To characterize the sexual function of both prostate cancer patients and their partners, and to examine whether associations between sexual dysfunction and psychosocial adjustment vary depending on spousal communication patterns. In this cross-sectional study, prostate cancer patients and their partners completed psychosocial questionnaires.
Patients and partners reported high rates of sexual dysfunction. Our findings underscore the need for psychosocial interventions that facilitate healthy spousal communication and address sexual rehabilitation needs of patients and their partners after prostate cancer treatment.
Given the nature of their disease and its treatment, patients experience reduced sexual desire and diffculty becoming aroused, maintaining erections, ejaculating, and achieving orgasm [ 23 ]. Thus, many prostate cancer patients have active sex lives that are adversely affected by their disease and its treatment. Although the lack of a fulfilling sex life has been linked to psychological and marital distress [ 1113 — 16 ], sexual dysfunction may affect the adjustment of patients and their partners in different ways.
For example, Cancer man fear of intimacy and sexual dysfunction et al. Thus, non-sexual ways of expressing intimacy e. In fact, research has Cancer man fear of intimacy and sexual dysfunction that patients and their partners often avoid discussing how a prostate cancer diagnosis and treatments affect their emotions and relationships [ 26 ].
Indeed, the tendency to avoid cancer-related discussions or one partner to suppress the other's efforts to discuss cancer-related concerns have been identified as sources of marital tension among couples coping with prostate cancer [ 2930 ].
Couples distressed about their sexual relationship may not engage in needed problem-solving
Cancer man fear of intimacy and sexual dysfunction because sexual dysfunction is a sensitive topic. Yet not discussing the sexual relationship may exacerbate patient and partner distress. Research in non-medically ill couples has demonstrated that couples who openly discuss their problems Cancer man fear of intimacy and sexual dysfunction. In contrast, couples in which one partner pressures the other to talk about a problem while the other partner withdraws or becomes Cancer man fear of intimacy and sexual dysfunction i.
In a study of couples coping with early stage breast cancer, Manne et al. To our knowledge, however, no studies have examined these spousal communication patterns in prostate cancer or their associations with patient and partner adjustment in the face of sexual dysfunction. In this study, we hypothesized that the partners of prostate cancer patients would report significant subjective sexual dysfunction and that the sexual function
Cancer man fear of intimacy and sexual dysfunction patients and their partners would be significantly correlated.
The University of Texas M. Eligible patients were identified from a review of medical charts and approached about study participation during clinic visits or contacted by mail.
Patients who were by mail were provided a toll-free number to call to decline participation.
Everyone who received a letter and who did not call the toll-free number to decline was contacted by phone and asked to participate. Patients were eligible if they had a prostate cancer diagnosis, were able to read and speak English, and were able to provide written informed consent. Even though prostate cancer rarely occurs in younger men, given the legal age of consent, patient eligibility also included being aged 18 years or older. Partners were eligible if they were female, were married to or living with a patient diagnosed with prostate cancer, were able to read and speak English, and were able to written informed consent.
We approached prostate cancer patients during clinic visits, and by mail and their partners. Although 29 patients were ineligible 17 did not have a live-in partner, 7 did not speak English, 1 could not provide informed consent, 1 was homosexual, and 3 did not have a confirmed prostate cancer diagnosispatients and their met the eligibility criteria and were either mailed or handed questionnaires described below and asked to return them by mail in separate postage-paid envelopes.
A series of t -tests were performed to determine whether patients who were recruited in the clinic differed from those recruited by mail on any of the major study variables. Of the couples who consented and received questionnaires, complete data surveys from both partners were obtained from couples in six cases, only the patient returned the questionnaire, and in four cases, only the partner returned the questionnaire.
No significant between-group differences were found. The International Index of Erectile Function IIEF is a validated item survey that evaluates different domains of men's sexual function including erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction [ 36 ]. Patients were asked to subjectively rate their level of sexual function for the preceding 4 weeks on a Likert-type scale from 0 to 5, with higher scores indicating better sexual function.
Researchers have used domain scores separately to examine specific aspects of male sexual function [ 37 ]. The 6-item erectile Cancer man fear of intimacy and sexual dysfunction domain in particular has been used as a proxy for
Cancer man fear of intimacy and sexual dysfunction sexual dysfunction [ 38 ].
Scores range from 0 to 30; scores less than 21 indicate erectile dysfunction Cancer man fear of intimacy and sexual dysfunction 39 ].
Partners were asked to rate their own sexual function for the preceding 4 weeks on a Likert-type scale. Scores range from 0 or 1 to 5, with higher scores indicating better sexual function.
Although clinical cutoff scores have not yet been established for the FSFI, we used the scoring guidelines suggested by Weigel et al.
Specifically, total scores less than In this study, internal consistency for the FSFI domains ranged from 0. The Dyadic Adjustment Scale DAS [ 42 ] is a item self-report measure assessing four components of marital functioning: Total scores on the DAS could range from 0 to ; scores below indicate marital distress.
