Sexual Values as the Key to Maintaining Satisfying Sex After Prostate Cancer Treatment: The Physical Pleasure–Relational Intimacy Model of Sexual Motivation

Abstract

Sexual dysfunction is the most significant long lasting effect of prostate cancer (PrCa) treatment. Despite the many medical treatments for erectile dysfunction, many couples report that they are dissatisfied with their sexual relationship and eventually cease sexual relations altogether. We sought to understand what distinguishes successful couples from those who are not successful in adjusting to changes in sexual function subsequent to PrCa treatment. Ten couples who maintained satisfying sexual intimacy after PrCa treatment and seven couples that did not were interviewed conjointly and individually. Interviews were transcribed and analyzed using grounded theory methodology. The theory that resulted suggests that individuals are motivated to engage in sex primarily because of physical pleasure and relational intimacy. The couples who valued sex primarily for relational intimacy were more likely to successfully adjust to changes in sexual function than those who primarily valued sex for physical pleasure. The attributes of acceptance, flexibility, and persistence helped sustain couples through the process of adjustment. Based on these findings, a new theory, the Physical Pleasure-Relational Intimacy Model of Sexual Motivation (PRISM) is presented. The results elucidate the main motives for engaging in sexual activity-physical pleasure and/or relational intimacy-as a determining factor in the successful maintenance of satisfying sexual intimacy after PrCa treatment. The PRISM model predicts that couples who place a greater value on sex for relational intimacy will better adjust to the sexual challenges after PrCa treatment than couples who place a lower value on sex for relational intimacy. Implications of the model for counselling are discussed. This model remains to be tested in future research.

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

“…Fifth, the interviews were conducted by two young female researchers. It is possible that men may have given more candid responses, and felt more at ease, had their interviewer been male, or closer to their own age; a line of argument explored in research with comparable participant-researcher dynamics (e.g., Beck, Robinson & Carlson, 2013;Letts, Tamlyn & Byers, 2010). However, the open and expressive way in which men responded to the interview questions did not appear to indicate underdisclosure.…”

The Sexual Adjustment Process of Cancer Patients and Their Partners: A Qualitative Evidence Synthesis

“…Struggling with urinary incontinence |fflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflffl{zfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflffl} Struggling with Sexual dysfunction (Wittmann et al, 2014) Sexual adaptation Accepting each other's feelings (Beck et al, 2013) ? Incorporating sexual changes into a new; expanded sense of self |fflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflffl ffl{zfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflfflffl ffl} Sexual acceptance Renegotiating the practices of sexual intimacy (Beck et al, 2013) ?…”

“…First, there are articles following a grief theory to describe the adjustment process (Beck et al, 2013;Fergus et al, 2002;Hanly et al, 2014;Hartman et al, 2014;Juraskova et al, 2003;Navon & Morag, 2003;Walker & Robinson, 2011, 2012Wilmoth, 2001;Wittmann et al, 2014). In this case, sexual changes are depictedin terms of a loss,andthe adjustment occurs throughthe pathwayofgriefandmourning.Differentstagesofsexualadjust- …”

“…Second, there are articles following a ''restructuring theory'' during cancer (Beck et al, 2013;Boehmer & Babayan, 2004;Fergus et al, 2002;Gilbert et al, 2010Hartman et al, 2014;Juraskova et al, 2003;Oliffe, 2005;Ramirez et al, 2010;Ussher et al,2013;Walker & Robinson, 2011, 2012.Unlike the grief theory, where the patient and partner work through different emotional stages, in the restructuring pathway the patient andpartner sexually adjust tocancer more cognitively,by developinganewsexualparadigm.Flexibilityisthecentralconceptof this adjustment. This pathway is embedded in a social constructionist paradigm, which means there is a strong focus on the social and cultural forces-inherent to the social environment of a person-that shapes his or her experiences of sexuality.…”

“…The stage of adaptation in the pathway according to the grief theory is the''acceptance''of changed sexuality, which can be described as ''getting on with life'' (Hanly et al, 2014), ''acceptance of the use of assistive aids'' (Wittmann et al, 2014), ''acceptance of the sexual status as the new normal'' (Hartman et al, 2014),''the development of realistic expectations''and ''the acknowledgement that railing against the current situation was a waste of energy'' (Beck et al, 2013). Accepting the changed sexuality is not only individual, but also occurs on an interactionist level, i.e., when the partners accept each other's feelings (Beck et al, 2013).…”