DETERMINACIÓN DE COMPUESTOS VOLÁTILES FERMENTATIVOS

Prior to treatment, sex was perceived by the men in some studies as a means to pleasure and achieving intimacy with their partner (Letts et al., 2010). Hence, the negative impact of prostate cancer treatment on men’s sex lives was a dominant theme across all but one study (Carter et al., 2011), where men had undergone active treatment. Sexual difficulties were often mediated by factors such as age, marital status and the nature of their personal relationships prior to, and during, their cancer experience. The main problems described across the majority of studies were reflected in a study by Letts et al. (2010) and included: full or partial loss of erection, reduced force of ejaculation, decreased orgasm, loss of libido

66

and decreased emotional changes, in addition to other relationship changes. The extent to which men experienced these problems varied across the studies. Furthermore, whilst men stated that they were usually aware of the potential risks to potency prior to their

treatment, many were clearly unprepared for the extent to which it occurred after they had been treated and the initial threat of survival had passed, as outlined earlier (Fergus et al., 2002).

Issues concerning men’s libido were also apparent. Whilst an intact libido, combined with the loss of sexual function was viewed as bothersome for some men, it was not as much of an issue for others. Letts et al. (2010) found that despite not being able to act on their sexual urges, some men felt that their intact libido was a reminder that at least something related to their sexuality had remained unchanged. In contrast, an intact libido left some men feeling frustrated as they were unable to physically act upon their desire. The absence of libido and sexual ability was also problematic, particularly for men undergoing hormone therapy. In these instances, the loss of both elements of sexual experience for men was compounded (Chapple & Ziebland 2002; Navon & Morag 2003; Ng et al., 2006). On the other hand, Oliffe (2006) found that the absence of libido helped some men to accept impotence. These men were less frustrated about their physical inability to perform sexually, as they were void of any desire. For the two gay men interviewed within a study by Filiault et al. (2008), distinct changes in their libido were noted as being distressing, given the centrality of sex in the participant’s lives as gay men. However, despite emphasising that the prostate gland is viewed as a site for pleasure for gay men, the researchers do not explain why the centrality of sex is so significant in the lives of gay man. Nonetheless, one gay man in Kelly’s (2004) study revealed that he had rejected treatments in order preserve sexual function, which may suggest that sex may have specific value for some gay men.

67

Men’s psychological adjustment to sexual difficulties is also apparent across several studies. Kelly (2004) and Letts et al. (2010) conveyed the sense of loneliness and isolation felt by some men who were inclined to view erectile dysfunction as ‘their problem.’ participants within both of these studies expressed relief at being able to share their worries for the first time with the interviewer. Hence, Letts et al. (2010) recommends the use of multidimensional assessments during follow up appointments to capture men’s emotional, as well as physical, state of health. The findings from an American study by Bokhour et al. (2001), which conducted seven focus group sessions, each consisting of seven men, suggests that erectile dysfunction may be more embedded within the social context of men’s lives than previously thought. Although the men in this study described complex issues relating to their sex lives, they did not necessarily view erectile dysfunction as a ‘health issue’. Hence, the researchers suggested that measurement outcomes aimed at determining disease and illness related quality of life, may not adequately reflect the wider range of emotional problems that may be associated with sexuality.

Several studies revealed that not all men were overly concerned by the loss of sexual function and that others were resigned to the permanent changes in their sex lives (Hagen et al., 2007; O’Shaughnessy & Laws, 2009; Walsh & Hegarty 2010). The use of erectile aids and medication designed for rehabilitation and improvement of the men’s sex lives were also frequently discussed across the studies. However, men’s satisfaction with their

effectiveness varied. Whilst many men were initially open to the idea of trying out aids and had accepted them as a normal part of their sexual repertoire (Kelly, 2004), others were uncertain about the appropriateness of treating erectile dysfunction (Oliffe, 2005). For example, a study of Latino and African-American men with prostate cancer by Maliski et al. (2008) found that Latino men were more hesitant regarding the use of medication,

although they did not explain their hesitation. On the other hand, African-American men reported that they were willing to try anything that could help them retain some form of

