Many men experience sexual difficulties after receiving prostate cancer treatment. We investigated sexual and relationship factors associated with management strategies to maintain sexual activity in prostate cancer patients. 210 prostate cancer patients (66.7 ± 7.4 years old) completed our survey online. Higher sexual function distress (Incidence rate ratio, IRR = 0.99, p = 0.005) and less frequent relationship strain (IRR = 1.01, p = 0.002) were associated with trying a higher number of sexual management strategies. Higher sexual function distress was associated with the use of oral medication (Odds Ratio, OR = 0.98, p = 0.026), vacuum erection device (OR = 0.98, p = 0.005), and vibrators (OR = 0.97, p = 0.005). Perceived importance of sexual interaction with a partner was associated with using oral medication (OR = 1.95, p = 0.027). Participant’s higher ideal frequency of sexual interaction with a partner was a predictor for the use of vibrators (OR = 1.03, p = 0.024). Less frequent relationship strain was associated with the use of vacuum erection device (OR = 1.03, p = 0.002), and vibrators (OR = 1.02, p = 0.012). Lastly, patients’ communication with their partner about sexual intimacy was also associated with use of vacuum erection device (OR = 3.24, p = 0.050, CI 1.0–10.5). Few participants (13–27%) were interested in trying penile implant, penile support device, external penile prosthesis, penile sleeve and anal devices. From our qualitative analyses, the main barriers to retaining sexual activity were erectile dysfunction and psychological issues. Three themes participants found useful to maintain sexual activity: preparatory behaviours for initiating or maintaining erections, adapting their sexual activity to fit with what was now possible, and the importance of the relationship or intimacy with their sexual partner. Psychological and relationship factors contribute to patients’ motivation to remain sexually active after treatment.
Subscribe to Journal
Get full journal access for 1 year
only $14.88 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Data are not archived in repositories.
Downing A, Wright P, Hounsome L, Selby P, Wilding S, Watson E, et al. Quality of life in men living with advanced and localised prostate cancer in the UK: a population-based study. Lancet Oncol. 2019;20:436–47.
Ussher JM, Perz J, Kellett A, Chambers S, Latini D, Davis ID, et al. Health-related quality of life, psychological distress, and sexual changes following prostate cancer: a comparison of gay and bisexual men with heterosexual men. J Sex Med. 2016;13:425–34.
Bergman B, Damber JE, Littbrand B, Sjogren K, Tomic R. Sexual function in prostatic cancer patients treated with radiotherapy, orchiectomy or oestrogens. Br J Urol. 1984;56:64–9.
Ellis WJ, Grayhack JT. Sexual function in aging males after orchiectomy and estrogen therapy. J Urol. 1963;89:895–9.
Choi S, Yoo SJ, Rhew HY. Changes of sexual function after castration in patients with advanced prostatic carcinoma. Korean J Urol. 1998;39:157–61.
Cormie P, Newton RU, Taaffe DR, Spry N, Joseph D, Akhlil Hamid M, et al. Exercise maintains sexual activity in men undergoing androgen suppression for prostate cancer: a randomized controlled trial. Prostate Cancer Prostatic Dis. 2013;16:170–5.
Ng E, Corica T, Turner S, Lim A, Spry N. Sexual function in men with castrate levels of testosterone: observations of a subgroup of sexually active men with prostate cancer undergoing androgen deprivation therapy. Open J Urol. 2014;4:98–103.
Osadchiy V, Eleswarapu SV, Mills SA, Pollard ME, Reiter RE, Mills JN. Efficacy of a preprostatectomy multi-modal penile rehabilitation regimen on recovery of postoperative erectile function. Int J Impot Res. 2020;32:323–8.
Miranda EP, Benfante N, Kunzel B, Nelson CJ, Mulhall JP. A randomized, controlled, 3-arm trial of pharmacological penile rehabilitation in the preservation of erectile function after radical prostatectomy. J Sex Med. 2021;18:423–9.
Tal R, Jacks LM, Elkin E, Mulhall JP. Penile implant utilization following treatment for prostate cancer: analysis of the SEER-Medicare database. J Sex Med. 2011;8:1797–804.
