Couples Counseling Boosts Sex Lives After Prostate Cancer

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 list.

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 Cancer.

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 Urology.

"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 other alternatives.

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 counseling.

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 System.

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 outcomes.

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 cities.

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 excellent."

"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.