**4. Discussion**

Sexuality is an important aspect of human life, and emotions related to sexual activity influence mental well-being, relationship, or how we see ourselves. Sexual function disorders (e.g., erectile dysfunction) caused by prostate carcinoma significantly reduces the quality of life of men [6–8]. Cancer treatment is also related to reduced sex drive and penile dysfunction manifesting itself through, for example, reduced ability to have an orgasm, erectile disorders, or urinary incontinence [9, 10]. The above changes in sexual functions are also related to anxiety and depression, challenges in everyday life, and disrupted intimate relations with the patient's partner [11–14]. However, other studies indicated that many patients with

**183**

concept of manhood [31, 32].

*Sexual and Psychoemotional Disorders in Male Patients Treated for Prostate Carcinoma*

sexual disorders after surgical treatment and radiotherapy.

An analysis of the sexual activity of the study patients showed that younger men more often indicated a strong or very strong sense of loss of manhood due to the disease or its treatment. A sense of loss of manhood was mostly declared by posttreatment patients or patients on cancer treatment. The type of treatment had no impact on

Patients undergoing surgical treatment or chemotherapy and hormone therapy showed the least interest in sexual life. On the other hand, there is no correlation between the level of sexual activity and the patients' age (p > 0.05). Posttreatment patients and patients on treatment were least sexually active. Additionally, taking into account the type of treatment, patients receiving surgical treatment or chemotherapy and hormone therapy were characterized by greatest sexual activity. Another study demonstrated that unwillingness to meet people or have sex is more common among men treated for cancer and it is most likely best observable

a sense of loss of manhood (p > 0.05). In one of their studies, Zaider et al. [1] found that 1/3 of the male patients lost an important aspect of their manhood as a side effect of disease treatment, which proved to be a significant obstacle to their sexuality. O′ Shaughnessy et al. [2] determined that the affected patients may not be fully aware of their sexual losses. In another study, an inability to perform sexually by men diagnosed with a chronic disease was described as a source of suffering [28, 29]. Harrington et al. [30] argued that a body image is an important aspect of human quality of life, especially in patients diagnosed with cancer. On the other hand, the loss of sexual functions in posttreatment patients may undermine their

prostate carcinoma suffer at a later stage from complications in the course of disease

On the other hand, feeling worried also depends on the stage of cancer treatment. Patients waiting for treatment more often declared to be worried (to a considerable or significant extent) than posttreatment patients. At the same time, all the patients who received surgical treatment, chemotherapy, and hormone therapy indicated that they felt worried. No fatigue was most often indicated by patients receiving radiotherapy or both radiotherapy and surgical treatment. However, health status also had an insignificant impact on patients feeling worried, even though patients with a greater quality of life score more rarely declared that they felt worried. Other studies suggest that hot flushes were strongly associated with insomnia and they caused depression particularly in the group of elderly men receiving hormone therapy [17–19]. However, Yang et al. [20] determined that physical condition of cancer patients was closely related to the fatigue index and it was also the major factor affecting the quality of life of patients. Other studies showed that regular monitoring of fatigue and its elimination could improve physical condition of patients and therefore improve their quality of life [21, 22]. It is well documented in the literature that all types of cancer treatment, and especially chemotherapy, are associated with side effects such as fatigue, depression, pain, and many other problems [23–25]. Urination problems during the day had a significant negative impact on the quality of life of patients. A similar but significantly weaker correlation was identified between the quality of life score and frequent nighttime urination or the quality of life score and the need to hurry into the toilet before passing urine. At the same time, having to get up frequently at night to urinate affects the night's rest and has a strong impact on how patients perceive their quality of life. However, pain during urination was declared by half of the patients, and no correlation was found between pain and the quality of life score. Vogl et al. [26] showed that an insignificant number of men undergoing cancer treatment had certain difficulties passing urine which were reversible over time. However, Arscott et al. [27] demonstrated that urinary tract symptoms are frequently associated with

*DOI: http://dx.doi.org/10.5772/intechopen.87208*

and its treatment [15, 16].

