Alterations of Sexual Function in Men With Cancer

doi:10.1016/j.soncn.2008.02.010

Seminars in Oncology Nursing

Volume 24, Issue 2, May 2008, Pages 102-114

https://doi.org/10.1016/j.soncn.2008.02.010 Get rights and content

Objectives

To provide an overview of the challenges in sexuality men face when they have been diagnosed and treated for various types of cancer.

Data Sources

Review and research articles, abstracts, books, electronic databases, clinical experience.

Conclusions

An in-depth assessment of sexual needs and issues specific to men includes physical and psychosocial problems related to sexuality. Interventions include psychosocial sexual interventions, coping strategies, communication strengthening exercises, or alternative sexual techniques that will assist if physical functioning is diminished. Various medical, surgical, or pharmacologic approaches are available.

Implications for Nursing Practice

Although it is recognized that male sexuality in the cancer arena has been overlooked in the past, nurses have the opportunity to change this trend in the clinical setting and improve sexual health care delivery for men.

Section snippets

Context of Sexuality for Men With Cancer

It is clear that cancer affects both members of the couple, not just the patient. This impact on partners and the dyadic relationship is reflected in a growing body of literature.5, 8, 9, 10, 11, 12, 13, 14 It has been shown that men and women tend to respond differently to the stress of a cancer diagnosis.9, 15, 16, 17 However, even successful treatment can alter the quality of the couple's relationship.¹⁸

Some researchers have noted partners of patients with cancer experience more

Psychological and Physiological Impact of Cancer Treatment on Men's Sexuality

The various kinds of treatment and approaches to manage a cancer diagnoses impact men and their sexual health-related quality of life (QOL). It is important to acknowledge that men often receive more than one treatment for their cancer diagnosis and, consequently, may face multiple challenges and treatment-related sequelae The examples discussed below reflect the primary concerns regarding sexuality men and their partners may face with a particular treatment approach and how it will impact this

Sexual Assessment

Sexuality and intimacy questions are frequently omitted by the provider taking the health history of the male cancer patient for various reasons.79, 80, 81 These reasons include clinic appointment time schedule, the provider's lack of recognition of the importance of sexual function related to the man's HRQOL, and the provider's comfort level in discussing sexual and intimacy issues. Some do not bring up the issue of sexuality because the average patient appointment time frequently is too short

Psycho-Social Sexual Interventions

Interventions for sexual dysfunction evolve out of the sexual assessment. During the assessment the oncology nurse can determine the couples' lifestyle preferences, the nature of their before-cancer sexual relationship, frequency of sexual activity, and relational satisfaction of both partners. The sexual intervention model adapted here is a psychosocial education model to assist couples with education in coping, communication, alternate or adapted techniques for sexual expression, management

Conclusion

Cancer impacts men's HRQOL in a number of ways. However, the focus of the preceding discussion has been on how cancer specifically affects sexuality for men who have been diagnosed and treated with various types of cancers. Some of the sequelae are more obvious, while other treatment-related side effects are less intuitive. It is important to note that the impact of cancer on men's sexual functioning and satisfaction does not happen in a vacuum. Rather, the context for this experience for men

Michael E Galbraith, RN, PhD: Associate Professor, School of Nursing, University of Colorado Denver, Aurora, CO.

References (94)

L.C. Campbell et al.
Prostate cancer in African Americans: relationship of patient and partner self-efficacy to quality of life
J Pain Symptom Manage
(2004)
F.J. Keefe et al.
Partner-guided cancer pain management at the end of life: A preliminary study
J Pain Symptom Manage
(2005)
B.K. Johnson
Prostate cancer and sexuality: implications for nursing
Geratr Nurs
(2004)
M. Pocard et al.
A prospective study of sexual and urinary function before and after total mesorectal excision with autonomic nerve preservation for rectal cancer
Surgery
(2002)
R. Katz et al.
Patient reported sexual function following laparoscopic radical prostatectomy
J Urol
(2002)
J. Noldus et al.
Patient-reported sexual function after nerve-sparing radical retropubic prostatectomy
Eur Urol
(2002)
J.W. Robinson et al.
Meta-analysis of rates of erectile function after treatment of localized prostate carcinoma
Int J Radiat Oncol Biol Phys
(2002)
C. D'Ancona et al.
Quality of life after partial penectomy for penile cancer
Urology
(1997)
U. Monga et al.
Sexuality in head and neck cancer patients
Arch Phys Med Rehab
(1997)
J. Slater et al.
Conformal proton therapy for early-stage prostate cancer
Urology
(1999)

J.R. Dahn et al.

