Men's experience with penile rehabilitation following radical prostatectomy: a qualitative study with the goal of informing a therapeutic intervention

Abstract

Objectives Erectile rehabilitation (ER) following radical prostatectomy (RP) is considered an essential component to help men regain erectile functioning; however many men have difficulty adhering to this type of a program. This qualitative study explored men's experience with ER, erectile dysfunction (ED), and ED treatments to inform a psychological intervention designed to help men adhere to ER post-RP. Methods Thirty men, one to three years post-RP, who took part in an ER program, participated in one of four focus groups. Thematic analysis was used to identify the primary themes. Results Average age was 59 (SD=7); mean time since surgery was 26 months (SD=6). Six primary themes emerged: 1) frustration with the lack of information about post-surgery ED; 2) negative emotional impact of ED and avoidance of sexual situations; 3) negative emotional experience with penile injections and barriers leading to avoidance; 4) the benefit of focusing on the long-term advantage of ER versus short-term anxiety; 5) using humor to help cope; and 6) the benefit of support from partners and peers. Conclusions Men's frustration surrounding ED can lead to avoidance of sexual situations and ED treatments, which negatively impact men's adherence to an ER program. The theoretical construct of Acceptance and Commitment Therapy (ACT) was used to place the themes into a framework to conceptualize the mechanisms underlying both avoidance and adherence in this population. As such, ACT has the potential to serve as a conceptual underpinning of a psychological intervention to help men reduce avoidance to penile injections and adhere to an ER program.

Life after prostate cancer treatment: a mixed methods study of the experiences of men with sexual dysfunction and their partners

“…Some of these men regretted their particular treatment or that they received treatment at all. These findings were echoed in CJ Nelson, S Lacey, J Kenowitz, H Pessin, E Shuk, AJ Roth and JP Mulhall [18]. On the other hand, some men in our study expressed no illusions about the role of the surgeon.…”

“…Some sought outside professional counseling or prostate cancer support groups to remedy their situation, and reported positive results in this endeavor. Other studies in the field report similar psychological ramifications as a result of sexual dysfunction [7, 8, 17, 18, 20]. Some men reported the same need to seek outside psychological help, since the primary care provider was not available for such services [7, 20].…”

Erectile dysfunction

“…Research indicates that as many as 69% of men deny the existence of their erectile dysfunction, and the median time to pursue treatment for erectile dysfunction is >2 years 181 . Men report that they experience significant disappointment and shame related to erectile dysfunction; and even when using erectile dysfunction treatments, men report a fear of failure and a tendency to avoid sexual situations as a result of this fear 182 . In fact, data indicate that 50–80% of men discontinue use of medical interventions (oral medications, ICIs or VEDs) for erectile dysfunction within 1 year 183,184 , and dropout rates related to PDE5 inhibitor use are estimated to be 30–50% 185–187 .…”

“…In fact, data indicate that 50–80% of men discontinue use of medical interventions (oral medications, ICIs or VEDs) for erectile dysfunction within 1 year 183,184 , and dropout rates related to PDE5 inhibitor use are estimated to be 30–50% 185–187 . Although men discontinue erectile dysfunction treatment for a number of reasons, avoidance of sexual activity might be a primary cause 182 . This avoidance leads to continued distress, anxiety and potential relationship difficulties.…”

Treatment for erectile dysfunction among older men in Northern Ireland

“…Worryingly, many men in receipt of treatments to improve erections do not find these treatments helpful or are unwilling to use them. This reflects findings regarding the use of penile rehabilitation programmes following prostate cancer where evidence shows that most men stop using ED treatments within 2 years . More research in this area is warranted to determine why many men do not find these services helpful or are unwilling to use them.…”