*Sexual and Psychoemotional Disorders in Male Patients Treated for Prostate Carcinoma DOI: http://dx.doi.org/10.5772/intechopen.87208*

prostate carcinoma suffer at a later stage from complications in the course of disease and its treatment [15, 16].

On the other hand, feeling worried also depends on the stage of cancer treatment. Patients waiting for treatment more often declared to be worried (to a considerable or significant extent) than posttreatment patients. At the same time, all the patients who received surgical treatment, chemotherapy, and hormone therapy indicated that they felt worried. No fatigue was most often indicated by patients receiving radiotherapy or both radiotherapy and surgical treatment. However, health status also had an insignificant impact on patients feeling worried, even though patients with a greater quality of life score more rarely declared that they felt worried. Other studies suggest that hot flushes were strongly associated with insomnia and they caused depression particularly in the group of elderly men receiving hormone therapy [17–19]. However, Yang et al. [20] determined that physical condition of cancer patients was closely related to the fatigue index and it was also the major factor affecting the quality of life of patients. Other studies showed that regular monitoring of fatigue and its elimination could improve physical condition of patients and therefore improve their quality of life [21, 22]. It is well documented in the literature that all types of cancer treatment, and especially chemotherapy, are associated with side effects such as fatigue, depression, pain, and many other problems [23–25]. Urination problems during the day had a significant negative impact on the quality of life of patients. A similar but significantly weaker correlation was identified between the quality of life score and frequent nighttime urination or the quality of life score and the need to hurry into the toilet before passing urine. At the same time, having to get up frequently at night to urinate affects the night's rest and has a strong impact on how patients perceive their quality of life. However, pain during urination was declared by half of the patients, and no correlation was found between pain and the quality of life score. Vogl et al. [26] showed that an insignificant number of men undergoing cancer treatment had certain difficulties passing urine which were reversible over time. However, Arscott et al. [27] demonstrated that urinary tract symptoms are frequently associated with sexual disorders after surgical treatment and radiotherapy.

An analysis of the sexual activity of the study patients showed that younger men more often indicated a strong or very strong sense of loss of manhood due to the disease or its treatment. A sense of loss of manhood was mostly declared by posttreatment patients or patients on cancer treatment. The type of treatment had no impact on a sense of loss of manhood (p > 0.05). In one of their studies, Zaider et al. [1] found that 1/3 of the male patients lost an important aspect of their manhood as a side effect of disease treatment, which proved to be a significant obstacle to their sexuality. O′ Shaughnessy et al. [2] determined that the affected patients may not be fully aware of their sexual losses. In another study, an inability to perform sexually by men diagnosed with a chronic disease was described as a source of suffering [28, 29]. Harrington et al. [30] argued that a body image is an important aspect of human quality of life, especially in patients diagnosed with cancer. On the other hand, the loss of sexual functions in posttreatment patients may undermine their concept of manhood [31, 32].

Patients undergoing surgical treatment or chemotherapy and hormone therapy showed the least interest in sexual life. On the other hand, there is no correlation between the level of sexual activity and the patients' age (p > 0.05). Posttreatment patients and patients on treatment were least sexually active. Additionally, taking into account the type of treatment, patients receiving surgical treatment or chemotherapy and hormone therapy were characterized by greatest sexual activity. Another study demonstrated that unwillingness to meet people or have sex is more common among men treated for cancer and it is most likely best observable

*Male Reproductive Health*

**Sexual activity Question** 

Feeling perdition masculinity 49 26

The interest in sexual intercourse 50 72

The degree of sexual activity 51 96

Satisfaction with sexual intercourse 52b 28

Difficulties with ejaculation 54b 20

**Problems with urination Question** 

*Question applies only to patients who are sexually active within the last 4 weeks (N = 60).*

*Number of issues in accordance with the questionnaire QLQ-C30.*

*Number of issues in accordance with the questionnaire QLQ-C30.*

*Demonstrated statistically significant correlations only; p < 0.05.*

*Sexual activity and quality of life of the patients.*

*Question applies only to patients who are sexually active within the last 4 weeks (N = 60).*