Sexual functioning and quality of life after prostate cancer treatment: considering sexual desire

Urology

(2004)

G.H. Mumma et al.

Long-term psychosexual adjustment of acute leukemia survivors: impact of marrow transplantation versus conventional chemotherapy

Gen Hosp Psychiatry

(1992)

D. Bohlen et al.

Fertility and sexual function following orchiectomy and 2 cycles of chemotherapy for stage 1 high risk nonseminomatous germ cell cancer

J Urol

(2001)

C. Higano

Side effects of androgen deprivation therapy: monitoring and minimizing toxicity

Urology

(2003)

F.R. Romero et al.

Sexual function after partial penectomy for penile cancer

Urology

(2005)

Institute of Medicine and National Research Council of the National Academies. From cancer patient to cancer survivor: lost in transition

(2006)

Cancer Facts and Figures

(2008)

Public Health and Aging: Trends in aging–United States and worldwide

Morbid Mortal Weekly Rep

(2003)

S.A. Cumbie et al.

Advanced practice nursing model for comprehensive care with chronic illness: model for promoting process engagement

Adv Nurs Sci

(2004)

J. Harden

Developmental life stage and couples' experience with prostate cancer: a review of the literature

Cancer Nurs

(2005)

G.T. Deimling et al.

The health of older-adult long-term cancer survivors

Cancer Nurs

(2005)

S. Lindau

A study of sexuality and health among older adults

N Engl J Med

(2007)

D. Feldman-Stewart et al.

What questions do families of patients with early stage prostate cancer need answered?

J Fam Nurs

(2001)

J. Giese-Davis et al.

Quality of couples' relationship and adjustment to metastatic breast cancer

J Family Psychol

(2000)

S. Manne et al.

Psychoeducational group intervention for wives of men with prostate cancer

Psychooncology

(2003)

K. Skerrett

Couple dialogues with illness: expanding the we

Fam Systems Health

(2003)

V.M. Wai-Ming

Psychological predictors of marital adjustment in breast cancer patients

Psychol Health Med

(2002)

L. Carlson et al.

Partner understanding of breast and prostate cancer experience

Psychooncology

(2001)

L.S. Porter et al.

Disclosure between patients with gastrointestinal cancer and their spouses

Psychooncology

(2005)

C. Shields et al.

Marital attachment and adjustment in older couples coping with cancer

Aging Ment Health

(2000)

V. Malcarne et al.

Problem solving skills and emotional distress in spouses of men with prostate cancer

J Cancer Educ

(2002)

L. Carlson et al.

Partners of cancer patients

J Psychosoc Oncol

(2000)

A. Kiss et al.

Effect of sex and gender on psychosocial aspects of prostate and breast cancer

Br Med J

(2001)

M.A. Perez et al.

Sexuality and intimacy following radical prostatectomy: patient and partner perspectives

Health Psychol

(2002)

A. Sestini et al.

Cancer of the prostate: a biopsychosocial review

J Psychosoc Oncol

(2002)

A.J. Roth

Improving quality of life: psychiatric aspects of treating prostate cancer

Psychiatric Times

(2005)

L. Neese et al.

Finding help for sexual problems after prostate cancer treatment: A phone survey of men's and women's perspectives

Psychooncology

(2003)

S.L. Manne et al.

Partner unsupportive responses, avoidant coping, and distress among women with early stage breast cancer: patient and partner perspectives

Health Psychol

(2005)

R. Banthia et al.

The effects of dyadic strength and coping styles on psychological distress in couples faced with prostate cancer

J Behav Med

(2003)

S. Maliski et al.

Mastery of postprostatectomy incontinence and impotence: his work, her work, our work

Oncol Nurs Forum

(2001)

J.L. Scott et al.

United we stand? The effects of a couple-coping intervention on adjustment to early stage breast or gynecological cancer

J Consult Clin Psych

(2004)

L. Butler et al.

Behind the scenes: partner's perceptions of quality of life post radical prostatectomy

Urol Nurs

(2000)

A.L. Canada et al.