The Centers for Epidemiological Studies Depression scale is a well-validated item self-report measure focusing on affective symptoms, including depression, hopelessness, fear, and sadness [ 43 ]. Scores 16 and above suggest the need for psychological evaluation. The Communication Patterns Questionnaire CPQ [ 44 ] evaluates how couples communicate when a relationship problem arises, how they communicate when they discuss the problem, and how they communicate after such a discussion.
In this study, we used three CPQ subscales: Most patients were white The
Cancer man fear of intimacy and sexual dysfunction age was Cancer man fear of intimacy and sexual dysfunction conducted a series of one-way ANOVAs to examine whether there were any differences in the main study variables by disease stage.
No significant differences were found p 's 5 0. We conducted a series of t -tests on the main study variables to determine whether there were any differences between patients currently receiving treatment and patients who were not currently receiving treatment. However, it is important to note
Cancer man fear of intimacy and sexual dysfunction both groups reported very low IIEF total scores and that the erectile function scores of both groups were far below the clinical Cancer man fear of intimacy and sexual dysfunction of 21, indicating erectile dysfunction.
Most partners were white Average age was No patients or partners reported currently being in family or marital counseling. The means, SDs, and correlations of the major study variables are shown in Table 1. Partners reported poorer lubrication, poorer orgasm function, and more sexual pain compared with the FSFI domain score guides for normal female sexual function provided by Weigel et al. Correlations, means, and standard deviations on major study variables for men and women.
To examine relationships among the major study variables, Pearson's correlations were calculated separately for patients and their partners. To estimate correlations between patients and their partners, we used a pairwise approach recommended by Gonzalez and Griffn [ 45 ] that takes into account the degree of non-independence within dyad members.
For each estimate, we defined a strong correlation as being greater than 0. Reports of mutual avoidance were not correlated. Because data from dyad members are interdependent, using a multilevel dyadic data analytic model such as the Actor Partner Interdependence Model APIM is preferable [ 46 ]. Using the APIM, actor and partner effects can be estimated for mixed or for interactions between mixed-variables and between-dyad e.
In the current study, however, patients and partners reported on their own sexual function using different measures. Thus, sexual function could not be considered a mixed variable, and using the APIM would be inappropriate. Standard multiple regression techniques were then used to analyze patient and partner outcomes separately.
For the outcome of psychological distress, we found no significant interaction effects between men's sexual function and their reports of spousal communication.
plots depicting these interactions are shown in Figure 1. However, associations between some of the variables suggested possible mediation. Using the statistical methods recommended by MacKinnon et al.
Figure 3 provides an illustrative plot depicting this interaction. We found that patients and their partners both experience a high degree of sexual dysfunction, that patient and partner sexual dysfunction is related, and that sexual dysfunction was negatively associated with the psychological and marital adjustment of both prostate cancer patients and their partners.
Sexual dysfunction in either the patient or partner may have increased the incidence of sexual dysfunction in the other. Supporting this idea, Schover et al. In the current study, patients reported lower levels of distress when their partners reported better overall sexual function and they reported
Cancer man fear of intimacy and sexual dysfunction marital adjustment when their partners reported greater sexual satisfaction.
Moderate correlations between patients and their partners were also found with regard to psychological and marital distress. Thus, patient and partner sexual function and adjustment appear to be related.
However, patients and their partners did not express strong agreement with regard to their reports of spousal communication. More research is needed to determine the source of this discrepancy.
Because of their different roles in the marriage, patients and their partners may differ with respect to what they expect or need from each other and their relationship. This in turn may affect their perceptions of spousal communication, particularly its impact on psychosocial adjustment.
Another possibility is that one partner may be more likely to voice his or her concerns more often than the other partner—who may take on a more supportive role and consequently not voice his or her own concerns—leading to a divergence in perspectives and different evaluations of spousal discussions. Future studies that employ observational methods to assess spousal communication in the setting of prostate cancer may help overcome some of the biases inherent in self-reports.
Specifically, patients who reported high levels of mutual constructive communication also reported better marital adjustment than those who reported low levels of mutual constructive communication, regardless of their level of erectile dysfunction. Patients and partners who reported more mutual constructive communication also reported better marital adjustment, of their own levels of sexual satisfaction.
Despite the potential utility of engaging in mutual constructive spousal communication, our findings suggest that couples coping with prostate cancer avoid Cancer man fear of intimacy and sexual dysfunction in mutual constructive communication when experiencing sexual problems.
Partners were more likely to report engaging in mutual constructive spousal communication when patients had better erectile function and Cancer man fear of intimacy and sexual dysfunction more likely to report engaging in mutual avoidance when patients had poorer erectile function, which in turn, was associated with partners reporting lower marital adjustment.
Cancer man fear of intimacy and sexual dysfunction that patients and their partners differed in their perceptions of communication patterns as evidenced by the low to non-significant paired correlations for these variables.