Difficulty getting or maintaining an

The feeling of embarrassment during

erection

intimacy

*Sexual activity patients.*

*a*

*b*

*a*

*b*

*c*

**Table 7.**

**Table 6.**

**no.a**

**Not at all**

(15.7)

(45.8)

(57.8)

(46.8)

(26.7)

(33.3)

(43.3)

**no.a**

53b 16

55b 26

**Number of patients (N = 166) N (%)**

**A little Quite a** 

44 (26.5)

48 (28.9)

34 (20.5)

10 (16.7)

12 (20.0)

12 (20.0)

> 4 (6.7)

**bit**

40 (24.1)

20 (12.1)

18 (10.8)

8 (13.3)

14 (23.3)

6 (10.0)

12 (20.0)

**Quality of life p-value R-Spearmanb**

**Very much**

56 (33.7)

22 (13.3)

18 (10.8)

14 (23.3)

18 (30.0)

22 (36.7)

18 (30.0)

**182**

**4. Discussion**

Sexuality is an important aspect of human life, and emotions related to sexual activity influence mental well-being, relationship, or how we see ourselves. Sexual function disorders (e.g., erectile dysfunction) caused by prostate carcinoma significantly reduces the quality of life of men [6–8]. Cancer treatment is also related to reduced sex drive and penile dysfunction manifesting itself through, for example, reduced ability to have an orgasm, erectile disorders, or urinary incontinence [9, 10]. The above changes in sexual functions are also related to anxiety and depression, challenges in everyday life, and disrupted intimate relations with the patient's partner [11–14]. However, other studies indicated that many patients with

Feeling perdition masculinity 49 0.134 — The interest in sexual intercourse 50 0.420 — The degree of sexual activity 51 0.384 — Satisfaction with sexual intercourse 52c 0.509 — Difficulty getting or maintaining an erection 53c 0.142 — Difficulties with ejaculation 54c 0.361 — The feeling of embarrassment during intimacy 55c 0.585 — in men with prostate carcinoma who receive hormone therapy. The study at hand showed that more than 95% of men treated with this method reported subjective sex drive disorders [6]. However, DiBlasio et al. [13] demonstrated that more than 95% of men receiving hormone therapy reported libido and sex drive disorders. The loss of libido is frequently observable in patients with Hodgkin disease (Hodgkin lymphoma), where more than 40% of men reported this side effect [14]. The loss of libido was also observable in patients with hematologic cancers [15, 16]. Different results were obtained by Olsson et al. [33] who argued that low libido may originate from fatigue and/or feeling unwell. Furthermore, this condition may be associated with the stage of disease and intensive cancer therapy.

Our study showed that among sexually active men, pretreatment and posttreatment patients as well as patients on cancer treatment were satisfied or very satisfied with their sexual life. The level of satisfaction with sexual life was also affected by the type of treatment, while the patients' age had no effect on their satisfaction with sexual life (p > 0.05). Given that good mental well-being depends on many factors, it cannot be stated without ambiguity that men can achieve sexual satisfaction only through a successful sexual intercourse. However, for men with chronic erectile disorders, inability to achieve penetration may be a source of considerable difficulties and frustration. For example, couples open to changes and willing to cooperate were able to adapt to the needs of the affected partner and to accept the side effects of cancer treatment [34–36].

