Couples-Based Interventions After Prostate Cancer Treatment
A study by Schover et al. [2011] built upon Canada et al.'s [2005] study. Schover and colleagues compare a face-to-face format to an internet-based format of a revised version of the Canada et al. intervention entitled Counseling About Regaining Erections and Sexual Satisfaction (CAREss). The study also included a three month wait list control condition. A second internet-based group was added to examine the relationship between website use and outcomes. The internet-based intervention was created with the hopes to be more convenient, to minimize the drop-out rate, and to play to the fact that many men already seek sexual content on the internet. Males who were married or living with a partner for over a year with localized PC who had either definitive surgery or RT three months to seven years previously were included in this study. The men had to be unable to achieve and maintain an erection for sexual intercourse for ≥50% of attempts within the past three months. The 112 couples (waitlist n=43 (waitlist randomized after three-month period to FF n=20 and WEB1 n=22), FF n=40, WEB1 n=41, WEB2 n=43) were given assessments at baseline, posttreatment (after 12 weeks), and at three-months, six-months, and 12-months follow-up.
The content of these interventions were based on the Canada et al. [2005] intervention described above. The face-to-face and internet-based formats of CAREss had the same content and homework and both were three sessions in length. For participants in the WEB condition, their therapists were available through email and to give feedback on homework. For participants in the FF condition, therapists discussed the homework in the next session. The exercises were designed to boost expression of affection and comfort in initiating sexual activity, enhance sexual communication, and aid in resuming sex without performance anxiety. The education provided gave suggestions regarding coping with postmenopausal vaginal atrophy and coping with male urinary incontinence. Participants learned cognitive reframing techniques to identify negative beliefs about sexuality, and received a decision aid for choosing ED treatment together.
There were no differences for any of the variables compared to the wait list controls. Additionally, there were no differences between the face-to-face CAREss group and the internet-based CAREss group. Therefore, these two groups were combined for repeated measures analyses. Men who received the CAREss intervention had significant gains on the subscale of erectile functioning (EF) on the IIEF between baseline and six-month follow-up as well as between baseline and one-year follow-up, with 16% having near-normal function (a score of ≥22 on the EF subscale of the IIEF) at baseline increasing to 39% at six months, and slightly declining again to 35% at one year follow-up. Men in the intervention conditions also improved significantly on the subscales of orgasmic function, intercourse satisfaction, and overall sexual satisfaction from baseline to one year. The rates of ED treatment use did not change significantly within any group. However, men who intensified their ED treatment [the use was defined as (I) none; (II) using oral medication only; and (III) using invasive ED treatment] had large, significant increases in IIEF scores across time. There were no significant differences in marital happiness, as measured by the A-DAS, or overall distress, as measured by the Brief Symptom Inventory (BSI-18), for men in either of the intervention conditions. However, the sample of men was not particularly distressed at baseline, which could have been the reason for the lack of change. Women as a whole in the intervention conditions did not improve significantly on sexual functioning/satisfaction, but when divided into the categories of those who had abnormal versus normal scores at baseline, the women who had abnormal scores at baseline in the intervention conditions did have significant improvement over time. Interestingly, normal FSFI scoring women in the intervention conditions at baseline actually declined and then recovered to baseline by one year. The baseline sexual functioning of women predicted the efficacy of CAREss in improving men's IIEF scores.
A Randomized Trial of Internet-based Versus Traditional Sexual Counseling for Couples After Localized Prostate Cancer (PC) Treatment
Methods
A study by Schover et al. [2011] built upon Canada et al.'s [2005] study. Schover and colleagues compare a face-to-face format to an internet-based format of a revised version of the Canada et al. intervention entitled Counseling About Regaining Erections and Sexual Satisfaction (CAREss). The study also included a three month wait list control condition. A second internet-based group was added to examine the relationship between website use and outcomes. The internet-based intervention was created with the hopes to be more convenient, to minimize the drop-out rate, and to play to the fact that many men already seek sexual content on the internet. Males who were married or living with a partner for over a year with localized PC who had either definitive surgery or RT three months to seven years previously were included in this study. The men had to be unable to achieve and maintain an erection for sexual intercourse for ≥50% of attempts within the past three months. The 112 couples (waitlist n=43 (waitlist randomized after three-month period to FF n=20 and WEB1 n=22), FF n=40, WEB1 n=41, WEB2 n=43) were given assessments at baseline, posttreatment (after 12 weeks), and at three-months, six-months, and 12-months follow-up.
Intervention
The content of these interventions were based on the Canada et al. [2005] intervention described above. The face-to-face and internet-based formats of CAREss had the same content and homework and both were three sessions in length. For participants in the WEB condition, their therapists were available through email and to give feedback on homework. For participants in the FF condition, therapists discussed the homework in the next session. The exercises were designed to boost expression of affection and comfort in initiating sexual activity, enhance sexual communication, and aid in resuming sex without performance anxiety. The education provided gave suggestions regarding coping with postmenopausal vaginal atrophy and coping with male urinary incontinence. Participants learned cognitive reframing techniques to identify negative beliefs about sexuality, and received a decision aid for choosing ED treatment together.
Results
There were no differences for any of the variables compared to the wait list controls. Additionally, there were no differences between the face-to-face CAREss group and the internet-based CAREss group. Therefore, these two groups were combined for repeated measures analyses. Men who received the CAREss intervention had significant gains on the subscale of erectile functioning (EF) on the IIEF between baseline and six-month follow-up as well as between baseline and one-year follow-up, with 16% having near-normal function (a score of ≥22 on the EF subscale of the IIEF) at baseline increasing to 39% at six months, and slightly declining again to 35% at one year follow-up. Men in the intervention conditions also improved significantly on the subscales of orgasmic function, intercourse satisfaction, and overall sexual satisfaction from baseline to one year. The rates of ED treatment use did not change significantly within any group. However, men who intensified their ED treatment [the use was defined as (I) none; (II) using oral medication only; and (III) using invasive ED treatment] had large, significant increases in IIEF scores across time. There were no significant differences in marital happiness, as measured by the A-DAS, or overall distress, as measured by the Brief Symptom Inventory (BSI-18), for men in either of the intervention conditions. However, the sample of men was not particularly distressed at baseline, which could have been the reason for the lack of change. Women as a whole in the intervention conditions did not improve significantly on sexual functioning/satisfaction, but when divided into the categories of those who had abnormal versus normal scores at baseline, the women who had abnormal scores at baseline in the intervention conditions did have significant improvement over time. Interestingly, normal FSFI scoring women in the intervention conditions at baseline actually declined and then recovered to baseline by one year. The baseline sexual functioning of women predicted the efficacy of CAREss in improving men's IIEF scores.
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