What Ghanaian Women Say About Their Husbands Recovery Of Sexual Intimacy After Prostate Cancer Treatment: Toward The Progress Of A Theoretical Model Of Couples ‘Sexual Recovery After Prostate Cancer In Ghana ; My Findings

What I Found
Patients and their partners differed in their sexual self-esteem, sexual depression, sexual preoccupation, and life satisfaction. Both had greater levels of depression, poorer quality of sexual communication, and more sexual dissatisfaction than the general population. Partners' level of general depression and depression concerning their sex lives were significant predictors of patients' relationship satisfaction, perceived quality of communication about the sexual relationship, and sexual satisfaction after controlling for patients' general and sexual depression.

In conclusion, Partners often serve as primary caregivers, thus partner adjustment can be critical to the health of the patient and to his primary relationship. Results suggest the importance of including partners' adjustment in assessing patient adjustment post-treatment. The Men’s Health Foundation Ghana suggest that physicians working with these patients partner with mental health or professionals train Psychosocial counselors who can help couples address the challenges they encounter and extend the continuity of care when the need for medical intervention has passed.

Some Quotes from the men and women I had encounter with concerning prostate cancer at the Men’s Health Foundation Ghana office.

“Ye, lets talk more on sex and prostate cancer because I am interested “- A happy man said

“Since you have knowledge in the subject and its prevention your husband has no problem at all- a man and a nurse in a chat at the Men’s Health Foundation Ghana research lab”.

“Majority of men don’t feel shy telling us of their sex life and prostate cancer because they want their problem solved so that they enjoyed a good sex life. They also complain of frequent urination and how it affects their sleep and daily activities. They also tell us about issues of pre mature ejaculation. The men have now gain confidence when they come to the Prostate Research Lab established by Men’s Health Foundation Ghana- Dorcas, a trainee sonographer quote on her experience so far on men who visit the center.

“Most men don’t have knowledge about prostate cancer and enlargement. They don’t know the difference between the two.” The men have no knowledge on the subject prostate cancer and the prostate gland itself and what it does exactly. They don’t even know their risk factors”

“I met a friend man who told me he went for prostate cancer surgery at Korle-bu and he was told he will have problem with his sex life and eventually he has problem with his sex life. I felt so bad for this man because he is a young man in his 40’s and recently got married. We need to fight for our men otherwise there is going to be a problem in the house”- A woman quote at the Aviation Social Center lecture on prostate cancer.

Background
Most women are not really aware of the side effect of conventional prostate cancer treatment on their men sex life. They are not aware that their men prostate gland is their hallmark just like they way the breast is also afflicts a woman’s pricest possession, a precious asset of inestimable value, an organ where the motherly and erotic converge the breast. It is called breast cancer. The other assails a small but precious organ near a man’s bladder that produces the liquid in which the sperm swims and is carried-the prostate gland. It is called prostate cancer.

Like some demons unleashed from the hottest part of hell, the two killer-silent killer diseases are on the rampage, making a mess of victim, sending many to their early grave if not detected early.

A young woman who heard me delivering a speech on sex life after prostate cancer treatment and how it affect men and how some go into castration has no other alternative but to shout “Wat” and started calling on the young men to come and listen. The women are even more concerned in Ghana about their men sex life than any other side effect.

The Psychosocial Aspects of Sexual Recovery after Prostate Cancer Treatment

Four main areas of concerned should be targeted in Ghana(1) the treatment of erectile dysfunction, (2) men's psychological and culturally diverse adaptation to the sexual side effects; (3) the impact of prostate cancer on couples' relationships; and (4) interventions to promote sexual function.

Sexual dysfunction, a loss of pleasure and diminution in sexual ability and activity, is a common long-term consequence of prostate cancer treatment. Following prostate cancer treatment, many men and their partners develop sexual dysfunction in response to erectile dysfunction. Erectile dysfunction is defined as the incapacity to achieve and maintain a penile erection sufficient to attain satisfactory sexual relations. Erectile dysfunction occurs in 25-85% of patients after surgical treatments (that is, prostatectomy), in 32-67% after radiation treatment, and in approximately 71% following short-term neoadjuvant hormonal therapy.

Erectile dysfunction occurs immediately after a prostatectomy with recovery of erection, often partial, taking up to, approximately, 2 years. Radiation treatments affect erections gradually as penile tissues, and cavernous nerves are changed by radiation effects, peaking approximately 2 years after treatment. Androgen deprivation therapy eliminates erections quickly and decreases libido while generating unpleasant side effects, such as hot flashes, fatigue, bone fragility, weight gain and muscle mass loss.

Although erectile dysfunction secondary to prostate cancer treatment has been well documented, the research literature on sexual dysfunction and recovery is still sparse. Sexual recovery is defined as return to patient-reported satisfactory level of sexual functioning.

