Couples counseling improves sexual intimacy after prostate treatment

Men experienced a marked improvement in their sexual function for up to one year, and women who started out with a sexual problem improved significantly with counseling.

"We know that one of the crucial factors in a man's having a good sexual outcome after treatment is a partner who also wants their sex life to get better," said Leslie Schover, Ph.D, a professor in MD Anderson's Department of Behavioral Science, lead investigator on the study and author of the paper, "A Randomized Trial of Internet-Based Versus Traditional Sexual Counseling for Couples After Localized Prostate Cancer Treatment." "Women's issues such as ill health, post-menopausal vaginal dryness and lack of desire for sex can be a major barrier in achieving satisfactory sexual outcomes."

CAREss (Counseling About Regaining Erections and Sexual Satisfaction) randomized 115 heterosexual prostate cancer survivors who were experiencing erectile dysfunction and their partners into three groups: a wait list group that received delayed counseling, a face-to-face counseling group, and a group that received an Internet-based sexual counseling program.

After three months, the wait-list couples were randomized into either the face-to face or the Internet-based counseling group. A second Internet-based group of 71 couples was added to boost the numbers and allow researchers to analyze the relationship between extent of website use and outcomes.

Couples were assessed before and after the three-month wait-list period, again after counseling, and also at six and 12-month follow-ups. In addition to web-based education and exercises, participants in the Internet-based group received feedback from their counselor through email.

Treating the Body and the Mind

Many prostate cancer survivors are as concerned about loss of desire and lack of satisfying orgasms as they are about erectile dysfunction. Men in this study improved on most dimensions of sexual function. From baseline to one year, men improved significantly in erectile function, but also in orgasmic function, intercourse satisfaction and overall sexual satisfaction. Sexual desire remained stable.

Some patients and/or partners are too anxious about sexual issues to seek help from a therapist face-to-face. An internet-based program that offers online tools and surveys, as well as interaction with the therapist by email, gives them a less threatening option. "Not only do men often use the internet to search for information on sex, but prostate cancer patients consider the web a valuable resource for information on the impact of treatment on sex," said Schover.

Another advantage of web-based counseling for couples is the potentially lower cost. While many insurance companies cover medical treatment of erection problems after prostate cancer, the cost of sex therapy is often not reimbursed. Already burdened with co-payments for their cancer treatment, many couples cannot afford additional costs associated with mental health care.

"Very few insurance policies sufficiently cover sexual counseling in particular, and mental health counseling in general," said Schover. "Another barrier is that there are few mental health care professionals trained to deal with both cancer coping and sexual problems."

The results from the CAREss study have already contributed to Schover's current research. She is developing a more general multimedia interactive counseling program to help men with any type of cancer and their partners improve their sex lives. She hopes this program will help men and couples with limited insurance or lack of access to a big city or cancer center.

The CAREss trial, and surveys leading to its development, were funded by grants from the American Cancer Society.

Co-authors with Schover are Andrea L. Canada, Ph.D, Rush University Medical Center, Chicago; Ying Yuan, Ph.D and Dawen Sui, MD Anderson Department of Biostatistics; Leah Neese, private practice, Mont Belvieu, Texas; Rosell Jenkins, Ph.D, private practice, Houston; and Michelle M. Rhodes, Ph.D, Prairie View A&M University, Prairie View, Texas.