SEX LIFE IN MALE PATIENTS FIVE YEARS AFTER RADICAL PROSTATECTOMY

The postoperative assessment following radical prostatectomy (RP) typically focuses on erectile function. Standardized questionnaires, such as the Expanded Prostate Cancer Index Composite (EPIC-26) or the International Index of Erectile Function (IIEF) places a strong emphasis on erectile function. The aim of the present analysis was to evaluate whether (prostate cancer) patients were sexually active both before diagnosis and 5 years after RP, and to explore what form their sexual activity takes.

Patients who underwent RP without prior neoadjuvant therapy were surveyed both preoperatively and 5 years postoperatively using a standardized questionnaire. Only patients who answered the questions regarding sexual activity both before diagnosis and 5 years after RP were included in the analysis, regardless of their sexual orientation. Sexual activity was defined as any sexual behaviour with another person, with or without intercourse or orgasm. Additionally, patients were asked in an open-ended format, whether they had focused on other or developed new sexual practices that did not rely on erectile function.

A total of 718 patients were included in the analysis, with a mean age of 70.7 (SD 7.8) years 5 years after RP. Prior to surgery, 73.2% reported engaging in sexual intercourse compared to 28.6% 5 years after RP. Overall, 76.2% were sexually active preoperatively compared to 39.8% 5 years after RP. 170 patients provided comments regarding new/other sexual practices (multiple answers possible): the majority focused on masturbation (36.5%, solo and partnered masturbation), followed by cuddling and caressing (28.2%), oral sex (20.0%), the use of aids/devices such as penis rings/loops and vacuum pumps (17.1%), others (8.8%), porn use (2.4%).

Patients after RP remain sexually active to some extend without engaging in penetrative intercourse. The results suggest that other forms of sexual activity, such as masturbation, physical intimacy (eg, cuddling and caressing), and oral sex, become more prominent. This indicates that the assessment of sex life following RP should not only concentrate on erectile function, but also integrate other aspects of sexual activity and intimacy into the doctor-patient conversation.

No conflicts of interest.