Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Erectile dysfunction and sexual health after radical prostatectomy: impact of sexual motivation

Abstract

The life expectancy of patients with localized prostate cancer at treatment initiation has increased, and post-treatment quality of life has become a key issue. The aim of this study is to assess the impact of Radical prostatectomy (RP) on patients’ sexual health and satisfaction according to sexual motivation using a self-administered questionnaire completed by two groups of RP patients, with high or lower levels of sexual motivation. A total of 63 consecutive patients were included (mean age, 63.9 years), of whom 74.6% were being treated for erectile dysfunction (ED). After RP, patients reported lower sexual desire (52.4%), reduced intercourse frequency (79.4%), anorgasmia (39.7%), less satisfying orgasm (38.1%), climacturia (25.4%), greater distress (68.3%) and/or lower partner satisfaction (56.5%). Among the most sexually motivated patients, 76.0% reported loss of masculine identity, 52% loss of self-esteem and 36.0% anxiety about performance. These rates were lower among less motivated patients (52.6, 28.9, and 18.4%, respectively). Mean overall satisfaction score was 4.8±2.9. The score was significantly lowered in motivated than less motivated patients (3.4 vs 5.8) (P=0.001). In conclusion, RP adversely affected erectile and orgasmic functions but also sexual desire, self-esteem and masculinity. The more motivated patients experienced greater distress and were less satisfied.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Huang GJ, Sadetsky N, Penson DF . Health related quality of life for men treated for localised prostate cancer with long-term followup. J Urol 2010; 183: 2206–2212.

    Article  Google Scholar 

  2. Crowe H, Costello AJ . Prostate cancer: perspectives on quality of life and impact of treatments on patients and their partners. Urol Nurs 2003; 23: 279–285.

    PubMed  Google Scholar 

  3. Giuliano F, Amar E, Chevallier D, Montaigne O, Joubert JM, Chartier-Kastler E . How urologists manage erectile dysfunction after radical prostatectomy: a national survey (REPAIR) by the French urological association. J Sex Med 2008; 5: 448–457.

    Article  Google Scholar 

  4. Teloken P, Mesquita G, Montorsi F, Mulhall J . Post-radical prostatectomy pharmacological penile rehabilitation: practice patterns among the international society for sexual medicine practitioners. J Sex Med 2009; 6: 2032–2038.

    Article  Google Scholar 

  5. Nelson CJ, Devesi S, Stasi J, Scardino PT, Mulhall J . Sexual bother following radical prostatectomy. J Sex Med 2010; 7: 129–135.

    Article  Google Scholar 

  6. Schover LR, Fouladi RT, Warneke CL, Neese L, Klein EA, Zippe C et al. The use of treatments for erectile dysfunction among survivors of prostate carcinoma. Cancer 2002; 95: 2397–2407.

    Article  Google Scholar 

  7. Claes HI, Goldstein I, Althof SE, Berner MM, Cappelleri JC, Bushmakin AG et al. Understanding the effects of sildenafil treatment on erection maintenance and erection hardness. J Sex Med 2010; 7: 2184–2191.

    Article  CAS  Google Scholar 

  8. Mulhall JP, Land S, Parker M, Waters B, Flanigan RC . The use of erectogenic pharmacotherapy regimen following radical prostatectomy improves recovery of spontaneous erectile function. J Sex Med 2005; 2: 532–542.

    Article  CAS  Google Scholar 

  9. Muller A, Parker M, Waters BW Flanigan RC, Mulhall JP . Penile rehabilitation following radical prostatectomy: predicting success. J Sex Med 2009; 6: 2806–2812.

    Article  Google Scholar 

  10. Montorsi F, McCullough A . Efficacy of sildenafil citrate in men with erectile dysfunction following radical prostatectomy: a systematic review of clinical data. J Sex Med 2005; 2: 658–667.

    Article  CAS  Google Scholar 

  11. Baniel J, Israilov S, Segenreich E, Livne PM . Comparative evaluation of treatment for erectile dysfunction in patients with prostate cancer after radical retropubic prostatectomy. BJU Int 2001; 88: 58–62.

    Article  CAS  Google Scholar 

  12. Mulhall JP, Bella AJ, Briganti A, McCullough A, Brock G . Erectile function rehabilitation in the radical prostatectomy patient. J Sex Med 2010; 7: 1687–1698.

    Article  Google Scholar 

  13. Mulhall JP, Parker M, Waters BW, Flanigan R . The timing of penile rehabilitation after bilateral nerve-sparing radical prostatectomy affects the recovery of erectile function. BJU Int 2010; 105: 37–41.

    Article  Google Scholar 

  14. Schover LR, Fouladi RT, Warneke CL, Neese L, Klein EA, Zippe C et al. Defining sexual outcomes after treatment for localized prostate carcinoma. Cancer 2002; 95: 1773–1785.

