-support 5 https://www.patientinsights.com/blogs/understanding-prostate-cancers-impact-and-support

One of the most significant physical side effects impacting relationships is erectile dysfunction (ED)6.... Prostate cancer itself can reduce sexual desire and the frequency of sexual intercourse6. Various treatments frequently cause ED, including radical prostatectomy, which can damage nerves, and its recovery can be difficult after one to two years6.... Radiotherapy and brachytherapy can also lead to ED by affecting the penile bulb, neurovascular bundle, or causing nerve injuries, although the frequency of maintaining erectile function after radiation may be higher than after surgery11.... Hormone therapy (androgen deprivation therapy, ADT) directly aims to block testosterone and commonly results in reduced sex drive and ED; while often temporary, long-term therapy can cause physical changes to the penis6.... Cryotherapy also lists ED as a potential side effect14. Beyond sexual function, other physical side effects like urinary incontinence from treatments such as radical prostatectomy or cryotherapy can also present challenges, although their direct impact on intimate relationships isn't as explicitly detailed as that of sexual dysfunction in the provided sources7.... 6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623527/ 7 https://www.patientinsights.com/blogs/understanding-prostate-cancers-impact-and-support 8 https://www.patientinsights.com/blogs/understanding-prostate-cancers-impact-and-support 9 https://www.patientinsights.com/blogs/understanding-prostate-cancers-impact-and-support 10 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623527/ 11 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623527/ 12 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623527/ 13 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623527/ 14 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623527/

The emotional and psychological impact on patients is significant and can strain relationships. The cancer diagnosis and treatments can cause psychiatric disorders like depression6.... Physical side effects, particularly ED, can severely affect a man's self-image and self-esteem, potentially leading to feelings of "loss of manhood" or inadequacy16.... This can cause emotional withdrawal from a marriage16. Patients may express feelings of "paying a price" to survive, have concerns about "death lurking," and face existential distress related to their mortality16.... 6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623527/ 15 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9899029/ 16 https://www.patientinsights.com/blogs/prostate-cancer-a-couples-disease 17 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3855071/ 18 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9899029/

Partners also experience considerable emotional and psychological distress, which is interdependent with the patient's state19.... Partners' anxiety levels can be higher than the patient's, especially soon after diagnosis20. Prostate cancer therapy has a negative impact on the partners' sexual relationship, and this appears to worsen over time, potentially leading to disappointment if sexual life doesn't improve as expected19. Partners have shared experiences in online forums of feeling guilt for being upset about the loss of sexual function while their partner battles cancer, and some have discussed the destructive impact on their family, even to the point of considering divorce or questioning if treatment is worth the cost to family life2.... A minority of partners also reported negative impacts on their personal activities and work life over time19. 19 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3855071/ 20 https://www.patientinsights.com/blogs/prostate-cancer-partner-support-resources-and-gaps 21 https://www.patientinsights.com/blogs/prostate-cancer-a-couples-disease 2 https://www.patientinsights.com/blogs/prostate-cancer-a-couples-disease

The impact extends to the broader family and friends. Cancer pain itself is considered a component of "total pain," which includes physical, psychological, spiritual, and social dimensions13.... The importance of relationships in the overall cancer experience is recognized18. Support is available for the patient's family and friends, particularly in the context of palliative care when curative treatment is not pursued23.... 22 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9899029/ 18 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9899029/ 13 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9899029/ 23 https://academic.oup.com/bmb/article/83/1/341/311259 24 https://www.nhs.uk/conditions/prostate-cancer/treatment/

Support for relationship issues is available through various channels, though with recognized gaps. Organizations like ZERO Prostate Cancer offer online peer support communities (forums, private social media groups) and support groups (virtual and local meetings) where patients, caregivers, and loved ones can connect, share experiences, and gain support20.... These platforms provide understanding and help families realize they are not alone, with partners using them to discuss challenges and seek advice, including on addressing sexual dysfunction or seeking therapy20.... The Prostate Cancer Foundation also lists "Support Groups" and resources "For Caregivers"20.... While psychosocial interventions targeting couples may help manage distress20, the sources highlight that relational and sexual counseling, preparation, and guidance are not commonly offered or emphasized as a routine part of prostate cancer treatment, despite the significant negative impact on couples' quality of life, especially regarding sexual function2...