“How to handle a woman?” sings King Arthur in the Broadway musical Camelot. The king is perplexed by a seemingly eternal puzzle: what do women most desire? In fact, it’s the very question addressed in the medieval legend of how handsome Sir Gawain came to marry the ugliest hag on earth—and how his correct response to the question transformed her (If you’re not familiar with the story, check out Wikipedia’s version of the magical Arthurian tale that solves the age-old riddle).

I want to pose a variation of the question, one that pertains to prostate cancer treatment. What do women want if their partner has erectile dysfunction (ED) after prostate cancer (PCa) treatment?

We already know what men want. They want their erections back. Radical (whole gland) treatments like surgery or radiation come with risks of sexual side effects. When a patient has post-treatment temporary or long-term or even (heaven forbid) permanent ED, his sense of self takes a big hit. They experience distress and depression over the loss of their sex life.^[i] Studies report that the impact of post treatment ED leads to a sense of diminished masculinity, embarrassment, lower self-worth, and even fear of being stigmatized.^[ii]

But the guys are not the only ones affected. Is anyone asking about the unmet needs of their female partners and what they want? The answer is, yes. In December 2023, a multicenter research team published a study, ‘’Unmet sexual health resource needs and preferences for interventions to address these needs among female partners of patients with prostate cancer.”^[iii] To the best of the authors’ knowledge, it’s the largest study so far on this topic. They interviewed over 200 female partners to learn what resources would help them deal with the impact of their men’s ED on their own sexual intimacy. Basically, the research team resurrected the old question, “What do women want?” and applied it to new territory.

The authors discovered major themes, including “… the benefits and drawbacks of technology-based interventions, the importance of sexual health resources throughout the PCa journey, and a desire for sexual health support groups that include partners.” The most common sexual health topics for which women wanted more information were:

1. male libido problems (30.0%)
2. erectile dysfunction (26.5%)
3. female libido and arousal problems (24.5%)

The women also wanted practical resources to gain more information about

• sexual health websites (41.5%)
• partners-only support groups (35%)
• support groups for couples (29.5%), and
• sexual medicine specialists (23.5%).

The authors are no research slouches. They are experienced clinicians, whose “pedigree” is evidenced by the institutions they represent; they hail from worthy PCa treatment centers including the University of Michigan, New York University, Memorial Sloan Kettering Cancer Center, Manhattan Veterans Affairs, and the Madigan Army Medical Center. Their findings have far-reaching implications for a huge underserved population: the women affected by their partners’ post-treatment ED.

The authors’ questions are arriving rather late in the game, given that for over 50 years prostatectomy and radiation have been the nearly-exclusively main conventional primary treatments. The answers to the questions finally give a voice to the countless women whose needs have been largely unexpressed in the research literature. This is not only a problem in the realm of PCa treatment. It reflects the societal observation of author Daniel Bergner (What do Women Want?) that “… women’s desire – its inherent range and innate power – is an underestimated and constrained force, even in our times.”

PCa is a couple’s journey. If we, as physicians, want to do the right thing by the women who love their partners affected by treatment, we must heed the findings of this study. In order to be sensitive to women’s unaddressed needs, we can start by meeting with couples in our post-treatment appointments, and ask them how they are doing along with their male partners. Breaking the silence is the first step toward supporting them. A next step could be directing them to the Prostate Cancer Foundation’s website which offers articles on topics like Partner’s Sexual Quality of Life and links to support resources. There they can find ways to address their unmet needs that suit their preferences. It may not be instant magic but as the legend goes, Sir Gawain broke the evil spell that afflicted his bride when he solved the timeless question of what women want: he let her make her own choice.

Thankfully, we now have breakthrough ways to greatly reduce ED risks of treatment—and in most cases, avoid them altogether. Our Center offers the three top effective, minimally invasive focal therapies: Focal Laser Ablation, TULSA, and Exablate MR guided Focused Ultrasound. With our experienced team, we are helping couples so neither member ever has to worry about unmet sexual needs after treatment.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Hyde MK, Opozda M, Laurie K, Vincent AD, Oliffe JL, Nelson CJ, Dunn J, Chung E, Gillman M, Manecksha RP, Wittert G, Chambers SK. Men’s sexual help-seeking and care needs after radical prostatectomy or other non-hormonal, active prostate cancer treatments. Support Care Cancer. 2021 May;29(5):2699-2711.
[ii] Chambers SK, Chung E, Wittert G, Hyde MK. Erectile dysfunction, masculinity, and psychosocial outcomes: a review of the experiences of men after prostate cancer treatment. Transl Androl Urol. 2017 Feb;6(1):60-68.
[iii] Gupta N, Zebib L, Wittmann D, Nelson CJ et al. Unmet sexual health resource needs and preferences for interventions to address these needs among female partners of patients with prostate cancer. Urology. 2023 Dec 29:S0090-4295(23)01109-3.