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Psychosocial contributors to patients’ and partners’ postprostate cancer sexual recovery: 10 evidence-based and practical considerations

International Journal of Impotence Research volume 33, pages 464–472 (2021)Cite this article

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Abstract

Sexual recovery after prostate cancer (PCa) treatment is challenging. When expectations are that erectile response will quickly return to baseline, patients can often struggle when this does not happen. Further difficulty is experienced when patients encounter physical, psychological, and relational barriers to sexual adjustment. Drawing on the psychosocial research literature and on 15 years of clinical experience counseling PCa patients about sexual recovery, this paper outlines considerations for clinical practice. Suggestions include broadening the target for successful outcomes after Pca treatment beyond erectile function to include sexual distress and other sources of sexual concern. Clinicians are urged to consider individual differences such as the larger context of the patient, including their values and preferences, their treatment goals, and their relationship situation and status, in order to promote successful sexual adaptation. When introducing treatment approaches, the role of grief and loss should be assessed, and patients should be supported to foster realistic expectations about the recovery process. Suggestions for how to introduce various sexual strategies to patients are also offered, including ways to support patients in making and sustaining behavioral changes associated with sexual intervention. Clinicians are offered suggestions to promote patients’ sexual flexibility, prevent long periods of sexual inactivity, and help patients to identify various sexual motivators. Consideration of these psychological, relational, and social factors are all likely to help facilitate better sexual outcomes for PCa patients.

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Acknowledgements

The concepts introduced in this paper have been formulated over years of working with a fantastic team of collaborators. I would like to thank the following people for helping me formulate my approach to working with PCa patients in the area of sexual recovery. My direct research collaborators and/or mentors include: John Robinson, Andrew Matthew, Debbie MacLeod, Richard Wassersug, Jay Lee, Stacy Elliot, Rosemary Basson, Lori Brotto, Erik Wibowo, Andrea Beck and Pablo Santos-Iglesias. Some of the researchers and writers in the field who have influenced my work include: Anne Katz, Daniella Wittmann, Stanley Althof, Barry McCarthy, Christian Nelson, Jane Ussher, Sharon Bober, & Leslie Schover.

Funding

Salary support for LW is provided by the Arnie Charbonneau Cancer Institute and the Daniel Family Leadership Chair in PsychoOncology, at the University of Calgary.

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Authors and Affiliations

  1. Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, AB, Canada

    Lauren M. Walker

  2. Division of PsychoOncology, Department of Oncology, University of Calgary, Calgary, AB, Canada

    Lauren M. Walker

  3. Department of Psychology, University of Calgary, Calgary, AB, Canada

    Lauren M. Walker

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Correspondence to Lauren M. Walker.

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Conflict of interest

LW is a co-founder of the Androgen Deprivation Therapy Educational Program for prostate cancer patients. For more information see www.lifeonadt.com. The ADT program has received unrestricted educational grants from pharmaceutical companies that have been administered to the European Urology Association and to the Prostate Cancer Centre (Calgary, Alberta). Funding for the ADT Program (in Canada and in Europe) has been provided by the following companies: Astellas, AbbVie, Bayer.

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Walker, L.M. Psychosocial contributors to patients’ and partners’ postprostate cancer sexual recovery: 10 evidence-based and practical considerations. Int J Impot Res 33, 464–472 (2021). https://doi.org/10.1038/s41443-020-00369-5

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