What’s known on the subject? and What does the study add?
Sexual function is often impaired after radical prostatectomy (RP) resulting in reduced sexual activity and sexual bother. The main focus in the literature concerning sexual adverse effects has been on erectile dysfunction and impairment of sexual function rather than the actual sexual bother it causes, although the sexual bother is most important to the individual patient’s quality of life. The relation between these measures, and in particular pre-operative prediction of post-operative sexual bother, has only been studied limitedly and with varying results. Some studies have found good mental health, low levels of pre-operative sexual bother, and higher education to be associated with absence of post-operative sexual bother, but another study could not identify any pre-operative predictors of a post-operative sexual bother. Severe sexual bother after RP were reported by 64% to 95% of the patients three years after operation, and the prevalence was associated with the level of pre-treatment sexual bother and pre-operative nerve-preservation. On the other hand, others have reported that only 43% of men have sexual bother 2 years after RP. However, none of these studies stratified patients according to their pre-operative sexual activity and most of them were American. It has been shown that American findings concerning sexual bother may not always be valid for non-American patients due to differing sex role expectations thus warranting the need for more non-American studies.
This study has shown that two thirds of patients experienced sexual bother one year after RP. We have identified patients with increased risk of experiencing overall sexual bother post-operatively: those who report pre-operative sexual bother, those who are sexually active before RP, and those who display neurotic personality-traits. Another important finding was that the proportion of patients who experienced bother relevant to having impaired post-operative SF was significantly higher among pre-operatively sexually active patients than those who had been inactive. This study adds knowledge that patients’ pre-operative sexual activity, sexual bother and personality should be taken into account to be able to give individualized information about the risk of getting sexual bother after RP.