Medical Help-Seeking for Sexual Concerns in Prostate Cancer Survivors

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Abstract

Introduction

Although sexual dysfunction is common after prostate cancer, men's decisions to seek help for sexual concerns are not well understood.

Aim

Describe predictors of actual prior help-seeking and intended future medical help-seeking for sexual dysfunction in prostate cancer survivors.

Methods

A cross-sectional survey of 510 prostate cancer survivors assessed masculine beliefs, attitudes, support/approval from partner/peer networks (subjective norm), and perceived control as predictors of medical help-seeking for sexual concerns. A theory of planned behavior (TPB) perspective was used to examine actual prior and planned future behavior and contributing factors. Statistical analyses included multiple and logistic regressions.

Main Outcome Measures

Intention to see a doctor for sexual advice or help in the next 6 months was measured using the intention subscale adapted from the Attitudes to Seeking Help after Cancer Scale. Prior help-seeking was measured with a dichotomous yes/no scale created for the study.

Results

Men were M _age 71.69 years (SD = 7.71); 7.54 years (SD = 4.68) post-diagnosis; received treatment(s) (58.1% radical prostatectomy; 47.1% radiation therapy; 29.4% hormonal ablation); 81.4% reported severe ED (IIED 0–6) and 18.6% moderate–mild ED (IIED 7–24). Overall, 30% had sought sexual help in the past 6 months, and 24% intended to seek help in the following 6 months. Prior help-seeking was less frequent among men with severe ED. Sexual help-seeking intentions were associated with lower education, prior sexual help-seeking, sexual importance/ priority, emotional self-reliance, positive attitude, and subjective norm ( R ² = 0.56).

Conclusion

The TPB has utility as a theoretical framework to understand prostate cancer survivors' sexual help-seeking decisions and may inform development of more effective interventions. Masculine beliefs were highly salient. Men who were more emotionally self-reliant and attributed greater importance to sex formed stronger help-seeking intentions. Subjective norm contributed most strongly to help-seeking intentions suggesting that health professionals/partners/peers have a key role as support mechanisms and components of psycho-sexual interventions.

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Most cited references 38

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The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction.

R Rosen, A. Riley, G. Wagner … (1997)

To develop a brief, reliable, self-administered measure of erectile function that is cross-culturally valid and psychometrically sound, with the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction. Relevant domains of sexual function across various cultures were identified via a literature search of existing questionnaires and interviews of male patients with erectile dysfunction and of their partners. An initial questionnaire was administered to patients with erectile dysfunction, with results reviewed by an international panel of experts. Following linguistic validation in 10 languages, the final 15-item questionnaire, the international index of Erectile Function (IIEF), was examined for sensitivity, specificity, reliability (internal consistency and test-retest repeatability), and construct (concurrent, convergent, and discriminant) validity. A principal components analysis identified five factors (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction) with eigenvalues greater than 1.0. A high degree of internal consistency was observed for each of the five domains and for the total scale (Cronbach's alpha values of 0.73 and higher and 0.91 and higher, respectively) in the populations studied. Test-retest repeatability correlation coefficients for the five domain scores were highly significant. The IIEF demonstrated adequate construct validity, and all five domains showed a high degree of sensitivity and specificity to the effects of treatment. Significant (P values = 0.0001) changes between baseline and post-treatment scores were observed across all five domains in the treatment responder cohort, but not in the treatment nonresponder cohort. The IIEF addresses the relevant domains of male sexual function (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction), is psychometrically sound, and has been linguistically validated in 10 languages. This questionnaire is readily self-administered in research or clinical settings. The IIEF demonstrates the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction.

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The Premature Ejaculation Prevalence and Attitudes (PEPA) survey: prevalence, comorbidities, and professional help-seeking.

Joseph-Alexander Verreet, Hartmut Porst, S Grupe … (2007)

This study evaluated the associated comorbidities and patient satisfaction with treatment options for premature ejaculation (PE), a common sexual dysfunction. A comprehensive, Internet-based survey (the PE Prevalence and Attitudes [PEPA] survey) was conducted among men ages 18-70 in the United States, Germany, and Italy (n=12,133). Men were classified as having PE based on self-report of low or absent control over ejaculation, resulting in distress for them or their sexual partner or both. The prevalence of PE was 22.7% (24.0% in the United States, 20.3% in Germany, and 20.0% in Italy) and did not vary significantly with age among men over age 24 yr. Men with PE were more likely to self-report other sexual dysfunctions (e.g., anorgasmia, low libido, erectile dysfunction) and psychological disturbances (e.g., depression, anxiety, excessive stress) than men without PE (p 70%) and most likely to have used (>50%) special positions during sex, interrupted stimulation, masturbation, and having intercourse more often than usual to manage their PE. Only 9.0% of men with PE reported having consulted a physician for the condition; 81.9% had to initiate the conversation about PE and 91.5% reported little or no improvement as a result of seeking treatment. PE is a highly prevalent sexual problem, with significant sexual and psychological comorbidities. Most men with PE do not seek assistance from their physician, and most of those who do are not satisfied with the results.