Wassersug R, Wibowo E. Non-pharmacological and non-surgical strategies to promote sexual recovery for men with erectile dysfunction. Trans Androl Urol. 2017;6:S776–94.
Wibowo E, Wassersug RJ, Robinson JW, Matthew A, McLeod D, Walker L. How are patients with prostate cancer managing androgen deprivation therapy side effects? Clin Genitourin Cancer. 2019;17:e408–e19.
Warkentin KM, Gray RE, Wassersug RJ. Restoration of satisfying sex for a castrated cancer patient with complete impotence: a case study. J Sex Marital Ther. 2006;32:389–99.
McGahuey CA, Gelenberg AJ, Laukes CA, Moreno FA, Delgado PL, McKnight KM, et al. The Arizona Sexual Experience Scale (ASEX): reliability and validity. J Sex Marit Ther. 2000;26:25–40.
Wei JT, Dunn RL, Litwin MS, Sandler HM, Sanda MG. Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer. Urology. 2000;56:899–905.
Hendrick SS, Dicke A, Hendrick C. The relationship assessment scale. J Soc Pers Relat. 1998;15:137–42.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101.
Schover LR, Fouladi RT, Warneke CL, Neese L, Klein EA, Zippe C, et al. Seeking help for erectile dysfunction after treatment for prostate cancer. Arch Sex Behav. 2004;33:443–54.
Bergman J, Gore JL, Penson DF, Kwan L, Litwin MS. Erectile aid use by men treated for localized prostate cancer. J Urol. 2009;182:649–54.
Orr J, Layte R, O’Leary N. Sexual activity and relationship quality in middle and older age: findings from the Irish Longitudinal Study on Ageing (TILDA). J Gerontol B Psychol Sci Soc Sci. 2019;74:287–97.
Liu H, Shen S, Hsieh N. A national dyadic study of oral sex, relationship quality, and well-being among older couples. J Gerontol B Psychol Sci Soc Sci. 2019;74:298–308.
Filiault SM, Drummond MJN, Smith JA. Gay men and prostate cancer: voicing the concerns of a hidden population. J Mens Health. 2008;5:327–32.
Hyde MK, Opozda M, Laurie K, Vincent AD, Oliffe JL, Nelson CJ, et al. Men’s sexual help-seeking and care needs after radical prostatectomy or other non-hormonal, active prostate cancer treatments. Support Care Cancer. 2020;29:2699–711.
Kinnaird W, Kirby MG, Mitra A, Davda R, Jenkins V, Payne H. The management of sexual dysfunction resulting from radiotherapy and androgen deprivation therapy to treat prostate cancer: a comparison of uro-oncology practice according to disease stage. Int J Clin Pract. 2020;75:e13873.
Haboubi NH, Lincoln N. Views of health professionals on discussing sexual issues with patients. Disabil Rehabil. 2003;25:291–6.
Ussher JM, Perz J, Gilbert E, Wong WKT, Mason C, Hobbs K, et al. Talking about sex after cancer: a discourse analytic study of health care professional accounts of sexual communication with patients. Psychol Health. 2013;28:1370–90.
Ussher JM, Perz J, Rose D, Kellett A, Dowsett G. Sexual rehabilitation after prostate cancer through assistive aids: a comparison of gay/bisexual and heterosexual men. J Sex Res. 2019;56:854–69.
Delpachitra S, Campbell AJ, Wibowo E. The influence of education level on sleep-related outcomes and sleep management strategies in prostate cancer patients. J Mens Health. 2021;17:60–68.
We thank Prostate Cancer Foundation New Zealand, Prostate Cancer International, Prostate Cancer Mailing List, American Cancer Society’s Cancer Survivors Network, Aneros, RxSleeve, and the Elator for distributing our survey online. We thank Dr Claire Cameron for statistical advices.
This study was funded by a fund to Dr EW from the Department of Anatomy at the University of Otago.
The authors declare no competing interests.
The study protocol was approved by the University of Otago Human Ethics Committee (H18/107).
Consent to participate
Informed consent was obtained from all individual participants included in the study.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Duthie, C.J., Graham, K., Rapsey, C.M. et al. Factors associated with various strategies for maintaining sexual activity after prostate cancer treatment. Int J Impot Res (2021). https://doi.org/10.1038/s41443-021-00466-z