Sexual adaptation and recovery following prostate cancer (PCa) can be difficult for patients and their partners. We sought to identify men’s sexual adaptation styles following PCa treatment and to assess relationships among various associated variables (e.g., age, perceived partner involvement, co-morbidities, relationship duration, time since PCa treatment, desire for physical affection, depression, relationship adjustment) and outcomes (sexual distress, sexual bother, sexual satisfaction, relationship adjustment).
We identified two broad categories of sexual adaptation styles: individual-focused (Masturbation/Erection and Acceptance/Resignation) vs. couples-focused (Sexual Renegotiation and Relationship Renegotiation). Our quantitative analysis revealed that one adaptation style is not superior to any other; that is, all styles have similar outcomes when compared to those who reporting not having adapted. Participants who had not adapted at all reported higher rates of depression, lower relationship adjustment, lack of sexual activity, and greater dissatisfaction with the adaptation process.
Qualitative responses, however, revealed distinct sentiments. Men categorized within the couples-focused styles, particularly the Sexual Renegotiation style, reported more positively valenced sexual adaptation experiences compared to men categorized within the individual-focused styles. For example, men in the Masturbation/Erection style tended to focus on reported experiences of erection recovery through sexual/erectile aids, as well as reliance on masturbation in the absence of (partnered) sexual activity. Participants within this style seemed to have an overwhelming sense of dismay about the state of their sexual adaptation as a couple. They seemed disappointed and/or frustrated by their partner’s lack of interest and/or support in regaining a sense of ‘normalcy’ or trying to find a ‘new normal’ (as those in the Sexual Renegotiation style did) – and thus reported themselves to be largely focused on sexual adaptation alone. For many, this meant a reliance on masturbation to achieve sexual satisfaction and/or aiming for erectile recovery through sexual/erectile aids. For many men in this category, goals related to erectile aids were often unsuccessful – which also yielded negatively valenced participant responses such as frustration with unsatisfactory physiological responses to aids. It may also be hypothesized that men within the Masturbation/Erection category are more focused on achieving pre-PCa erectile function, believing that is the only ‘cure’ to the problem of their partner’s lack of sexual interest/involvement. These men largely reported going about adaptation alone, due to a lack of partner support. This was typically distressing for men, given that all study participants were partnered, however, these men were not receiving support from their partner and therefore had to attempt the road to recovery alone. No doubt, such experiences can be distressing and likely contribute to an air of negativity within their responses.
Firm erections are an integral component of masculinity, and when compromised, can result in severe psychological distress and sexual impairment for men. A proportion of men in our sample, particularly within the individual-focused styles (Masturbation/Erection or Acceptance/Resignation), tended to take on an ‘all or nothing’ mentality. This meant that for many, all (partnered) sexual activity was abandoned altogether in the context of erectile dysfunction. While there is often still potential for both partners to experience some degree of sexual satisfaction through non-penetrative forms of sexual activity, this was not the adaptive route many men focused on. For this group of adapters, the tendency was to move towards an avoidance of sexual exploration with their partners.
While outcomes (such as sexual distress, sexual bother, sexual satisfaction, and relationship adjustment) may not differ much quantitatively between the different sexual adaptation styles, we found there to be stark differences in terms of sexual and relationship satisfaction, distress, and adjustment within the qualitative data itself. As such, individuals within the couples-focused styles generally reported greater overall satisfaction compared to their counterparts within the individual-focused styles, which were typically negatively valenced.
Written by:
- Fatima I. Shah, BSc (Hons), Department of Oncology, Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
- Fiona Macleod, PhD, RPsych, Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB, Canada
- Lauren M. Walker, PhD, RPsych, Tom Baker Cancer Centre, Alberta Health Services, Arnie Charbonneau Cancer Research Institute, Department of Oncology, Department of Psychosocial Resources, Department of Psychology, University of Calgary, Calgary, AB, Canada.