Pilot intervention to enhance sexual rehabilitation for couples after treatment for localized prostate carcinoma

Cancer

(2005)

F.M. Lewis

Family-focused oncology nursing research

Oncol Nurs Forum

(2004)

S. Sanders et al.

Couples' surviving prostate cancer: long-term intimacy needs and concerns following treatment

Clin J Oncol Nurs

(2006)

C.H. Yarbro et al.

Cancer symptom management

(2004)

S. Hendren et al.

Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer

Ann Surg

(2005)

Cited by (31)

Self-Reported Sexual Function in Sexually Active Male Hodgkin Lymphoma Survivors
2020, Sexual Medicine
Citation Excerpt :
This is probably explained by the fact that the BEACOPP schedule includes 2 alkylating agents, namely procarbazine and cyclophosphamide, while the ABVD regimen has only one, namely dacarbazine. Alkylating agents can lead to damage of the gonads, a well-known cause of sexual dysfunction.6–11,13,14,16 Apart from these drugs, gonadal effects also depend on cumulative doses and combinations that have been applied.26
Unambiguous data on sexual dysfunction after Hodgkin lymphoma (HL) treatment are scarce.
To form a baseline in this area, we compared patient-reported sexual function in sexually active male HL survivors in complete remission with a sexually active, age-matched, male Dutch sample population. Furthermore, we explored whether sociodemographic and clinical factors were associated with sexual dysfunction in HL survivors and investigated whether reporting to perceive sexual problems was indicative for sexual dysfunction.
This cross-sectional study included male patients with HL who were treated with chemotherapy and age-matched sexually active males.
Outcome measures included the internationally validated International Index of Erectile Function (IIEF) and self-reported sexual problems by adding 3 items to the study-specific questionnaire.
Erectile dysfunction (ED) occurred in 23.3% of the HL survivors vs in 23.0% of controls: respectively 13.3% and 12.3% had moderate to severe ED. However, more HL survivors positively answered the question whether they did perceive sexual problems than controls (20.0% vs 7.0%; P = .087). More patients treated with bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procabazine, and prednisone (BEACOPP) had sexual problems 33.3% vs 8.3% who were treated with doxorubicin, bleomycin, vinblastine, and dacarbazine (P = .057). Importantly, we found that the mean IIEF score for erectile function was 15.7 in HL survivors who reported to perceive sexual problems (moderate ED) vs 28.3 (normal) in those without perceiving sexual problems.
In general, sexual function of male HL survivors is comparable to that of matched normal controls. Perceiving sexual problems was associated with lower sexual function measured by the IIEF. None of the HL survivors who were treated with doxorubicin, bleomycin, vinblastine, and dacarbazine perceived sexual problems. However, one-third of HL survivors who were treated with BEACOPP did, including ED in one-third of the cases. This is an important consideration for daily clinical practice as BEACOPP is increasingly used as standard therapy in advanced-stage HL.
Eeltink CM, Lissenberg-Witte BI, Incrocci L, et al. Self-Reported Sexual Function in Sexually Active Male Hodgkin Lymphoma Survivors. Sex Med 2020;8:428–435.
Health-Related Quality of Life, Psychological Distress, and Sexual Changes Following Prostate Cancer: A Comparison of Gay and Bisexual Men With Heterosexual Men
2016, Journal of Sexual Medicine
Citation Excerpt :
This has resulted in gay and bisexual (GB) men, conservatively estimated to make up 3% to 5% of PCa survivors,10 being described as an “invisible diversity,”11 or a “hidden population.”12 There have been appeals for health providers to acknowledge that GB men may experience PCa differently from heterosexual men, necessitating targeted information and support.12,13 However, recent reviews of PCa educational resources report an absence of such targeted support,14,15 leading to calls for research to inform its future development.
Decrements in health-related quality of life (HRQOL) and sexual difficulties are a recognized consequence of prostate cancer (PCa) treatment. However little is known about the experience of gay and bisexual (GB) men.
HRQOL and psychosexual predictors of HRQOL were examined in GB and heterosexual men with PCa to inform targeted health information and support.
One hundred twenty-four GB and 225 heterosexual men with PCa completed a range of validated psychosexual instruments.
Functional Assessment of Cancer Therapy – Prostate (FACT-P) was used to measure HRQOL, with validated psychosexual measures, and demographic and treatment variables used as predictors.
GB men were significantly younger (64.25 years) than heterosexual men (71.54 years), less likely to be in an ongoing relationship, and more likely to have casual sexual partners. Compared with age-matched population norms, participants in both groups reported significantly lower sexual functioning and HRQOL, increased psychological distress, disruptions to dyadic sexual communication, and lower masculine self-esteem, sexual confidence, and sexual intimacy. In comparison with heterosexual men, GB men reported significantly lower HRQOL (P = .046), masculine self-esteem (P < .001), and satisfaction with treatment (P = .013); higher psychological distress (P = .005), cancer related distress (P < .001) and ejaculatory concern (P < .001); and higher sexual functioning (P < .001) and sexual confidence (P = .001). In regression analysis, psychological distress, cancer-related distress, masculine self-esteem, and satisfaction with treatment were predictors of HRQOL for GB men (R²_Adj = .804); psychological distress and sexual confidence were predictors for heterosexual men (R²_Adj = .690).
