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LESLIE R. SCHOVER
Sexual Healing in Patients with Prostate Cancer on
Hormone Therapy
Leslie R. Schover, PhD
OVERVIEW
Since prostate cancer becomes more common with age, at least one-third of men have sexual problems at diagnosis. All localized
treatments for prostate cancer greatly increase the prevalence of sexual dysfunction, which include loss of desire, erectile dysfunction,
and changes in orgasm. Even men on active surveillance have a higher rate of problems than matched peers without prostate cancer.
However, men given androgen deprivation therapy (ADT) have the worst rates of sexual dysfunction. Even after 3 to 4 months of ADT,
men’s desire for sex is decreased and irreversible damage may occur to the erectile tissue in the penis. Erections do not recover in
about one-half of men, even if ADT is discontinued. Although intermittent ADT allows some recovery of sexual function, serum
testosterone requires 9 to 12 months off ADT to recover. Again, one-half of men have permanent erectile dysfunction. If ADT causes
atrophy of the erectile tissue, blood leaks out of the venous system during erection. This syndrome is difficult to treat except with
surgery to implant a penile prosthesis. Despite the high rate of sexual problems in men on ADT, a small group stays sexually active
and is able to have reliable erections. To improve men’s sexual satisfaction on ADT, it may be important to educate them about getting
extra mental and physical sexual stimulation, as well as using penile rehabilitation during hormone therapy. Information on reaching
orgasm and coping with problems such as dry orgasm, pain with orgasm, and urinary incontinence during sex also should be provided.
In 1998 I spoke about sexuality for men with prostate cancer
and their partners at a large symposium at the University
of Michigan. Only about 5 minutes of my 25-minute talk
was devoted to sexual function and androgen deprivation
therapy. I acknowledged that most men noticed a decrease in
their desire for sex, had diffıculty getting and keeping erections,
and required more effort to reach an orgasm. However,
I pointed out that as many as 20% of men had satisfying sex
with a partner at times, although it took more mental and
physical stimulation to get aroused and have an orgasm. Men
with erection problems also might still enjoy sex enough to
get medical or surgical treatment to improve their erections.
The next day, a woman told me how important my presentation
was to her and her husband. During his 3 years on hormone
therapy, they never had sex. His oncologist said it
would not be possible. My talk inspired them to go back to
the hotel and try. The result was a very satisfying session of
lovemaking that included intercourse with a fırm erection
and orgasms for both partners.
Such instant cures have not been common during my career,
but this incident highlights the importance of providing
men and their partners more optimistic, though accurate, expectations
about sexuality during hormone therapy. Our culture
tends to believe that hormones have absolute power to
control sexual desire and function instead of seeing them as
one factor in the complex interaction of sexual beliefs and
experiences, relationship issues, and skills in coping with a
chronic illness.
This article summarizes what is known about men’s sexual
function during androgen deprivation therapy for prostate
cancer and suggests options to help men and their partners
maintain more active sex lives if desired.
SEXUAL FUNCTION IN MEN WITH
PROSTATE CANCER
One-third to one-half of men already have sexual dysfunction
at the time of prostate cancer diagnosis. Prevalenceincreases
with aging and comorbid disease. 1-3 In addition, all
current treatments for localized prostate cancer, including
active surveillance, greatly increase rates of sexual dysfunction.
Men randomly assigned to active surveillance or radical
prostatectomy in the Scandinavian Prostate Cancer Group
Study were compared to matched controls. 4 At 12-year
follow-up, 84% of men who had a prostatectomy, and 80% of
men on active surveillance, but only 43% of controls had
erectile dysfunction (ED). Although 28% of men on surveillance
began androgen deprivation therapy (ADT) in the interim,
and others had progressive disease, ED may increase
with damage to the neurovascular bundles from repeated
From the Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX.
Disclosures of potential conflicts of interest are found at the end of this article.
Corresponding author: Leslie R. Schover, PhD, Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Unit 1330, PO Box 301439, Houston, TX 77230-1439; email:
lschover@mdanderson.org.
© 2015 by American Society of Clinical Oncology.
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