    Article  Google Scholar 

  15. Koeman M, van Driel MF, Schultz WC, Mensink HJ . Orgasm after radical prostatectomy. BJU Int 1996; 77: 861–864.

    Article  CAS  Google Scholar 

  16. Kauffman JM, Graydon RJ . Androgen replacement after curative radical prostatectomy for prostate cancer in hypogonadal men. J Urol 2004; 172: 827–828.

    Article  Google Scholar 

  17. Rhoden EL, Averbeck MA, Teloken PE . Androgen replacement in men undergoing treatment for prostate cancer. J Sex Med 2008; 5: 2202–2208.

    Article  Google Scholar 

  18. Miller LR, Partin AW, Chan DW, Bruzek DJ, Dobs AS, Epstein JI et al. Influence of radical prostatectomy on serum hormone levels. J Urol 1998; 160: 449–453.

    Article  CAS  Google Scholar 

  19. Barnas JL, Pierpaoli S, Ladd P, Valenzuela R, Aviv N, Parker M et al. The prevalence and nature of orgasmic dysfunction after radical prostatectomy. BJU Int 2004; 94: 603–605.

    Article  Google Scholar 

  20. Salonia A, Gallina A, Briganti A, Colombo R, Bertini R, Da Pozzo LF et al. Postoperative orgasmic function increases over time in patients undergoing nerve-sparing radical prostatectomy. J Sex Med 2010; 7: 149–155.

    Article  Google Scholar 

  21. Choi JM, Nelson CJ, Stasi J, Mulhall JP . Orgasm associated incontinence (climacturia) following radical pelvic surgery: rates of occurrence and predictors. J Urol 2007; 177: 2223–2226.

    Article  Google Scholar 

  22. Lee J, Hersey K, Lee CT, Fleshner N . Climacturia following radical prostatectomy: prevalence and risk factors. J Urol 2006; 176: 2562–2565.

    Article  Google Scholar 

  23. Abouassaly R, Lane BR, Lakin MM, Klein EA, Gill IS . Ejaculatory urine incontinence after radical prostatectomy. Urology 2006; 68: 1248–1252.

    Article  Google Scholar 

  24. Sighinolfi MC, Rivalta M, Mofferdin A, Micali S, De Stefani S, Bianchi G . Potential effectiveness of pelvic floor rehabilitation treatment for postradical prostatectomy incontinence, climacturia, and erectile dysfunction: a case series. J Sex Med 2009; 6: 3496–3499.

    Article  Google Scholar 

  25. Meyer JP, Gillatt DA, Lockyer R, Macdonagh R . The effect of erectile dysfunction on the quality of life of men after radical prostatectomy. BJU Int 2003; 92: 929–931.

    Article  Google Scholar 

  26. Bokhour BG, Clark JA, Inui TS, Silliman RA, Talcott JA . Sexuality after treatment for early prostate cancer: exploring the meanings of ‘erectile dysfunction’. J Gen Intern Med 2001; 16: 649–655.

    Article  CAS  Google Scholar 

  27. Matthew AG, Goldman A, Trachtenberg J, Robinson J, Horsburgh S, Currie K et al. Sexual dysfunction after radical prostatectomy: prevalence, treatment, restricted use of treatments and distress. J Urol 2005; 174: 2105–2110.

    Article  Google Scholar 

  28. Nelson CJ, Choi JM, Mulhall JP, Roth AJ . Determinants of sexual satisfaction in men with prostate cancer. J Sex Med 2007; 4: 1422–1427.

    Article  Google Scholar 

  29. Perez MA, Meyerowitz BE, Lieskovsky G, Skinner DG, Reynolds B, Skinner EC . Quality of life and sexuality following radical prostatectomy in patients with prostate cancer who use or do not use erectile aids. Urology 1997; 50: 40–46.

    Article  Google Scholar 

  30. Miller DC, Wei JT, Dunn RL, Montie JE, Pimentel H, Sandler HM et al. Use of medications or devices for erectile dysfunction among long-term prostate cancer treatment survivors: potential influence of sexual motivation and/or indifference. Urology 2006; 68: 166–171.

    Article  Google Scholar 

Download references

Acknowledgements

We disclose the sources of any support for the work, received in the form of grants and/or equipment and drugs.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to R Messaoudi.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies the paper on International Journal of Impotence Research website

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Cite this article

Messaoudi, R., Menard, J., Ripert, T. et al. Erectile dysfunction and sexual health after radical prostatectomy: impact of sexual motivation. Int J Impot Res 23, 81–86 (2011). https://doi.org/10.1038/ijir.2011.8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijir.2011.8

Keywords

This article is cited by

Search

Quick links