68

sexual functioning. Although these findings may suggest a cultural difference in attitudes between the two groups of men in this study, the authors also acknowledge that they findings may also be attributed to the higher ratio of single men in the African-American sample, who may have been more concerned about maintaining an active sex life in the future. Fergus et al. (2002) highlighted the sense of hope experienced by men, who initially felt confident that technology would restore their sex lives. However, these men soon realised the reality of using erectile aids was different to what they expected and often came with a cost. Complaints about medications and erectile aids were synonymous across most studies that discussed this issue. Some men described feeling pain when attempting to use them. However, the most common complaints centred on the lack of spontaneity when men wanted to use them and disappointment with their overall effectiveness (Bokhour et al., 2001; Chapple & Ziebland, 2002; Fergus et al., 2002; Heidesteg et al., 2005; Letts et al., 2010; Walsh & Hegarty, 2010).

Another dominant theme in relation to sexual difficulties concerned the men’s

relationships with their wives or partners. Partnered men described feeling wary about initiating signs of affection towards their partners, for fear that this would lead to an expectation of sexual intimacy, which they were then unable to fulfil (Bokhour et al., 2001; Letts et al., 2010). Other men expressed regret about the effect of sexual difficulties on their relationships (Hagen et al., 2007; Letts et al., 2010; Grunfield et al., 2012) as

communication between themselves and their partners had become awkward. Letts et al. (2010) suggests that this is because some men did not know how their wives or partners felt about the changes in their sexual relationships, as whilst some men discussed sexual matters with their partners at the time of diagnosis, it was rarely spoken about following treatment. Once again, this finding reiterates the need for psycho-sexual matters to be broached throughout the men’s cancer journey by healthcare providers as this may afford

69

more opportunities for men and their partners to discuss issues as they become more salient.

Four studies found that unpartnered men, or those not sexually active prior to surgery were also affected by changes to their sexual functioning (Bokhour et al., 2001; Fergus et al., 2002; Letts et al., 2010; Kazer et al., 2011a). Therefore, these findings emphasise how sexuality is not only about ‘function’ but is an integral part of a man’s sense of sexual self.

For some men, sexual difficulties were experienced with a sense of stigma. This was particularly evident in studies where gay men, single men and those from ethnic minorities were represented in their study samples (Fergus et al., 2002; Navon & Morag, 2003; Jones, et al., 2011; Kazer et al., 2011; Nanton & Dale, 2011). For Caribbean men, their high investment in sexual performance meant that it was difficult for them to recover emotionally after treatment (Jones, et al., 2011). For single men, the fear of shame and embarrassment meant that disclosure of sexual difficulties was delivered with hesitation and apprehension (Fergus et al., 2002; Letts et al., 2010; Kazer et al., 2011).

Gay men, who were included within four studies, reported additional concerns to those experienced by heterosexual men (Fergus et al., 2002; Kelly, 2004; Filiault et al., 2008; O’Shaughnessy & Laws, 2009). However, although gay men were grossly under represented within study samples, their experiences were similar across all four studies and therefore, worthy of discussion. One gay man equated his diagnosis of prostate cancer to having HIV (Fergus et al., 2002) Unlike heterosexual men who often turn to partners for support, this man anticipated rejection by potential lovers and worried about ridicule and gossip, likening the need to disclose his diagnosis to the ‘coming out’ process that many gay men experience (Fergus et al., 2002). Likewise, Filiault et al. (2008) found that gay men were troubled by the prospect of not measuring up, particularly as unlike female partners, these men’s partners were sexually functioning men of the same sex to whom gay men could

70

visually compare themselves to. Furthermore, one gay man stated that the way he related to other gay men had changed, particularly in a sexual context. This echoes descriptions by heterosexual men who reported qualitative shifts in the way they interacted with women since undergoing treatment (Bokhour et al., 2001).

For the one gay man included in O’Shaughnessy and Law’s (2009) study, the inability to sustain an erection had a particularly negative impact on his sexual identity. Short term and multiple relationships afforded few opportunities for him to explain impotence in a way that would invite empathy or patience. However, similar to other studies that include gay men, this study fails to explain how relationships amongst gay men differ, to those amongst heterosexual men. Therefore, conclusions and recommendations by researchers who have included gay men within their studies are generally based around the experiences of men with female partners.