Sex Rehabilitation
1
SEXUAL DYSFUNCTION AND ADAPTATION IN COUPLES AFFECTED BY PROSTATE CANCER SURGERY: Andrew Matthew 1,5 , Ph.D., Leah Jamnicky 1 , R.N., Sidney Radomski 1 , MD., John Trachtenberg 1,5 , MD., Shabbir M.H. Alibhai 2,5 , MD., Neil Fleshner 1,5 , MD., Anthony Finelli, MD 1 ., Michael Jewett 1 , MD., Alex Zlotta 1 , MD., Kristen Currie 1 MA., Wei Xu 1 Ph.D, Daniel Santa Mina 1,4 , Ph.D (cand)., and Paul Ritvo 1,3,4 , Ph.D. 1.. Princess Margaret Hospital; 2. Toronto General Hospital; 3. Cancer Care Ontario, 4 York University; 5 University of Toronto 1) To map the field of couples’ responses to sexual dysfunction (DISTRESS) 2) To map the field of couples’ responses to pro-erectile agents and devices (ADHERENCE) OBJECTIVES Prostate cancer (PCa) is the most common cancer in Canadian men 1 . The primary choice for early stage, localized PCa is the radical prostatectomy (RP). Unfortunately, 75% of patients experience sexual dysfunction (SD) for at least 2 years following RP 2 , and 40-75% of patients experience long-term SD 3-5 . 60% of patients report moderate to severe distress with SD 6 . Psychosocial distress associated with SD is especially elevated in younger men and partners of RP patients 7-9 . Although pro-erectile aids are effective at improving post-RP SD, the benefits are offset by low rates of ongoing use 10-11 . BACKGROUND This is a longitudinal multi-centre study, using a qualitative methodology design. Twenty-five (n=25) post-radical prostatectomy patients experiencing sexual dysfunction and their partners were interviewed (simultaneously and independently) at 3 time points: 3 to 6 months, 12 to 15 months, and 21 to 24 months post surgery. All patient/partner/couple interviews were tape-recorded, transcribed and imported into NVIVOsoftware (REF1), a computerized qualitative analysis program. Categories and associated sub-categories were developed using the Grounded Theory Paradigm Model (REF2) method for qualitative analysis. METHODS Given the prevalence of ED post-RP Given the severity of distress Given the gap between efficacy and ongoing use Given the influence of psychological factors on ED and use of Pro-erectile Agents Given the knowledge of Shielding Factors -More research and new more comprehensive clinical approaches are needed- SUMMARY Confusion regarding Course of Recovery Unrealistic Expectations Performance Anxiety -Trial and Failure Confusion re: use of ED Therapy - Lack of systematic approach Obstacles to Effective Use of ED Therapy - Side-effects - Invasiveness - Cost/Accessibility Lack of Naturalness & Spontaneity Figure 2. Avoidance/Rejection of Pro-Erectile Therapy Creativity/Resourcefulness to Changes in Sexual Response Importance of Orgasms Effective Communication Broad Perspective of Masculinity Acceptance -Patience -Global Oncology Perspective Shielding Factors Realistic Optimism - hope Humour Figure 3. Distress and Non-Adherence: Shielding Factors 1) Will add references 2) REF1: NVIVO (2006). QSR International Pty Limited. 3) REF2: Strauss, A. & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques. London: Sage. REFERENCES The unique relevance of this research is its focus on intimate, sensitive responses of patients and partners to cancer treatment-related disability and the coordination of activities of physicians and psychosocial professionals in deriving appropriate and sensitive treatment that provides assistance in resolving sexual dysfunction and sustaining healthy sexual and non- sexual intimacy. The data obtained in this study can be used to inform the development of appropriate and sensitive bio-psychosocial couples’ interventions that addresses, cognitive, emotional, and communicative problems associated with sexual dysfunction and sexual dysfunction treatment post-radical prostatectomy. CONCLUSION STEPS TOWARDS A BIOPSYCHOSOCIAL MODEL OF TREATMENT The figures below depict three organizing domains (Patient/Partner Distress, Avoidance/Rejection of ED Therapy, and Shielding Factors) used to meaningfully group emergent categories and subcategories. RESULTS Patient Retreat from Partner - Physical - Cognitive/Emotional Patient Distress - Masculinity - Inadequacy in pleasing partner - Treatment regret Partner Distress - Patient retreat - Inadequacy in pleasing partner Ineffective Communication - Even in “good” communicators Loss of Usual Social Support - Partner - Individual friend - Couple friends Change in Sexual Response Pattern - Patient - Partner - Couple Patient & Partner Distress Figure 1. Patient and Partner Distress
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Transcript of Sex Rehabilitation
SEXUAL DYSFUNCTION AND ADAPTATION IN COUPLES AFFECTED BY PROSTATE CANCER SURGERY:
Andrew Matthew1,5, Ph.D., Leah Jamnicky1, R.N., Sidney Radomski1, MD., John Trachtenberg1,5, MD., Shabbir M.H. Alibhai2,5, MD., Neil Fleshner1,5, MD., Anthony Finelli, MD1., Michael Jewett1, MD., Alex Zlotta1, MD., Kristen Currie1 MA.,
Wei Xu1 Ph.D, Daniel Santa Mina1,4, Ph.D (cand)., and Paul Ritvo1,3,4, Ph.D.
