Sexual Rehabilitation and Cancer Survivorship: A State of Art Review of Current Literature and Management Strategies in Male Sexual Dysfunction Among Prostate Cancer Survivors

Abstract

Introduction The challenges for prostate cancer survivors include the surveillance of prostate cancer recurrence and management of physical, cognitive, sexual, and socioeconomic quality of life issues. Sexual function remains an important issue in men, who often continue to be interested in sex after prostate cancer treatment. The various post-prostate cancer treatment-related sexual dysfunctions are penile deformities and erectile dysfunction (ED); sexual desire and mental health; ejaculatory and orgasmic dysfunctions; and changes in partner relationship and dynamics. Aims The aim of this study is to provide state of art review of the various male sexual dysfunctions in prostate cancer survivors and the management strategies in sexual rehabilitation. Methods and Materials A literature search for English language original and review articles either published or e-published was performed using PubMed database. Keywords included prostate cancer, prostate cancer treatment, prostate prostatectomy (RP), sexual dysfunction, erectile dysfunction (ED), sexual desire, mental health, ejaculation, orgasmic, climacturia, and relationship. Results There has been considerable volume of publication in recent years on prostate cancer-related male sexual dysfunction. Penile deformities and ED shared similar pathophysiology and that penile smooth muscle fibrosis ultimately results in structural alterations and end-organ failure. Penile rehabilitation using oral phosphodiesterase type 5 (PDE5) inhibitors is considered the standard of care especially in patients who received nerve-sparing RP and should be instituted as soon as possible to protect and prevent corporal endothelial and smooth muscle damage. However, there is no consensus on the exact timing, dose, and duration of PDE5 inhibitors and its impact in non-nerve-sparing RP and other forms of prostate cancer treatment modalities. Current literature on hypoactive sexual desire, ejaculatory, and orgasmic dysfunctions in patients who received prostate cancer treatment is limited. Psychological and sexual counseling play an important role in rehabilitation and treatment of various forms of male sexual dysfunctions. Conclusion While several preventive and treatment strategies for the preservation and recovery of sexual function are available, no specific recommendation or consensus guidelines exist regarding the optimal rehabilitation or treatment protocol. While medical and surgical therapies are effective in erectile function recovery and/or preservation, psychological and sexual counseling are equally important in sexual rehabilitation.

Psychosocial perspectives on sexual recovery after prostate cancer treatment

“…Still, despite conflict ing data, 62,63 use of PDE5Is early after treatment (or in some cases even prophy lactic) 64 is generally recommended by experts. 37,44,50,52,65 The merits of daily use of a PDE5I, versus on-demand use, remain controversial-at least in terms of facilitating the speed of recovering penile rigidity adequate for penetrative intercourse. However, there is an understanding that daily use might help prevent long-term and irreversible adverse changes in penile physiology.…”

“…43 Thus, patients should be encouraged to begin ED treatment and/or to resume partnered or solo (that is, masturbation) sexual activities as soon as possible after radical prostatectomy. 44,50,65,76 Follow-up consultations with patients on a penile rehabilitation programme will be necessary, as compliance is typically poor. 77,78 Pairing ED treatments, such as ICIs and PDE5Is, with sexual counsel ling increases treatment compliance.…”

The clinical communication and information challenges associated with the psychosexual aspects of prostate cancer treatment

“…Men diagnosed with PC face difficult choices between treatment options that can result in incontinence, infertility, feminisation, and chronic changes to sexual functioning, including erectile dysfunction, penile atrophy, and loss of libido (Chung and Brock, 2013;Donovan et al, 2016;PCUK, 2012).…”

Sexuality and aging

“…Gynecological and urological malignancies may cause anatomic changes to sexual organs, leading to functional impairments. Treatments for breast, prostate, colorectal, and gynecological cancers can also cause marked changes in body image, which can negatively influence sexual function [8,9].…”