British physicist Stephen Hawking (1942-2018) was globally recognized as one of the most gigantic intellects in our time. According to study.com, Hawking was awarded “…thirteen honorary degrees, the Franklin Medal, the Hughes Medal, the Albert Einstein Medal, the Wolf Prize in Physics, the Albert Einstein Award, and many more.” For Hawking, unraveling the mystery of black holes seemed to be his calling. However, there was one insurmountable brain puzzle not even he could solve: women. “”They are,” he said “a complete mystery.”^[i]

Of course, stereotyping the female gender as mysterious can be viewed as sexist—which is not my intention. However, there is one area in the field of prostate cancer (PCa) that has remained in the dark because it has been much overlooked. While it has been long acknowledged that PCa treatments come with sexual side effect risks for the patient, here’s the question: if the patient has erectile dysfunction (ED) after treatment, how does it affect the sexuality of the woman who loves him?

To solve the mystery, a research team from NYU Langone Health’s Perlmutter Cancer Center created a questionnaire on a woman’s sexual and emotional health if her partner has post-treatment impotence. Developing a research-worthy questionnaire does not simply mean making up some questions. Based on earlier investigations and conferences with experts, the team identified areas like communication, emotional/psychological distress, loss of connection, impact on intimacy, satisfaction with sexual activity not involving penetration, and willingness to explore other sexual activities. The team then conducted interviews with female partners whose responses helped refine the questions.

Once this part of the process was complete, the team recruited 200 female partners across the country. Langone Health’s newsletter states that “…using a statistical analysis, they arrived at 19 questions that best captured partners’ concerns and determined that the survey was reliable and valid (meaning the results actually represent what they are intended to measure).”

What the women reported

Based on the responses, the researchers discovered a “substantial impact” on female partners. Among the issues were a loss of connectedness, lack of spousal communication, high distress levels, and inadequate resources/discussions with healthcare providers. Failing to heed women’s needs is like trying to walk with one leg. As one blog explains, “Though women don’t experience the direct physical impact [of ED], sexual problems will arise within the relationship. This lack of intimacy and sexual stimulation can cause a range of strong emotions.” The questionnaire results point to a need for post-treatment social services that offer couples support, sexual rehabilitation, help with couples’ communication, and healing a sense of loss or grief.

Today, the majority of PCa patients who opt for treatment have a radical (whole gland) approach like robot-assisted prostatectomy. Radical surgery has the highest incidence of post-treatment impotence. Even with a nerve-sparing approach, ED rates range from 14-90% (depending on several factors.)^[ii] Everyone assumes that this will be physically and emotionally challenging for the patient, but recovering from PCa treatment is not just about healing the body and getting “back to normal.” As we learn from the Langone Health questionnaire results, female partners also contend with sexual and emotional affects that complicate the dynamics of couplehood. I again don’t mean to stereotype, but there’s a popular saying that “if mama ain’t happy, ain’t nobody happy.” In this case, it means if a woman’s needs aren’t identified, acknowledged and addressed in the aftermath of post-treatment male side effects, there’s a good chance that unexpressed feelings and preferences will make the road to partnership recovery bumpier than it needs to be.

As physicians who treat PCa, we need to be sensitive to the other person in the room—the female partner–who will not herself undergo surgery, radiation, or ablation—but who nonetheless will join her partner in dealing with any side effects that occur. The Langone Health team will next explore the impact of PCa treatment on the sexuality of male and nonbinary partners.

I’m thankful that researchers and clinicians are shedding light on the women’s side of PCa treatments. If you’re interested, the Prostate Cancer Foundation has made the Partner Sexual Health Questionnaire available for download here.

I’m also thankful that our Center is able to offer qualified candidates a choice of less invasive, effective MRI-guided focal therapies like our Focal Laser Ablation, TULSA-PRO, and Exablate MRI-guided Focused Ultrasound. Focal therapy can dramatically reduce the chances of incontinence and ED, allowing couples to quickly recover and resume their lifestyles and lovestyles. Contact us for more information on how we may be able to provide both partners a smoother recovery road on all levels.

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] Sample, Ian. “Stephen Hawking admits he finds women ‘a complete mystery.’” The Guardian, Jan. 4, 2012. https://www.theguardian.com/science/2012/jan/04/stephen-hawking-women-complete-mystery
[ii] Bratu O, Oprea I, Marcu D, Spinu D et al. Erectile dysfunction post-radical prostatectomy – a challenge for both patient and physician. J Med Life. 2017 Jan-Mar;10(1):13-18.