Many men not prepared for ED after colorectal treatment

Unlike men with prostate cancer, those with colorectal cancer are not routinely offered information and treatment for erectile dysfunction (ED), charge the authors of a new study.

To examine the experiences of men after treatment for colorectal cancer, Professor Sue Wilson of the Cancer and Chronic Disease Team at the University of Birmingham (United Kingdom) and colleagues interviewed 28 men who had been treated for the disease with surgery (24), chemotherapy (20), radiotherapy (13), and stoma (13).

All but four of the participants experienced erectile dysfunction as a consequence of treatment, but were not informed about this effect and were unprepared for it (BMJ.com; www.bmj.com/content/343/bmj.d5824.full.pdf). More than half of the 24 men reporting erectile dysfunction (13) never sought help for the condition, and nine others sought no further help after unsuccessful treatment. Reticence was the most common explanation given for not seeking help, including simple embarrassment, a lack of confidence, a general fear of looking “stupid,” and waiting to be asked rather than raising the subject themselves.

Four men expressed low expectations of clinicians based on poor care experiences, and believed that if they asked for help, the clinicians' responses would be offensive. Three men believed they already had their “fair share” of care. Six men perceived that ED was not on the clinical agenda and did not want to raise the issue for fear that it would be deemed inappropriate.

Of the 10 men who sought treatment for erectile dysfunction, four took the initiative and directly approached their general practitioner for help, and three were offered help by their general practitioner (one man's wife asked the physician to speak with her husband about the problem). One man and the wife of another man asked a different provider for help and were referred to the general practitioner. The remaining man asked the stoma nurse for help.

Almost none of the men in the sample were receiving adequate, effective, and affordable care for ED, and the authors reported strong evidence of ageism. They speculated that after appropriate training, colorectal clinical nurse specialists could be the team member to oversee the provision of information on erectile dysfunction for men being treated for colorectal cancer, monitor progress, and coordinate ongoing care.

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