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Reviewed research
Authors Hamilton K, Chambers SK, Legg M, et al.
Review Date July 2015
Citation Support Care Cancer 2015; 23: 133-142
Background
Androgen deprivation therapy (ADT) is a common treatment for prostate cancer which can affect men’s sexuality including through changes in libido, erectile function and testicular size. However, men’s experiences of ADT in relation to their sexuality have received little attention in the research literature. With sexual dysfunction being a common concern among men with prostate cancer, it is important to understand ways in which to reduce the effects of ADT on men’s physical and mental well-being. Recent research has identified physical exercise as a possible factor to reduce such effects but little is known about why this may be.
Aim
To understand how ADT affects men’s sexuality, how men cope with sexual concerns, and how exercise may reduce these concerns.
Methods
Participants were recruited via their treating clinician from an existing research trial addressing participation in an exercise intervention in men with prostate cancer. The intervention comprised a three-month supervised exercise program involving aerobic and resistance training. Men were selected from both exercise and usual care groups in the study (to which participants were randomly allocated). Eligibility criteria included having been on ADT for less than 12 months, being sexually active prior to treatment and/or intended to be after, able to read and speak English, and having no other forms of cancer. Audio-recorded, semi-structured interviews were conducted via telephone. Interviews were then transcribed and analysed using thematic analysis that was theory driven (as opposed to participant driven).
Results
Eighteen men participated in the study, comprising 11 men from the exercise group (mean age 63.1 years; mean length of ADT 10.8 years) and 7 men from the usual care group (mean age 60.3 years; mean length of ADT 5.5 years). All but one man identified as heterosexual. Interviews took place over an average of 30 minutes.
The findings were organised around the three themes of the interview guide used. Responses were similar for each study group for the first two themes and the final theme applied only to men in the exercise intervention group.
Concerns about sexual health
Men were concerned about the impact of their inability to engage in penis-vaginal sexual intercourse on their partners’ relationship satisfaction; this was often expressed as a bigger concern than the effect on themselves, particularly when their partner was younger than them:
“In terms of sexual activity, that sort of petered right off, that caused me a lot of concern because my wife’s about nine years younger than me.”
Men who were single reported being less motivated to enter into a relationship due to concerns about their sex drive and performance. Many men expressed negative thoughts about the effects of ADT on their perceived masculinity. Examples included symptoms they associated with being a woman (e.g. hot flushes) and an inability to embody idealised male sexuality (e.g. erection, penis-vaginal sex).
Coping with sexual health concerns
Participants who believed that sexual intercourse was of less importance as you age reported being less affected by the effects of ADT on their sexuality and that other aspects of their intimate relationships (e.g. emotional intimacy) had increased in importance. Some participants explained that their ability to engage in penis-vaginal sex did not define who they were as men. Men also often focused on ADT’s role in them continuing to live rather than its side-effects.
Supportive partners were reported as being helpful in accepting the impact of ADT on men’s sexuality. Specifically, partners who identified that it was ADT causing sexual changes, who altered their expectations for penis-vaginal sex, and who expressed satisfaction with intimate and sexual activities alternate to penis-vaginal sex were praised by men:
“But using other means, you know, with my hands and so on and she was satisfied you see and she was pleased with that, see. And that got us even closer, you know.”
Exercise to combat sexual health concerns
Men reported the exercise program to be beneficial as it gave them an opportunity to reinforce their masculinity and to receive support from their peers. Exercise offered men a ‘hands on’ means of addressing ADT-associated weight gain, an opportunity to engage in a traditionally masculine activity, and to discuss the impact of ADT on their sexuality in a safe environment with those who were also experiencing it.
Conclusion
Men exhibited emotional resilience to the effects of ADT on their sexual function. Reformulating ideals about male sexuality as not being contingent on erection and penis-vaginal sex (in consultation with partners) enabled men to adapt to changes. Exercise conducted in a group setting helped to reaffirm masculinity and provide peer support. Cancer support services should consider incorporating group exercise into psychosocial and sexual well-being interventions for men with prostate cancer.
Points to Note
- ADT affects men’s sexual function; an area of great concern to many men with prostate cancer.
- Men who participated in an exercise program or who received usual care were interviewed about their experiences of ADT and sexuality.
- Men who reconstructed their perception of masculinity to be something that was not contingent on heteronormative sexual values adapted to the effects of ADT on their sexuality.
- Group exercise programs for men with prostate cancer may help reduce the effects of ADT on men’s sexuality by reaffirming masculinity and providing peer support.
- It is likely that men will process their experiences differently over time; this cross-sectional study was not capable of capturing this.
- The current study did not consider the perspective of partners and although one participant identified as homosexual there was no mention of whether this man’s experiences differed to those who identified as heterosexual; future research is needed to address these limitations.
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