1..Princess Margaret Hospital; 2.Toronto General Hospital; 3.Cancer Care Ontario, 4York University; 5University of Toronto
1) To map the field of couples’ responses to sexual dysfunction (DISTRESS)
2) To map the field of couples’ responses to pro-erectile agents and devices (ADHERENCE)
OBJECTIVES
Prostate cancer (PCa) is the most common cancer in Canadianmen1. The primary choice for early stage, localized PCa is theradical prostatectomy (RP). Unfortunately, 75% of patientsexperience sexual dysfunction (SD) for at least 2 yearsfollowing RP2, and 40-75% of patients experience long-termSD 3-5. 60% of patients report moderate to severe distress withSD6. Psychosocial distress associated with SD is especiallyelevated in younger men and partners of RP patients7-9.Although pro-erectile aids are effective at improving post-RPSD, the benefits are offset by low rates of ongoing use10-11.
BACKGROUND
This is a longitudinal multi-centre study, using a qualitativemethodology design. Twenty-five (n=25) post-radicalprostatectomy patients experiencing sexual dysfunction andtheir partners were interviewed (simultaneously andindependently) at 3 time points: 3 to 6 months, 12 to 15months, and 21 to 24 months post surgery. Allpatient/partner/couple interviews were tape-recorded,transcribed and imported into NVIVOsoftware (REF1), acomputerized qualitative analysis program. Categories andassociated sub-categories were developed using theGrounded Theory Paradigm Model (REF2) method forqualitative analysis.
METHODS
Given the prevalence of ED post-RPGiven the severity of distressGiven the gap between efficacy and ongoing useGiven the influence of psychological factors on ED and use of Pro-erectile AgentsGiven the knowledge of Shielding Factors
-More research and new more comprehensiveclinical approaches are needed-
SUMMARY
Confusion regarding Course of
RecoveryUnrealistic Expectations
Performance Anxiety
-Trial and Failure
Confusion re: use of ED
Therapy
- Lack of systematic approach
Obstacles to Effective Use
of ED Therapy
- Side-effects
- Invasiveness
- Cost/AccessibilityLack of Naturalness &
Spontaneity
Figure 2. Avoidance/Rejection of Pro-Erectile Therapy
Creativity/Resourcefulness to Changes in
Sexual ResponseImportance of Orgasms
Effective Communication
Broad Perspective of Masculinity
Acceptance
-Patience
-Global Oncology Perspective
Shielding FactorsRealistic Optimism
- hope
Humour
Figure 3. Distress and Non-Adherence: Shielding Factors
1) Will add references2) REF1: NVIVO (2006). QSR International Pty Limited.3) REF2: Strauss, A. & Corbin, J. (1990). Basics of
qualitative research: Grounded theory proceduresand techniques. London: Sage.
REFERENCES
The unique relevance of this research is its focus onintimate, sensitive responses of patients and partnersto cancer treatment-related disability and thecoordination of activities of physicians and psychosocialprofessionals in deriving appropriate and sensitivetreatment that provides assistance in resolving sexualdysfunction and sustaining healthy sexual and non-sexual intimacy. The data obtained in this study can beused to inform the development of appropriate andsensitive bio-psychosocial couples’ interventions thataddresses, cognitive, emotional, and communicativeproblems associated with sexual dysfunction and sexualdysfunction treatment post-radical prostatectomy.
CONCLUSION
STEPS TOWARDS A BIOPSYCHOSOCIAL MODEL OF TREATMENT
The figures below depict three organizing domains(Patient/Partner Distress, Avoidance/Rejection of EDTherapy, and Shielding Factors) used to meaningfullygroup emergent categories and subcategories.
RESULTS
Patient Retreat from Partner
- Physical
- Cognitive/Emotional
Patient Distress
- Masculinity
- Inadequacy in pleasing partner
- Treatment regret
Partner Distress
- Patient retreat
- Inadequacy in pleasing partner
Ineffective Communication
- Even in “good” communicators
Loss of Usual Social Support
- Partner
- Individual friend
- Couple friends
Change in Sexual Response Pattern
- Patient
- Partner
- Couple
Patient & Partner Distress
Figure 1. Patient and Partner Distress