However, our studies showed that men receiving treatment or radiotherapy have considerable or major difficulties in achieving or maintaining erection. Other study [3] shown that erectile disorders were observed in 77% of men treated for prostate carcinoma who underwent radical prostatectomy and in 60% of patients receiving radiotherapy. It was also observed that post-radiotherapy erectile disorders were usually delayed (1 or 2 years after therapy) in contrast to a quick response achieved in a group of patients immediately after surgical treatment [28]. Erectile disorders were also observed in other populations, for example, in patients treated for anal diseases or rectal and testicular cancer [9, 11]. Difficulties with ejaculation were not correlated with the age of patients (p > 0.05). Problems with ejaculation were least frequent among patients prior to cancer treatment, while all the posttreatment patients reported having such difficulties. Patients who received surgical treatment, hormone therapy or both radiotherapy and hormone therapy had no problems with ejaculation. Sullivan et al. [37] determined that radiotherapy, especially if it is focused on the prostate gland, may be associated with anejaculation (inability to ejaculate). A study in 364 men diagnosed with prostate carcinoma and undergoing radiotherapy showed that as many as 72% of the patients experienced anejaculation. However, elderly men and patients receiving lower doses of radiation were less exposed to this side effect. This situation may lead to an intentional avoidance of orgasm by men suffering from prostate carcinoma. On the other hand, Wassersug et al. [12] noticed that the lack of ejaculation in men having homosexual relations caused particular discomfort. However, in our study, a feeling of embarrassment during intimate contact (in sexually active men) was not correlated with age but with the stage of cancer treatment and the type of therapy.

Embarrassment during sexual contact was not experienced by pretreatment patients, patients receiving surgical treatment, hormone therapy, or radiotherapy combined with hormone therapy. Additionally, none of the discussed aspects of sexual activity, in relation to all the patients or only those sexually active during the last 4 months, had no impact on the quality of life score (p > 0.05 for all cases). Harrington et al. [38] showed that men who underwent hormone therapy are exposed to verbal abuse due to changes in their appearance as a side effect of the

**185**

authors.

*Sexual and Psychoemotional Disorders in Male Patients Treated for Prostate Carcinoma*

therapy (weight gain, loss of muscle mass, reduced hair, gynecomastia). Reduced embarrassment and dissatisfaction with one's own body was reported by men with the same diagnosis but undergoing treatment other than hormone therapy. A feeling of embarrassment is also caused by changes in body weight (weight gain or weight loss) which in turn affects the image of one's own manhood [39, 40]. However, problems related to the body image are not necessarily focused only on the penis. In male patients treated for colorectal cancer, intestinal stoma was associated not only with erectile disorders but also with a feeling of shame before

1.Despite the existing psychoemotional disorders, no correlation was

2.The type and stage of cancer treatment (mostly prior to therapy) had a significant impact on feeling tense, worried, depressed, and irritable. It was also shown that feeling depressed affects the patient's health status to a considerable extent. Our results show the urgent need to provide the patients with continuous psychological care, especially those waiting for treatment and

found between the age of patients and feeling tense, worried, irritable, or depressed. Additionally, complaints reported by sexually active patients showed no correlation between age and a sense of loss of manhood, erectile disorders, satisfaction with sexual life, or embarrassment during intimate

3.The method of treatment had no major impact on a sense of loss of manhood and the degree of sexual activity, while the stage of treatment (posttreatment patients and patients on treatment) had a negative effect on these parameters. Pretreatment patients declared high or very high satisfaction with their sexual life, while posttreatment patients and those on cancer treatment indicated low sexual satisfaction. However, feeling embarrassed during intimate contact as well as erectile disorders correlated both with the type and stage of cancer treatment. An analysis of the sexual functioning of prostate carcinoma men suggests that the patients should be under the care

This article does not contain any studies with animals performed by any of the

*DOI: http://dx.doi.org/10.5772/intechopen.87208*

themselves and their partner.

**5. Conclusions**

contact.

those on treatment.

of a clinical sex therapist.

**Ethical approval (animals)**

All authors declare no conflict of interests.

The study was financed from own funds.

**Conflict of interest**

**Funding**

*Sexual and Psychoemotional Disorders in Male Patients Treated for Prostate Carcinoma DOI: http://dx.doi.org/10.5772/intechopen.87208*

therapy (weight gain, loss of muscle mass, reduced hair, gynecomastia). Reduced embarrassment and dissatisfaction with one's own body was reported by men with the same diagnosis but undergoing treatment other than hormone therapy. A feeling of embarrassment is also caused by changes in body weight (weight gain or weight loss) which in turn affects the image of one's own manhood [39, 40]. However, problems related to the body image are not necessarily focused only on the penis. In male patients treated for colorectal cancer, intestinal stoma was associated not only with erectile disorders but also with a feeling of shame before themselves and their partner.