These findings confirm differences between GB and heterosexual men in the impact of PCa on HRQOL across a range of domains, suggesting there is a need for GB targeted PCa information and support, to address the concerns of this “hidden population” in PCa care.
Addressing changed sexual functioning in cancer patients: A cross-sectional survey among Dutch oncology nurses
2015, European Journal of Oncology Nursing
Citation Excerpt :
For most types of cancer, regardless of the patient's age or relationship status, the disease and its treatment can lead to a deterioration in sexual health (Baker et al., 2005; Beckjord et al., 2011; Den Oudsten et al., 2012; Galbraith and Crighton, 2008; Hughes, 2008; Lange et al., 2009; Sadovsky et al., 2010; Wright et al., 2002).
In most types of cancer, the disease and its treatment can result in altered sexual function (SF). Oncology nurses are strategically placed to address SF since they have frequent patient interaction. Our aim was to establish their knowledge about and attitudes to SF in oncology care and identify their perceived barriers to addressing the subject.
A 37-item questionnaire was administered during the 2012 Dutch Oncology Nursing Congress and mailed to 241 Dutch oncology nursing departments.
The majority of 477 nurses (87.6%) agreed that discussing SF is their responsibility. Discussing SF routinely is performed by 33.4% of these nurses, consultations mainly consisted of mentioning treatment side-effects affecting SF (71.3%). There were significant differences depending on experience, knowledge, age, academic degree and department policy. Nurses ≤44 years old (p < 0.001), with <10 years oncology experience (p = 0.001), insufficient knowledge (p < 0.001), no academic degree (p < 0.001), and in whose department policy was lacking or inadequate (p < 0.001), were less comfortable discussing SF. Barriers included lack of training, presence of a third party and no angle or motive for initiating discussion.
Findings suggest oncology nurses consider counselling on sexual issues to be an important responsibility, in line with discussing other side-effects caused by the disease or its treatment. Nevertheless, cancer patients may not routinely be receiving a sexual health evaluation by oncology nurses. Results emphasize the potential benefit of providing knowledge, including practical training and a complete department protocol.
Review: Psychosocial Interventions Addressing Sexual or Relationship Functioning in Men with Prostate Cancer
2012, Journal of Sexual Medicine
Citation Excerpt :
Even if erectile function returns, with or without the assistance of medical aids, many men experience sexual and relationship distress and disruption, and changes in self‐confidence [6,13-15]. Beyond the direct impact of changes to sexual functioning on a couple's relationship, a cancer diagnosis itself can place significant strain on that relationship [16,17]. As such, the importance of including the partner, and addressing general and sexual communication skills in clinical treatment and intervention programs has been highlighted by several authors [9-11,18-20].
Although previous research has evaluated the effectiveness of psychosocial interventions for men with prostate cancer, no previous review has investigated the effects of psychosocial interventions on both sexual and relationship functioning.
To review the effectiveness of psychosocial interventions that focus on sexual and/or relationship functioning for men with prostate cancer and their partners.
A systematic literature review of research reported in the Medline, PsychINFO, PsychArticles databases from January 1990 to September 10, 2011.
The review focused on the evaluation of interventions that aimed to improve the sexual and/or relationship functioning of men and their partners.
There was evidence that psychosocial interventions can improve men's sexual functioning, particularly when delivered face‐to‐face and when using more complex strategies to target sexuality in men and in relationships. There was inconclusive evidence for the effectiveness of psychosocial interventions in improving men's relationship functioning or the sexual or relationship functioning of their partners.
There is a need for further research to target improving and measuring men and their partner's sexual and relationship functioning in the context of prostate cancer. The effectiveness of tailoring interventions to the specific needs of men and to their stage of cancer also needs to be further examined. Chisholm KE, McCabe MP, Wootten AC, and Abbott J‐AM. Review: Psychosocial interventions addressing sexual or relationship functioning in men with prostate cancer. J Sex Med 2012;9:1246–1260.
Cancer and its effects on female sexuality: an overview with case studies
2023, Journal fur Gynakologische Endokrinologie
Cancer and its effects on female sexuality: an overview with case studies
2023, Journal fur Urologie und Urogynakologie

