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 the sexual Sexual dysfunction in married couples 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 Perez et al.
Thus, non-sexual ways of expressing intimacy e. In fact, research has suggested 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 of 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 discussions 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 i. In contrast, couples in which one partner pressures the other to talk about a problem while the other partner withdraws or becomes defensive 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 study, we hypothesized that the partners of prostate cancer patients would report significant subjective sexual dysfunction and that the sexual function of patients and their partners
Sexual dysfunction in married couples 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 approached 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, "Sexual dysfunction in married couples" able to read "Sexual dysfunction in married couples" speak English, and were able to provide 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 Sexual dysfunction in married couples prostate cancer diagnosispatients and their partners 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 also used domain scores separately to examine specific aspects of male sexual function [ 37 ]. The 6-item erectile function domain in particular has been used as a proxy for male sexual dysfunction [ 38 ]. Scores range from 0 to 30; scores less than 21 indicate erectile 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 Sexual dysfunction in married couples better sexual function.
Although clinical cutoff scores have not yet been established for the "Sexual dysfunction in married couples," 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 mean age was We 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 that both "Sexual dysfunction in married couples" reported very low IIEF total scores and that the erectile function scores of both groups were far below the clinical cutoff 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 ].
Sexual dysfunction in married couples
Using the APIM, actor and partner effects can be estimated for mixed variables 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 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. Illustrative 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 greater 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
Sexual dysfunction in married couples on psychosocial adjustment. Another possibility is that one partner may be more likely to voice his or her concerns "Sexual dysfunction in married couples" 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.