Sexual Function in Elderly Men Receiving Androgen Deprivation Therapy (ADT)

Abstract

Introduction: Androgen deprivation therapy (ADT) is commonly used in men with prostate cancer, either as primary therapy or as salvage therapy. The treatment has a range of side effects including sexual dysfunction.

Aim: To review available literature on sexual dysfunction in men undergoing ADT and to discuss the management of this dysfunction.

Methods: A literature review was performed regarding androgens' role in sexual function and on sexual dysfunction in men receiving ADT.

Main outcome measures: To describe the prevalence and nature of ADT-related sexual dysfunction and to give clinical recommendations on the evaluation and treatment of the problem.

Results: Most men experience reductions in both sexual desire and erectile function with ADT. However, approximately 20% of the patients maintain some degree of libido and sexual function. In addition, partner considerations, maintenance of intimacy, and maintaining a sense of masculinity may all be reasons for attempting to uphold a sex life. When counseling and treating patients undergoing ADT, it is important to include partners and to listen to the couples' needs. The patients' choices regarding continued sexual activity should be respected and those who desire to maintain some kind of sexual relationship should be helped in doing so. Treatments may include normal erectogenic aids (phosphodiesterase 5 enzyme inhibitors, intraurethral alprostadil, vacuum erection devices, injection therapy, and penile implants), sexual counseling, and instruction in alternative sexual practices. Management of expectations and partner involvement are crucial.

Conclusions: Sexual function is severely affected in most men undergoing ADT. However, it is important to be aware that a sexual desire may be preserved in some patients. Likewise, it is important to respect that sexual activity is not solely driven by a man's libido. Therefore, issues relating to sexuality should be routinely dealt with in men undergoing ADT. Fode M and Sønksen J. Sexual function in elderly men receiving androgen deprivation therapy (ADT). Sex Med Rev 2014;2:36-46.

Keywords: Androgen Deprivation Therapy; Erectile Function; Prostatic Neoplasms; Quality of Life; Sexual Function; Side Effects.