AUA 2023: New Guidelines for Sexual Health Care with Prostate Cancer

( Dr. Daniela Wittman gave a summary of new guidelines from an international panel on sexual health care for prostate cancer patients. As background, she notes that sexual dysfunction is the most commonly reported health related quality of life outcome following therapies for prostate cancer, affecting men, partners, and their relationships. National origin, ethnicity, and race affect perspectives on gender roles, sexual orientation, relationships, culture driven health beliefs, disparities and access to health care, and uptake of healthcare offered.

In the recently published guidelines for sexual health care for prostate cancer patients in the Journal of Sexual Medicine, Dr. Wittmann and colleagues summarize recommendations from international panel. In today's talk, she reviews these recommendations. This was peer-reviewed by an international panel of multidisciplinary experts, 26 peer reviewers, and two patients. Following the comment review, the panel revised the draft as needed. The guidelines are a part of a broader Movember initiative to provide maximum support for men and their partners in prostate cancer survivorship. Movember provided funding for the guidelines methodologist. the key audience for this includes primary care providers, urologists, radiation and medical oncologist, sexual health counselors, nurses, physical therapists, patients, and their partners.

biopsychosocial sexuality.jpg

Many components contribute to cancer related sexual problems. these include biological, interpersonal, social cultural, and psychological components.

The guiding principles of the guidelines and management include:

  1. the health care worker plays an active role in routinely addressing sexual concerns and prostate cancer survivorship
  2. sexuality and sexual recovery are multidimensional
  3. the role of grief in mourning in couples is recovery of sexual intimacy has emerged as a path towards a new sexual paradigm despite sexual dysfunction
  4. men rarely return to baseline sexual function after prostate cancer treatment
  5. including the partner in sexual health counseling, if both partners agree, is preferable when men are partnered
  6. support by a multidisciplinary team of health care providers is needed to best assist & support men and their partners who desire to recover sexual intimacy after prostate cancer therapy

The guidelines had 47 statements, and these statements primarily focus on clinicians educating the patients and partners. The following are the guideline sections:

  1. counseling patients about the impact of prostate cancer therapies on the biopsychosocial aspects of sexuality (3 statements)
  2. counseling patients on the impact of individual prostate cancer therapies on sexual function (13 statements)
  3. assessment of sexual dysfunction and sexual distress (4 statements)
  4. lifestyle modification (1 statement)
  5. psychosexual treatment (6 statements)
  6. biomedical treatment (15 statements)
  7. lifestyle modification strategies (1 statement)
  8. clinician education (1 statement)
  9. healthcare programs and systems (3 statements)

In the first section, here are the 3 main statements:


In Part II, the statements (416) primarily focused on the impact of surgery, radiation, and hormonal therapy on the following domains.

  • Erectile dysfunction
  • Additional sexual impacts (change in penile length, decrease in ejaculate, potential penile curvature, orgasmic pain, low desire, climacturia, genital shrinkage)
  • Impact on fertility

Statements 4-6 are seen below:

statements 4 to 6.jpg

Statements 22-27 focus on Part 5 (psychosexual treatment):

statements 3.jpg

Part 6 focuses on biomedical treatments, including:

  • Nerve-sparing during prostatectomy
  • penile rehabilitation
  • erectile dysfunction therapies
  • treatment for other sexual problems
  • testosterone supplementation

Part 8 and 9 focus on clinician education and healthcare programs:

statement 44.jpg

statements 6

She ended by noting that these guidelines have been endorsed by multiple societies including the International Society for sexual medicine, sexual medicine Society of North America, Society of urologic nurses and associates, American psychosocial oncology.

Presented by: Daniela Wittmann, PhD, LMSW, Clinical Associate Professor, University of Michigan, Ann Arbor, MI

Written by: Thenappan (Thenu) Chandrasekar, MD – Urologic Oncologist, Associate Professor of Urology, University of California, Davis @tchandra_uromd @UCDavisUrology on Twitter during the 2023 American Urological Association (AUA) Annual Meeting, Chicago, IL, April 27 – May 1, 2023


  1. Wittmann D, Mehta A, McCaughan E, Faraday M, Duby A, Matthew A, Incrocci L, Burnett A, Nelson CJ, Elliott S, Koontz BF, Bober SL, McLeod D, Capogrosso P, Yap T, Higano C, Loeb S, Capellari E, Glodé M, Goltz H, Howell D, Kirby M, Bennett N, Trost L, Odiyo Ouma P, Wang R, Salter C, Skolarus TA, McPhail J, McPhail S, Brandon J, Northouse LL, Paich K, Pollack CE, Shifferd J, Erickson K, Mulhall JP. Guidelines for Sexual Health Care for Prostate Cancer Patients: Recommendations of an International Panel. J Sex Med. 2022 Nov;19(11):1655-1669. doi: 10.1016/j.jsxm.2022.08.197. Epub 2022 Oct 1. PMID: 36192299.