Acceptance of pharmacological rehabilitation of erectile competence in Radical Retropubic Prostatectomy patients, 2004


Patients affected by localized adenocarcinoma of the prostate undergo radical retropubic prostatectomy (RRP) for the ablation of the gland. The surgical procedure may involve a damage of the erectile nerves due to thermal or stretching manouvers needed to eradicate the malignancy, with consequent erectile difficulty.

The problem is well known and rehabilitation is often attempted using pharmacological injective or oral prosthesis. Unfortunately few projects take into consideration the patient’s psychological status. We must remember that receiving a diagnosis of cancer is a devastating experience both for the patient and the couple. There is little doubt that cancer be included in the category of PTSD.

Once the tumor spread is under control, the emotional distress is the most difficult aspect patients have to overcome. In fact, RRP patients and couples agree to meet with the sex therapist gladly, but seldom carry on with treatment, because their depressed mood persists well into the recovery period.

Even in well bonded couples a life threatening disease creates distance, interferes with physical pleasure, and destroys sexual lust. Hugging, caressing, holding are intimate experiences showing affection and caring. They are a source of comfort, but no longer a prelude to sex.

We believe that no course of psychotherapy centered on the sexual dysfunction can be administered successfully unless patients/couples are ready to elaborate their loss. Therefore, we recommend to postpone it to better times to avoid a failure that will lower confidence, raise anxiety, and worsen the couple relation. To protect the patient’s erectile tissues we recommend that the caring physician will offer a pharamacological erectogenic regimen until the right time to enter a psycho-sexual-pharmacological rehabilitation program.