(165) UNDERSTANDING THE SEXUALITY OF COUPLES AFTER PENECTOMY TO TREAT PENILE CANCER
Authors: Fosse Jr. A , Barros R , Schul A , Carvalho D , Bozzi R , Souza G , Passos M 
Published: December 2024

Abstract

Introduction
Penectomy is the main therapeutic option for oncological control. However, this surgery typically has a strongly negative effect on the body image, self-esteem and masculine sexuality of patients. Unfortunately, the literature is scarce on the sexual life of couples after penectomy.

Objective
To analyze the impact on the quality of the sexual life of couples after penectomy to treat penile cancer.

Methods
Patients who underwent penectomy and their respective partners were recruited for interviews on sexual quality using a semi-structured questionnaire prepared by teh research team, the International Index of Erectile Function-5 (IIEF-5) and Six-Item Female Sexual Function Index Scoring (FSFI-6) questionnaires, in addition to information on penile rigidity with the Erection Hardness Score (EHS).

Results
Fifteen couples were included in this study. The time of the relationships ranged from one to 50 years (mean = 21 years). Thirteen (86.6%) patients were submitted to total penectomy and two (13.3%) to partial penectomy. The size of the penile stump varied from 3.5 to 9 cm (mean = 6.2 cm), with only one patient (7.7%) having stump &lt;4 cm. Thirteen (86.6%) men reported maintaining sexual activity after the surgery, with total penectomy in one of these cases. Eleven (73.3%) women reported continuing to have sexual relations, without concordance with the men’s response of two cases. Of the 13 patients who underwent partial penectomy, only 8 answered the IIEF-5 questionnaire. Of these, three (37.5%) developed mild erectile dysfunction (ED) and two (25%) developed moderate ED. Five (38.4%) out of 13 patients undergoing partial penectomy reported worsened EHS. Three (23.1%) women reported not reaching orgasm, although all had regular degree of satisfaction according to the FSFI-6. Regarding the preferred sexual positions for vaginal intercourse, five men (55.6%) reported preference for the position with the man on top, two (22.2%) with the woman on top, one (11.1%) the doggy-style, and one (11.1%) the lateral position. Of the seven women who reported vaginal sexual activity, four (57.1%) preferred the position with the man on top, one (14.3%) with the woman on top, one (14.3%) the doggy-style and one (14.3%) the lateral position. Adaptive behaviors were adopted by four men. Two (13.3%) began having sexual relations in the dark and the other two (13.3%) began using a silicone penis substitute for vaginal penetration. There was no statistically significant correlation between the size of the penile stump and the sexual satisfaction or type of sexual activity.

Conclusions
Sexual dysfunctions were present in all the couples after penectomy due to penile cancer. Nevertheless, the majority of couples reported continued active sexual life, despite the occurrence of mild erectile dysfunction in most cases. Many women reported regular sexual satisfaction, and were able to reach orgasm. Besides this, adaptive behaviors were used for the purpose of alleviating the impact of the penile mutilation and improving the sexual satisfaction of the couples. However, multicentric studies with larger samples are necessary.

Disclosure
No.