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Sexual function in men older than 50 years of age: results from the health professionals follow-up study.

Constance Bacon, Murray Mittleman, Ichiro Kawachi … (2003)

Although many studies have provided data on erectile dysfunction in specific settings, few studies have been large enough to precisely examine age-specific prevalence and correlates. To describe the association between age and several aspects of sexual functioning in men older than 50 years of age. Cross-sectional analysis of data from a prospective cohort study. U.S. health professionals. 31 742 men, age 53 to 90 years. Questionnaires mailed in 2000 asked about sexual function, physical activity, body weight, smoking, marital status, medical conditions, and medications. Previous biennial questionnaires since 1986 asked about date of birth, alcohol intake, and other health information. When men with prostate cancer were excluded, the age-standardized prevalence of erectile dysfunction in the previous 3 months was 33%. Many aspects of sexual function (including overall function, desire, orgasm, and overall ability) decreased sharply by decade after 50 years of age. Physical activity was associated with lower risk for erectile dysfunction (multivariable relative risk, 0.7 [95% CI, 0.6 to 0.7] for >32.6 metabolic equivalent hours of exercise per week vs. 0 to 2.7 metabolic equivalent hours of exercise per week), and obesity was associated with higher risk (relative risk, 1.3 [CI, 1.2 to 1.4] for body mass index >28.7 kg/m2 vs. <23.2 kg/m2). Smoking, alcohol consumption, and television viewing time were also associated with increased prevalence of erectile dysfunction. Men who had no chronic medical conditions and engaged in healthy behaviors had the lowest prevalence. Several modifiable health behaviors were associated with maintenance of good erectile function, even after comorbid conditions were considered. Lifestyle factors most strongly associated with erectile dysfunction were physical activity and leanness.

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Author and article information

Contributors

Melissa K. Hyde

Journal

Journal ID (nlm-ta): Sex Med

Journal ID (iso-abbrev): Sex Med

Title: Sexual Medicine

Publisher: Elsevier

ISSN (Electronic): 2050-1161

Publication date PMC-release: 11 January 2016

Publication date Collection: March 2016

Publication date (Electronic): 11 January 2016

Volume: 4

Issue: 1

Pages: e7-e17

Affiliations

[1 ]Menzies Health Institute Queensland, Griffith University, Gold Coast, Qld, Australia

[2 ]Cancer Council Queensland, Brisbane, Qld, Australia

[3 ]Department of Urology, Royal Melbourne Hospital, Melbourne, Vic., Australia

[4 ]Epworth Prostate Centre, Epworth Healthcare, Melbourne, Vic., Australia

[5 ]Australian Prostate Cancer Research, Melbourne, Vic., Australia

[6 ]Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA

[7 ]Prostate Cancer Foundation of Australia, Sydney, NSW, Australia

[8 ]School of Social Science, The University of Queensland, Brisbane, Qld, Australia

[9 ]Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia

[10 ]Centre for Clinical Research, The University of Queensland, Brisbane, Qld, Australia

Author notes

[∗ ] Corresponding Author: Melissa K. Hyde, PhD, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Qld 4222, Australia. Tel: +61-7-5552-7898; Fax: +61-7-5552-9081Menzies Health Institute QueenslandGriffith UniversityGold Coast CampusQld4222Australia melissa.hyde@ 123456griffith.edu.au

Article

Publisher ID: S2050-1161(15)00005-7

DOI: 10.1016/j.esxm.2015.12.004

PMC ID: 4822483

PubMed ID: 26796856

SO-VID: de4a41fa-2897-4381-a675-fa367d27c64b

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

History

Date received : 20 October 2015

Date accepted : 24 October 2015

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Medical Help-Seeking for Sexual Concerns in Prostate Cancer Survivors

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Abstract

Introduction

Aim

Methods

Main Outcome Measures

Results

Conclusion

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Cancer Metabolism

Most cited references 38

The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction.

The Premature Ejaculation Prevalence and Attitudes (PEPA) survey: prevalence, comorbidities, and professional help-seeking.

Sexual function in men older than 50 years of age: results from the health professionals follow-up study.

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Cited by 9

Most referenced authors 685