Erectile dysfunction, masculinity, and psychosocial outcomes : A review of the experiences of men after prostate cancer treatment
Journal article
Chambers, Suzanne K., Chung, Eric, Wittert, Gary and Hyde, Melissa K.. (2017). Erectile dysfunction, masculinity, and psychosocial outcomes : A review of the experiences of men after prostate cancer treatment. Translational Andrology and Urology. 6(1), pp. 60-68. https://doi.org/10.21037/tau.2016.08.12
Authors | Chambers, Suzanne K., Chung, Eric, Wittert, Gary and Hyde, Melissa K. |
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Abstract | Prostate cancer (PC) treatment side-effects such as erectile dysfunction (ED) can impact men’s quality of life (QoL), psychosocial and psycho-sexual adjustment. Masculinity (i.e., men’s identity or sense of themselves as being a man) may also be linked to how men respond to PC treatment and ED however the exact nature of this link is unclear. This review aims to provide a snapshot of the current state of evidence regarding ED, masculinity and psychosocial impacts after PC treatment. Three databases (Medline/PsycINFO, CINHAL, and EMBASE) were searched January 1st 1980 to January 31st 2016. Study inclusion criteria were: patients treated for PC; ED or sexual function measured; masculinity measured in quantitative studies or emerged as a theme in qualitative studies; included psychosocial or QoL outcome(s); published in English language, peer-reviewed journal articles. Fifty two articles (14 quantitative, 38 qualitative) met review criteria. Studies were predominantly cross-sectional, North American, samples of heterosexual men, with localised PC, and treated with radical prostatectomy. Results show that masculinity framed men’s responses to, and was harmed by their experience with, ED after PC treatment. In qualitative studies, men with ED consistently reported lost (no longer a man) or diminished (less of a man) masculinity, and this was linked to depression, embarrassment, decreased self-worth, and fear of being stigmatised. The correlation between ED and masculinity was similarly supported in quantitative studies. In two studies, masculinity was also a moderator of poorer QoL and mental health outcomes for PC patients with ED. In qualitative studies, masculinity underpinned how men interpreted and adjusted to their experience. Men used traditional (hegemonic) coping responses including emotional restraint, stoicism, acceptance, optimism, and humour or rationalised their experience relative to their age (ED inevitable), prolonged life (ED small price to pay), definition of sex (more than erection and penetration), other evidence of virility (already had children) or sexual prowess (sown a lot of wild oats). Limitations of studies reviewed included: poorly developed theoretical and context-specific measurement approaches; few quantitative empirical or prospective studies; moderating or mediating factors rarely assessed; heterogeneity (demographics, sexual orientation, treatment type) rarely considered. Clinicians and health practitioners can help PC patients with ED to broaden their perceptions of sexual relationships and assist them to make meaning out of their experience in ways that decrease the threat to their masculinity. The challenge going forward is to better unpack the relationship between ED and masculinity for PC patients by addressing the methodological limitations outlined so that interventions for ED that incorporate masculinity in a holistic way can be developed. |
Keywords | erectile dysfunction (ED); masculinity; prostate cancer (PC); psychosocial; quality of life (qoL) |
Year | 2017 |
Journal | Translational Andrology and Urology |
Journal citation | 6 (1), pp. 60-68 |
Publisher | AME Publishing Company |
ISSN | 2223-4683 |
Digital Object Identifier (DOI) | https://doi.org/10.21037/tau.2016.08.12 |
PubMed ID | 28217451 |
Scopus EID | 2-s2.0-85013270052 |
PubMed Central ID | PMC5313306 |
Open access | Published as ‘gold’ (paid) open access |
Research or scholarly | Research |
Page range | 60-68 |
Funder | Australian Research Council (ARC) |
Publisher's version | License File Access Level Open |
Output status | Published |
Publication dates | |
Online | Feb 2017 |
Publication process dates | |
Accepted | 22 Jun 2016 |
Deposited | 10 Nov 2021 |
ARC Funded Research | This output has been funded, wholly or partially, under the Australian Research Council Act 2001 |
https://acuresearchbank.acu.edu.au/item/8x068/erectile-dysfunction-masculinity-and-psychosocial-outcomes-a-review-of-the-experiences-of-men-after-prostate-cancer-treatment
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Publisher's version
OA_Chambers_2017_Erectile_dysfunction_masculinity_and_psychosocial_outcomes.pdf | |
License: CC BY-NC-ND 4.0 | |
File access level: Open |
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