Does restoration of erectile function after prostate cancer surgery equal overall sexual satisfaction? Not necessarily, according to a new study in the Journal of Sexual Medicine.
A team of Italian researchers found that roughly a quarter of men who achieved their preoperative erectile function were sexually satisfied.
Erectile dysfunction (ED) is common after radical prostatectomy – surgical removal of the prostate gland. The prostate is surrounded by nerves, many of which are important for erections. Some nerve damage during surgery is unavoidable.
Also, some men have poor erectile function before surgery, which makes post-surgery improvements more difficult.
Past studies have focused on men’s ability to restore their erectile function back to the way it was before surgery. However, these studies have not considered patient satisfaction.
For this study, the researchers worked with 652 men who had undergone bilateral nerve-sparing radical prostatectomy for localized prostate cancer (confined to the prostate gland itself). This type of surgery aims to preserve as many nerves as possible on either side of the prostate.
The men completed a questionnaire called the International Index of Erectile Function (IIEF) just before their surgery. They continued to fill out the IIEF every three months for the next three years. This tool assesses men’s ability to have erections as well as their overall sexual satisfaction during the previous four weeks.
At baseline, before surgery, about half of the men had some degree of ED. Thirty-three percent of the patients said they were satisfied with their sex lives.
During the post-surgery follow up, 59% of the men were able to restore their erectile function back to their baseline levels. But of these men, only 27% were sexually satisfied.
Generally, the men who had normal function before surgery, and who were able to get back to normal function after surgery, were satisfied overall, the researchers said. These results suggest that satisfaction may be more related to the ability to achieve normal erectile function, rather than just being able to return to a similar level as before surgery.
The findings could help clinicians counsel prostate cancer patients on post-surgical expectations.
“In particular, the probability of recovering back to baseline [erectile function] status and of being satisfied after surgery should be an integral part of the preoperative discussion between the patient and the treating physician regarding expected benefits and side effects associated with surgery,” the authors wrote.
Post-surgical results could improve with “appropriate psychosexual support,” they added.
The acknowledged that many factors can influence a man’s sex life. For example, the stress and anxiety of a prostate cancer diagnosis might interfere with erections and satisfaction. In this study, the researchers did not find out why, exactly, men were dissatisfied.
The Journal of Sexual Medicine
Rossi, Martina Sofia, et al.
“Erectile Function Recovery After Nerve-Sparing Radical Prostatectomy for Prostate Cancer: Is Back to Baseline Status Enough for Patient Satisfaction?”
(Full-text. April 2016)