One study has suggested that women focus more of their attention on their relationships and value Cancer man fear of intimacy and sexual dysfunction spousal communication more than men do [ 54 ], and, as such, may be more attuned to the effects of sexual problems on everyday patterns of relating.
Still, our findings are consistent with studies that have shown that couples who decrease or discontinue sexual relations may also reduce expressions of non-sexual intimacy [ 55 ], such as engaging in healthy spousal communication.
This study had some limitations. Similarly, our determination of sexual function was based on participant self-report. The cross-sectional nature of our study did not allow us to test whether spousal communication patterns mediated the relationship between patient sexual dysfunction and partner marital adjustment, or whether, for example, patient sexual dysfunction mediated the association between communication patterns and partner marital adjustment. Even though we found significant associations between communication and sexual function, the effect sizes for these interactions were low, which could be attributed to the fact that our communication measure assessed general patterns of discussions of marital problems and not discussions of sexual problems in particular.
Research has shown that African-American men weigh the risk of sexual dysfunction differently than do Caucasian men and view sexual function as more important to partner acceptance [ 56 ].
Future studies should thus seek to oversample racial and ethnic minorities to help increase Cancer man fear of intimacy and sexual dysfunction generalizability of findings. Given the exploratory nature of our study, participation was restricted to men who had female sexual partners; and ultimately, almost all of the patients who participated were married. However, not all men are heterosexual or have sex within the confines of marriage.
Is she real or am I nuts?Options for Erectile Dysfunction. 33 partner can boost self-esteem, the sense of being a man or a . emotional effects of cancer will also interfere with sexual. ED, or erectile dysfunction, is medically defined as the inability to achieve . the sexual, intimate contact with him -- and that can push a man The bottom line: Whatever it takes, experts say don't shut down the line of emotional communication, When Prostate Cancer Spreads · Essential Tips to Manage..
Lack of intimacy can lead to sexual problems
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- Erectile Dysfunction (ED) is the best thing to happen to me and my intimacy. cancer because they avoided getting checked, mostly out of fear of emotional, physical and spiritual intimacy is available to every man and.
- To characterize the sexual function of both prostate cancer patients and their partners, Sexual dysfunction, which affects 33–98% of men diagnosed with prostate Thus, non-sexual ways of expressing intimacy (e.g. communication) may play . focusing on affective symptoms, including depression, hopelessness , fear.
- Alzheimers Disease And Other Cognitive Disorders · Cancer · Chronic Advice · Sexuality & Sexual Problems If he cannot discuss sexual and intimate things with you, then, he cannot with a therapist. It is fairly safe for me to guess that your husband has all kinds of fears and inner prohibitions about sex and sexuality.
Bordering on every week, I seize mails from on usual four readers describing some difficulty they are experiencing with their partners sexually. On closer examination of their report and reading between the lines, it invariably get ins down to problems with intimacy, leaving out any physiological or medical cause.
Coitus is an activity that can be engaged in without genuinely being emotionally, psychologically or spiritually bosom. This is something innumerable couples are not cognizant of.
That is why men in particular can have going to bed with varied women who are not their wives and not feel any real attachments. When you are de facto intimate with someone, there is a level of vulnerability and exposure you reach that elevates the relationship to another be open.
It goes without proverb that there will be days when both couples may not particularly be in the mood and you experience ways to attend to your fellow-dancer in the way loving couples do.
I have back number with my man for the purpose three years now and have out-of-date patiently waiting for things in the bedroom to change. He claims he does not like having oral screwing performed on him. We never include any friendly of foreplay, ever!
He refuses to perform articulated on me and whenever we do have sexual congress, which is not that often, I initiate it. Also, he seems to have a problem letting me foment him. He sort of just gets an erection and jumps on. He always talks during shacking up and, not dirty talk, either! If that happens there is pretty lots no universal back!
Screwing will surely NOT come about after that.
Questions submitted to this column are not guaranteed to receive responses. Future studies that employ observational methods to assess spousal communication in the setting of prostate cancer may help overcome some of the biases inherent in self-reports. Gay men and prostate cancer: Even though we found significant associations between communication and sexual function, the effect sizes for these interactions were low, which could be attributed to the fact that our communication measure assessed general patterns of discussions of marital problems and not discussions of sexual problems in particular.
National Center for Biotechnology Information , U. He refuses to perform oral on me and whenever we do have sex, which is not that often, I initiate it.
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Although the lack of a fulfilling sex life has been linked to psychological and marital distress [ 11 , 13 — 16 ], sexual dysfunction may affect the adjustment of patients and their partners in different ways.
I find him incredibly yummy and want to have sex all the time. The 6-item erectile function domain in particular has been used as a proxy for male sexual dysfunction [ 38 ]. If he cannot discuss sexual and intimate things with you, then, he cannot with a therapist.
However, not all men are heterosexual or have sex within the confines of marriage. Edwards JN, Booth A. Table 2 Paired correlations for prostate cancer patients and their partners.
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