Sexuality Following Radical Prostatectomy: Is Restoration of Erectile Function Enough?

Abstract

Introduction: Radical prostatectomies can result in urinary incontinence and sexual dysfunction. Traditionally, these issues have been studied separately, and the sexual problem that has received the most focus has been erectile dysfunction.

Aim: To summarize the literature on sexually related side effects and their consequences after radical prostatectomy and focus on the occurrence and management of problems beyond erectile dysfunction.

Methods: The literature on sexuality after radical prostatectomy was reviewed through a Medline search. Original research using quantitative and qualitative methodologies was considered. Priority was given to studies exploring aspects of sexuality other than erectile function.

Main outcome measures: The prevalence, predictive factors, and management of post-prostatectomy sexual problems beyond erectile dysfunction.

Results: Most patients will develop urinary incontinence in relation to sexual activity after surgery. This can present at the time of orgasm (ie, climacturia) or arise during arousal. In general, the problem subsides with time and pelvic floor training and tension penile loops can be used as treatments. Orgasmic disturbances after radical prostatectomy include altered perception of orgasm, anorgasmia, and orgasm-associated pain. The prevalence rates of these problems vary widely among studies but usually decrease with time. Phosphodiesterase type 5 inhibitors can increase orgasmic sensation and α-blockers can alleviate pain. Penile shortening and de novo deformity have been described; more research on their clinical impact is needed. When evaluating any of the problems mentioned, psychological factors should be considered and the patient's partner should be involved whenever possible.

Conclusion: Radical prostatectomies can cause a wide range of sexual problems. Therefore, restoration of erectile function alone is not enough. On the contrary, it is crucial that clinicians focus on patients' full sexual rehabilitation.

Keywords: Climacturia; Erectile Dysfunction; Orgasmic Dysfunction; Prostate Cancer; Radical Prostatectomy; Sexuality.