Couples' Sexual Recovery Trajectory After Surgery for Prostate Cancer: Change in Sexual Function, Sexual Satisfaction and Dyadic Satisfaction

Purpose: Erectile function is a typical side-effect of surgery for prostate cancer. Much of the research focuses on helping the man recover erectile function and on identifying partner and couple distress. Couples’ sexual recovery has not been studied prospectively. Studies have demonstrated discrepancy in men’s and partners’ sexual function and distress, both before and after surgery. Partners are often seen as influential factors in the men’s sexual recovery. The present study sought to follow men’s and partners’ sexual function, sexual satisfaction, and dyadic satisfaction prospectively,  from before surgery to nearly two years after surgery.

Method: Couples’ survey data were available at three time points: 28 at baseline (T1), 20 three months after surgery (T2), and 16 at 18 months on average (T3). The Expanded Prostate Index Composite assessed erectile function and urinary incontinence; the Sexual Experience Questionnaire assessed men’s satisfaction with erections, individual, and couple sexuality; the Female Sexual Function Index assessed female sexual function, and the Dyadic Adjustment Scale assessed partnership satisfaction. Demographic data were obtained at baseline. An SPSS mixed procedure for linear models was used to assess change in functional scores over time, to compare men and partners and to assess the influence of covariates such as as age, education, income, comorbidities (other illness conditions) and rehabilitation behaviors.

Results: Men were 62 years old, partners 58 years old on average prior to surgery. They were highly educated, mostly white and had a wide income range. Surgery for most entailed an approach that preserved as much erectile function as possible. The men were generally relatively healthy. Erectile function declined after surgery, and then improved at T3, while men’s sexual satisfaction declined after surgery, but did not rebound at T3. Female partners’ sexual satisfaction declined at T2 and continued to decline at T3. Female partners’ couple satisfaction was greatest when female partners experienced sexual satisfaction, and the couple’s income was reasonably high.

Implications for practice: Both men’s and partners’ sexual satisfaction decline after prostate cancer surgery, even as erectile function begins to rebound. Female sexual satisfaction and income level appear influential factors in female partners’ satisfaction in the relationship during the first 2 years of couples’ recovery of sexual intimacy after surgery for prostate cancer. Attending to female partners’ experience of the sexual recovery is an important aspect of the couple’s sexual recovery and therefore the couple, not just the individual man, should be addressed in social work interventions.