Seeking for Erectile Dysfunction Help
Asking for help in sexual matters is not easy for either the person who asks or for the person from whom help is sought. Most people consider sexual activity a private matter and feel awkward when discussing sexual difficulties, even within the couple. In a provider-patient relationship, the dynamics of help seeking can be burdensome, if one or both members of the partnership feel uncomfortable broaching the subject.

The Impact of Prostate Cancer on Couples' Relationships. Prostate cancer has often been called a 'couple's disease' because the illness and treatments affect both patients' and their partners' well being.

Effects on Partners and Relationships. The research literature on the partners of prostate cancer survivors indicates that partners tend to be more distressed than survivors, wish to be included in information gathering and decisions, and benefit from support and inclusion in the recovery. Otherwise, they may develop distress and psychiatric problems. The early and late stages of the illness pose a particularly strong risk. The factors that cause distress in partners are patients' physical pain and physical limitations. Some partners are distressed by men's urinary incontinence.

Couple relationships are affected by prostate cancer treatment. Communication within the couple is reported as an area of difficulty because couples often do not share their concerns; men and women report different needs for intimacy and guidance about recovery from treatment. The trajectory of coping may be different for patients and partners. I realized that patient satisfaction with quality of life related to sexuality is significantly associated with the partner's satisfaction with the same.

Couples' Sexuality. The few studies that focus on sexuality offer diverse views that may reflect the different ways in which prostate cancer survivors and their partners appear to react to sexual dysfunction. Some studies suggest that partners are less concerned about sexuality than patients, but this may be due to the fact that partners expect loss of sexual availability of the survivors and give up on sex prematurely

Interventions to Promote Sexual Functioning.

There have been very few interventions designed to help men or men and their partners manage changes in sexual function or well being Most intervention studies include psychoeducation regarding coping with the sexual side effects of prostate cancer treatment, but not all measure sexual or intimacy outcomes.

There should be program on education about the effects of prostate cancer treatment, menopause and treatments for erectile dysfunction, communication and promotion of intimacy.

What Men’s Health Foundation Ghana think on this issues in Ghana

The research on erectile dysfunction treatment embodies the hope that men can return to their ideal, precancer functioning. This is often impossible due to nerve and tissue injury during treatment. Men's reluctance to seek help in sexual recovery may represent unresolved disappointment with the medical treatment's inability to recapture spontaneous sexuality.

In reality, men's sexual response is often altered after prostate cancer treatment. The spontaneous movement from desire to arousal and intercourse is affected by the unresponsive nerves that govern erections. Now, to enjoy sex, men have to accept a lowered or even lack of physiologic response, tune out intrusive thoughts of disappointment and focus on sensual stimulation, even though it may take longer to achieve arousal and orgasm.

Men recovering from prostate cancer should be made aware of the potential impact of the loss of erectile functioning on their sexual relationship. Describing typical changes in sexual response due to various treatments can encourage realistic appraisal of sexual changes and reduce men's feelings of isolation and helplessness. While supporting men's strengths, it is important to assess their tendency to displace disappointment on goal-oriented tasks as a way of warding off feelings of vulnerability and grief. Help seeking depends on the willingness to acknowledge problems and convey them to others. Successful sexual recovery from prostate cancer treatment can ensue if men allow themselves to grieve the loss of familiar sexuality and explore new, satisfying sexual activity after prostate cancer treatment.

The partner and couple research alerts us to the importance of the partner's well being as a factor in positive sexual outcomes in the prostate cancer survivor. Partners clearly benefit from participation in the treatment and sexual recovery process. However, there is a significant gap in our understanding of the way in which partners' postmenopausal difficulties with desire and penetrative sex affect partners. Women's postmenopausal and men's postprostate cancer difficulties can create mechanical and emotional challenges to intercourse and contribute to couples' anxiety about experiencing and giving sexual pleasure.

Improved knowledge and communication about sexuality in middle and older age is a necessary goal of successful recovery for both survivor and partner. For some couples, poor communication and sexual dysfunction may have predated prostate cancer. The treatment of prostate cancer may offer an opportunity to re-examine couples' sexual functioning and propel them toward a better adjustment in the long run.

Like any other conduct, sexual practices are culturally determined to some degree. Delivery of care during recovery from prostate cancer must be performed in a culturally competent manner.

Finally, our observations and recommendations clearly resonate with the Institute of Medicine's call for psychosocial intervention in cancer to minimize adverse psychological and social effects.

Dr. Raphael Nyarkotey Obu is a registered alternative medical practitioner who specializes in Prostate cancer and studied the Masters program in prostate cancer –Sheffield Hallam University, UK and a PhD candidate in prostate cancer, Indian Board of Alternative Medicines Academy, Kolkata, India and the founder of Men’s Health Foundation Ghana and De Men’s clinic and Prostate Research Lab in Dodowa, Akoto House. Tel: 0500106570