View all citing articles on Scopus

Michael E Galbraith, RN, PhD: Associate Professor, School of Nursing, University of Colorado Denver, Aurora, CO.

Frances Crighton, RN, PhD: Tony Grampas Urological Oncology Program, University of Colorado Hospital, Aurora, CO.

View full text

Alterations of Sexual Function in Men With Cancer

Objectives

Data Sources

Conclusions

Implications for Nursing Practice

Section snippets

Context of Sexuality for Men With Cancer

Psychological and Physiological Impact of Cancer Treatment on Men's Sexuality

Sexual Assessment

Psycho-Social Sexual Interventions

Conclusion

J Pain Symptom Manage

J Pain Symptom Manage

Geratr Nurs

Surgery

J Urol

Eur Urol

Int J Radiat Oncol Biol Phys

Urology

Arch Phys Med Rehab

Urology

Urology

Gen Hosp Psychiatry

J Urol

Urology

Urology

Institute of Medicine and National Research Council of the National Academies. From cancer patient to cancer survivor: lost in transition

Cancer Facts and Figures

Public Health and Aging: Trends in aging–United States and worldwide

Morbid Mortal Weekly Rep

Advanced practice nursing model for comprehensive care with chronic illness: model for promoting process engagement

Adv Nurs Sci

Developmental life stage and couples' experience with prostate cancer: a review of the literature

Cancer Nurs

The health of older-adult long-term cancer survivors

Cancer Nurs

A study of sexuality and health among older adults

N Engl J Med

What questions do families of patients with early stage prostate cancer need answered?

J Fam Nurs

Quality of couples' relationship and adjustment to metastatic breast cancer

J Family Psychol

Psychoeducational group intervention for wives of men with prostate cancer

Psychooncology

Couple dialogues with illness: expanding the we

Fam Systems Health

Psychological predictors of marital adjustment in breast cancer patients

Psychol Health Med

Partner understanding of breast and prostate cancer experience

Psychooncology

Disclosure between patients with gastrointestinal cancer and their spouses

Psychooncology

Marital attachment and adjustment in older couples coping with cancer

Aging Ment Health

Problem solving skills and emotional distress in spouses of men with prostate cancer

J Cancer Educ

Partners of cancer patients

J Psychosoc Oncol

Effect of sex and gender on psychosocial aspects of prostate and breast cancer

Br Med J

Sexuality and intimacy following radical prostatectomy: patient and partner perspectives

Health Psychol

Cancer of the prostate: a biopsychosocial review

J Psychosoc Oncol

Improving quality of life: psychiatric aspects of treating prostate cancer

Psychiatric Times

Finding help for sexual problems after prostate cancer treatment: A phone survey of men's and women's perspectives

Psychooncology

Partner unsupportive responses, avoidant coping, and distress among women with early stage breast cancer: patient and partner perspectives

Health Psychol

The effects of dyadic strength and coping styles on psychological distress in couples faced with prostate cancer

J Behav Med

Mastery of postprostatectomy incontinence and impotence: his work, her work, our work

Oncol Nurs Forum

United we stand? The effects of a couple-coping intervention on adjustment to early stage breast or gynecological cancer

J Consult Clin Psych

Behind the scenes: partner's perceptions of quality of life post radical prostatectomy

Urol Nurs

Pilot intervention to enhance sexual rehabilitation for couples after treatment for localized prostate carcinoma

Cancer