Decrease in intercourse satisfaction in men who recover erections after radical prostatectomy Journal Article

Authors: Terrier, J. E.; Masterson, M.; Mulhall, J. P.; Nelson, C. J.
Article Title: Decrease in intercourse satisfaction in men who recover erections after radical prostatectomy
Abstract: Introduction: Recovery of erections after radical prostatectomy (RP) is assumed to lead to recovery in sexual satisfaction. Although data suggest a relationship between sexual function and sexual satisfaction, it is unclear whether presurgical levels of sexual satisfaction are attained for men who “recover” erections post-RP. Aim: The goal of this analysis is to determine whether the recovery of erectile function restores presurgical levels of sexual satisfaction. Methods: We assessed 229 men pre-RP and 24-months post-RP. At both time points, participants completed the Erectile Function Domain (EFD) and the Intercourse Satisfaction Domain (ISD) of the International Index of Erectile Function (IIEF). Erectile function recovery at 24 months was defined as (1) (EFD≥24) or (2) EFD back to baseline (BTB). One hundred sixty-six men with penetration hardness erections (PHEs) at baseline (EFD >24) were included in the analyses. Repeated measure t-tests were used to compare changes in ISD scores and effect size (Cohen's d) was calculated to determine the clinical significance of these changes. Multivariable analyses (MVA) were used to test the relationship between EFD and ISD. Results: The mean age of men was 58 (SD = 7) years. The mean EFD score at baseline was 29 (SD = 2), which declined significantly to 20 (SD = 10) at 24 months. ISD also decreased significantly between baseline and 24 months (12 to 8.3, P <.001, d = 0.87), even among men with PHEs at 24 months (12.3 to 11.3, P <.001, d = 0.50) and men who achieved BTB erections at 24 months (12.4 to 11.7, P =.02, d = 0.35). For men with PHEs at 24 months, MVAs identified baseline ISD (beta = 0.46) and 24-month EFD (beta = 0.23) as the only significant predictors of 24-month ISD. However, among men who achieved BTB erections at 24 months, baseline ISD (beta = 0.49) was the only significant predictor of 24-month ISD. Clinical Implications: These findings underscore the importance of the integration of psychological support and medical care to best meet the needs of patients. Furthermore, these results can be used to facilitate pre-RP communication and counseling with patients to improve understanding and manage post-RP expectations. Strengths & Limitations: The study methodology, specifically the use of BTB as a means of defining erectile function and the longitudinal, prospective study design are relative strengths. Despite the longitudinal design, the study did not include a control group of healthy, age-matched men. Conclusion: Results highlight the enduring impact of sexual dysfunction, namely erectile dysfunction, on intercourse satisfaction following RP and suggest that restoration of function in and of itself does not ensure the restoration of satisfaction. Terrier JE, Masterson M, Mulhall JP, et al. Decrease in intercourse satisfaction in men who recover erections after radical prostatectomy. J Sex Med 2018;15:1133–1139. © 2018 International Society for Sexual Medicine
Keywords: adult; controlled study; major clinical study; outcome assessment; preoperative evaluation; sexual satisfaction; prediction; prostate cancer; prostatectomy; medical care; erectile dysfunction; convalescence; patient counseling; sexual intercourse; penis erection; erectile function; international index of erectile function; health care need; intercourse satisfaction; human; male; priority journal; article; penetration hardness erection
Journal Title: Journal of Sexual Medicine
Volume: 15
Issue: 8
ISSN: 1743-6095
Publisher: Elsevier Inc.  
Date Published: 2018-08-01
Start Page: 1133
End Page: 1139
Language: English
DOI: 10.1016/j.jsxm.2018.05.020
PROVIDER: scopus
PUBMED: 30033192
Notes: Article -- Export Date: 4 September 2018 -- Source: Scopus
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MSK Authors
  1. John P Mulhall
    399 Mulhall
  2. Christian Nelson
    258 Nelson