Academic journal article International Journal of Men's Health

Older Men and Sexual Function: Is BPH Treatment a High Stakes Decision?

Academic journal article International Journal of Men's Health

Older Men and Sexual Function: Is BPH Treatment a High Stakes Decision?

Article excerpt

How the possibility of treatment-induced sexual dysfunction affects men's decision making about benign prostatic hyperplasia (BPH) treatment has not been well studied. As part of a study (N = 188) of older men's reactions to a videotape BPH treatment decision aid, narrative data were analyzed for 74 men who stated concerns about treatment-induced sexual dysfunction. College-educated men (n = 54) were more likely than non-college educated men (n = 20) to mention sexual concerns. A substantial proportion of men appeared to view BPH treatment decision making as "high stakes" due to the risk of sexual dysfunction, including 23% who preferred watchful waiting to "riskier" medications or surgery. The extent to which these concerns also occur but are not necessarily stated by non-college educated men requires additional investigation. Within a partnership health care approach, clinicians who are counseling men about BPH treatment options should ask about possible concerns about treatment-induced sexual dysfunction.

Keywords: benign prostatic hyperplasia; decision-making; sexual function; treatment preferences

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Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate gland that is highly prevalent in older men. BPH can cause bothersome symptoms such as urinary hesitancy and frequency that can significantly impact the quality of life. However, BPH treatments can cause unwanted side effects that include the possibility of impaired sexual function. Limited information is available about how men view tradeoffs between BPH symptoms and treatment risks. Older adults often remain and value being sexually active well into later life (Meston, 1997). Enhanced healthcare partnership approaches (Coulter, 1999) place a heightened emphasis on patient preferences regarding the acceptability of benefit/risk tradeoffs in treatment decisions that impact quality of life, such as sexual well-being.

The purpose of the analysis in this paper is to examine how the possibility of sexual dysfunction is incorporated in the BPH treatment decision making of older black and white American men. The context of the analysis is the viewing of a videotape BPH treatment decision aid. The partnership model of collaboration between clinicians and patients is supported via tools such as patient decision aids that inform and empower patients for collaborative treatment decision making. The analysis is part of a larger study done to assess the responses of older men (N = 188) (Rovner et al., 2004) to a previously well-tested BPH decision aid (FIMDM, 2000).

METHODS

SAMPLE

The data for this analysis arose from the spontaneous comments of 74 men (from among N = 188) who expressed concerns about sexual dysfunction as they were interviewed while watching the BPH videotape. The 74 men included black and white American men with college and noncollege levels of education, recruited from community settings in an area of Michigan (see Table 1 for sample characteristics).

CLINICAL CHARACTERISTICS AND MEASURES

Men of the appropriate age to experience BPH (age 43-83; M = 61 [+ or -] 8 years) were selected for the relevance of the health decision task. The men were on average experiencing mild/moderate symptoms of BPH and low "symptom bother" at the time of the interview (Rovner et al., 2004). BPH symptom severity was measured using the American Urologic Association (AUA) scale, and symptom bother was assessed via a modified version of the Barry et al. (Barry, Mulley, Fowler, & Wennberg, 1988) scale. General health was measured on a five-point scale from the Short Form 36 health status measure. Most men reported being in good health (M = 3.6, SD = 1.0); 54 were married, 16 divorced/separated, two never married, and one widowed, and one did not specify his marital status. College educated men (n = 54) were more likely than non-college educated men (n = 20) to mention sexual concerns. …

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