Introduction

Erectile dysfunction (ED) is a common issue after prostate surgery, known as radical prostatectomy (RP), with rates varying widely between 10% and 87%. This range is due to factors like patient age, differing definitions of ED, and sometimes overly positive self-reports. ED after RP significantly impacts quality of life and can contribute to depression, as it affects men’s sense of self and masculinity.

While many treatment options are available, including medications, penile injections, vacuum erection devices, and even penile implants, ED remains undertreated. Surveys show that around 31% of men with ED post-RP never receive treatment. Even among men interested in maintaining sexual activity, 24% have not pursued treatment.

Studies suggest that one of the main barriers to ED treatment after RP is poor communication between patients and urologists. Many urologists overestimate their patients’ erectile function and underestimate their desire for treatment, leading to unaddressed quality of life concerns.

This study aimed to uncover why so many patients do not receive ED treatment, hoping to improve care by addressing these communication gaps.

Methods

Specifically, this study analyzed ED treatment among men with prostate cancer who had undergone RP in Germany. It was part of the larger HAROW study, which tracked various treatments for localized prostate cancer. Researchers followed up with 936 RP patients in 2017 and, by 2023, contacted 525 men who had both ED and an interest in sex.

Patients were surveyed on their communication with their urologists and partners about ED, sources of ED information, and any treatments they used. The authors of the study assessed barriers to using ED treatment and measured sexual function using validated questionnaires. Key questions included the participants’ interest in sex and the quality of their erections. The data were analyzed with statistical tests to identify factors influencing ED treatment use, considering variables like age, communication, and partner support.

All participants gave written consent, and ethics approval was obtained. The findings aim to improve understanding of the factors limiting ED treatment uptake in men post-RP.

Results

A total of 525 patients ED or incontinence after prostate surgery were asked about their treatment experiences. Of the patients surveyed, 304 responded, and 246 had ED. The average age at surgery was 64, and at the time of the survey, it was 77. About 49% of patients reported no erections, while 28% could achieve erections sufficient for masturbation.

Notably, 46% had never attempted any ED treatment, often due to older age, less interest in sex, and fewer nerve-sparing surgeries. Communication about ED varied: those who had not sought treatment tended to discuss it less with their partners and urologists. In fact, 80% of those who never tried treatment indicated that their partners had little interest in sex, compared to 60% of those who had tried treatment. Also, those who didn’t get treatment often lacked conversations with their urologists (34% vs. 60%).

Patients reported various barriers to seeking help for ED, such as feeling they had accepted the condition, doubting treatment effectiveness, and believing that sexuality was no longer significant. Overall, the study highlights the need for better communication and support for men dealing with ED after prostate surgery.

Discussion & Conclusion

Ultimately, the researchers found that not discussing ED with a urologist and having a partner uninterested in sex were strong predictors of not receiving treatment.

The study emphasizes the importance of communication between patients, their partners, and urologists in managing ED. Patients who talked about ED were more likely to seek treatment, suggesting that open dialogue can help. While many patients felt embarrassed discussing ED, a significant portion still wanted to communicate about it. Notably, urologists play a crucial role, as many patients did not receive sufficient information about treatment options. Some patients reported resigning to their ED, believing treatment wouldn’t help. Therefore, urologists should proactively address ED with their patients and provide information on treatment options to improve care and support.

References:

• Baunacke, M., Groeben, C., Borkowetz, A., Hoffmann, F. H., Chun, F. K. H., Weissbach, L., Thomas, C., & Huber, J. (2024). Urologist communication is a primary factor leading to erectile dysfunction treatment postprostatectomy. The Journal of Sexual Medicine, 21(10), 904–911. https://doi.org/10.1093/jsxmed/qdae105