AUA2023 BEST POSTERS Understanding the Sexual Health Concerns and Needs of Female Partners of Prostate Cancer Survivors
By: Natasha Gupta, MD, MSc, New York University, New York, Manhattan Veterans Affairs, New York; Laura Zebib, MPH, University of Michigan, Ann Arbor; Daniela Wittmann, PhD, University of Michigan, Ann Arbor; Christian J. Nelson, PhD, Memorial Sloan Kettering Cancer Center, New York; Carolyn A. Salter, MD, Madigan Army Medical Center, Tacoma, Washington; John P. Mulhall, MD, MSc, FECSM, FACS, FRCSI, Memorial Sloan Kettering Cancer Center, New York; Nataliya Byrne, BA, New York University, New York, Manhattan Veterans Affairs, New York; Tatiana Sanchez Nolasco, MPH, New York University, New York, Manhattan Veterans Affairs, New York; Stacy Loeb, MD, MSc, PhD (hon), New York University, New York, Manhattan Veterans Affairs, New York | Posted on: 30 Aug 2023
Prostate cancer (PCa) is the most common noncutaneous cancer in men, with >3.5 million survivors in the U.S.1 PCa and its treatments can cause significant sexual dysfunction, with up to 85% of survivors reporting changes such as erectile dysfunction, penile deformity, and/or reduced libido.2-5 Due to the reciprocal nature of sexual relationships, dysfunction among survivors can impact partners, and this impact is likely widespread. In the National Poll on Healthy Aging, 73% of men aged 65-80 years were partnered, and 54% of partnered men were sexually active.6 Given the prevalence and median age of PCa diagnosis in the U.S., these data suggest that more than 1,000,000 partners may be affected. Although there is an NIH-funded study examining sexual health among gay couples facing PCa (led by a colleague, Dr Rosser)7, few studies have examined the impact of PCa on the sexual health of heterosexual partners.8
The goal of our study was to gain an in-depth understanding of the impact of PCa on female partners’ sexual quality of life. To do this, we conducted semi-structured individual telephone interviews with female partners recruited from multiple clinical locations and national online support groups from September 2021 to March 2022. Interviews were audio-recorded, transcribed verbatim, independently coded by multiple team members to identify major recurring themes, and conducted on a rolling basis until no new major themes emerged (n=12 interviews).
Among 12 participants, the median age was 65 years (range 53-81), 9 were white, the median time since their partner’s PCa diagnosis was 2.25 years (range 11 months-20 years), and a majority reported that their partner had undergone radical prostatectomy, radiation, and/or hormonal therapy for PCa. Major emergent themes pertained to sexual health challenges in the context of aging and PCa, the role of the partner in coping with and adjusting to sexual dysfunction, and unmet sexual health resource needs (see Table). Specifically, partners described sexual losses and grief due to the interplay of both age- and PCa-related sexual dysfunction. They described PCa-related sexual dysfunction as a couple’s disease and sexual recovery as a dyadic process that impacted both members of the couple. Additionally, partners stated that sexual health was important, even though survival concerns were paramount. In terms of coping and adaptive strategies, partners discussed the importance and benefit of expanding the sexual repertoire to include nonpenetrative activity as a means to facilitate intimacy. They also noted that being proactive about physical intimacy and coming to terms with changes in sexual function were positive coping strategies. However, female partners described difficulties communicating about sex with their male partners in the setting of dysfunction. Finally, in terms of sexual health resource needs, partners reported frustration with a lack of physician-led sexual health counseling, and cited the benefits of interacting with other female partners and proactive information-seeking as a means to address unmet sexual health resource needs.
