A biopsychosocial approach to sexual recovery after prostate cancer treatment: Suggestions for oncology nursing practice

Abstract

In the past decade there has been a surge of literature documenting the impact of prostate cancer (PCa) treatment-induced erectile dysfunction (ED) on intimate relationships. While there have been significant advances in the treatment of ED, with phosphodiesterase inhibitors, vacuum erection devices and intracavernous injections, patients and their partners continue to struggle to finds ways to maintain enjoyable sexual activity. Only half of PCa patients are willing to try ED treatments, and less than half of those patients, who find ED treatments helpful in improving erectile function, will continue to use them long-term.While there are effective strategies that can be taught to patients for overcoming the barriers associated with the use of ED treatments, many patients struggle on their own with these challenges, become discouraged, and quickly give up. Nurses play a large role in patient education and counselling, both in preparing patients for PCa treatment, and in follow-up. Consequently, they are well positioned to play a significant part in promoting sexual recovery among PCa patients and, thus, increasing patients’ and partners’ experiences of success. Nurses are well versed in providing holistic biopsychosocial care, which is a much-needed approach to complement the use of biomedical ED treatments. We begin by providing suggestions for nurses to increase their competence in discussing, assessing and intervening in the area of sexual difficulties. We follow with specific suggestions, based on the PCa literature, to guide nurses in supporting patients receiving ED treatment. Guidance is offered regarding approaches to patient education that fosters the development of realistic treatment expectations. Not only should these suggestions help improve adherence to ED treatments, but they should also help patients think more broadly about the sexual recovery process, encouraging the development of goals in sexual recovery beyond restoration of erectile function. Flexibility in sexual practice is found to be a key in successful sexual renegotiation, therefore, non-penetrative sexual strategies—that are not dependent on erections—should be offered to patients, as a routine part of clinical practice. Additional suggestions regarding couple communication, persistence in the treatment process, and working through grief associated with sexual losses are also offered in addition to strategies for overcoming specific barriers such as loss of libido and demoralization associated with treatment failures.Key words: prostate cancer, erectile dysfunction, sexual adaptation, counselling, patient education