Table. Major Emergent Themes and Representative Quotes
|Female sexual health/losses in the context of aging/prostate cancer
“I’ve been going through menopause…we used a lot of lube because [vaginal] dryness was really the biggest issue.”
|Sexual dysfunction as a couple’s disease, recovery as a dyadic process
“I think any cancer is a partner struggle, but especially when you take out the sex component.”
|Survival vs sex
“Would you rather have intercourse or have a live partner? I’d rather have a live partner.”
|Expanding the sexual repertoire
“Much more stimulation, hand, mouth, etc…he needs me to do more of that upfront.”
|Coping: Being proactive versus avoidant
“He did not have the urge anymore to have intercourse. So I kind of became the instigator.”
|Coping: Coming to terms with sexual function changes
“However, the change after he had the surgery, we’ve not been able to have penetrating sex…it has affected our sex life but not our relationship.”
|Difficulty communicating about sex
“So then, if you’re a wife who’s trying to learn that and understand that and still have your own needs met, at what point do you say the right thing or the wrong thing?”
|Lack of physician-led sexual health counseling/support
“There is no quality of information [about sexual health]. First of all, they don’t tell you, and you have no idea…People are afraid to touch sex with a 10-foot pole, even doctors.”
|Benefit of peer interactions, proactive information seeking in addressing unmet needs
“It’s something that if women could talk to each other and know they’re not alone, some of these terrible things in their relationships that you just think you can’t overcome, you find new strength to be able to do it.”
In summary, our study contributes to a foundational understanding of female partners’ sexual health concerns and unmet needs both related to and independent of PCa survivor sexual health. Our results demonstrate that female partners experience sexual losses due to both age- and PCa-related declines in sexual health and experience PCa-related sexual dysfunction as a “couple’s disease.” Female partners also report a lack of sexual health counseling and support and, therefore, have unmet sexual health resource needs. Future research and clinical efforts should include partners in the sexual recovery process and develop sexual care programs to address partners’ unmet needs.
The results of this study were presented at the AUA 2023 annual meeting and were published in The Journal of Sexual Medicine.9
Disclosures: We have no conflicts of interest. This study was supported by an Idea Development Award from the Department of Defense (W81XWH2010380), the Edward Blank and Sharon Cosloy-Blank Family Foundation, the Agency for Healthcare Research and Quality (5T32HS026120-04), the NYU Clinical and Translational Science Institute Grant (5UL1TR001445), and the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through Grant Award Number KL2TR001446. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality or the National Institutes of Health.
- Miller KD, Nogueira L, Devasia T, et al. Cancer treatment and survivorship statistics, 2022. CA Cancer J Clin. 2022;72(5):409-436.
- Capogrosso P, Vertosick EA, Benfante NE, et al. Are we improving erectile function recovery after radical prostatectomy? Analysis of patients treated over the last decade. Eur Urol. 2019;75(2):221-228.
- Emanu JC, Avildsen IK, Nelson CJ. Erectile dysfunction after radical prostatectomy: prevalence, medical treatments, and psychosocial interventions. Curr Opin Support Palliat Care. 2016;10(1):102-107.
- Nelson CJ, Kenowitz J. Communication and intimacy-enhancing interventions for men diagnosed with prostate cancer and their partners. J Sex Med. 2013;10(Suppl 1):127-132.
- Sullivan JF, Stember DS, Deveci S, Akin-Olugbade Y, Mulhall JP. Ejaculation profiles of men following radiation therapy for prostate cancer. J Sex Med. 2013;10(5):1410-1416.
- Institute for Healthcare Policy and Innovation. National Poll on Healthy Aging. Let’s Talk About Sex. July 25, 2022. https://www.healthyagingpoll.org/report/lets-talk-about-sex
- Capistrant BD, Lesher L, Kohli N, et al. Social support and health-related quality of life among gay and bisexual men with prostate cancer. Oncol Nurs Forum. 2018;45(4):439-455.
- Loeb S, Salter CA, Nelson CJ, Mulhall JP, Wittmann D. A call to arms: increasing our understanding of the impact of prostate cancer on the sexual health of partners. J Sex Med. 2020;17(3):361-363.
- Gupta N, Zebib L, Wittmann D, et al. Understanding the sexual health perceptions, concerns, and needs of female partners of prostate cancer survivors. J Sex Med. 2023;20(5):651-660.