The sexual functions of the Peyronie's disease patient's partner before and after surgical curvature correction treatment.

Illiano E1, Trama F2, Marchesi A2, Natale F3, Costantini E2

Research Type

Clinical

Abstract Category

Pelvic Pain Syndromes

Abstract 335
ePoster 5
Scientific Open Discussion Session 21
On-Demand
Sexual Dysfunction Surgery Quality of Life (QoL)
1. Andrology and Urogynecological Clinic,Santa Maria Terni hopsital,University of Perugia, 2. Andrology and Urogynecological Clinic,Santa Maria Terni hopsital,University of Perugi, 3. Urogyneoclogical Clinic ,San Carlo Nancy Rome
Presenter
F

Francesco Trama

Links

Abstract

Hypothesis / aims of study
Peyronie's disease (PD) usually affects men between 55 and 60 years of age, with a prevalence varying between 0.5% and 20.3% It is characterized by a disorder of the albuginea tunic in which first fibrotic plaque appears and then calcifies. However, in accordance with the 2019 EAU guidelines, surgical treatment is the only effective method for resolution of the curvature generated by the pathology and consequent patient satisfaction. Surgical treatment is performed in patients with stabilized disease for at least 6 to 12 months. From the psychological point of view, the progression of the pathology leads to difficulties in penetration, a consequent decrease in the feeling  with one's partner, decrease in the frequency of sexual intercourse, and can lead to social isolation and depression. Therefore, one can define a pathology that affects the couple in the sexual sphere tout-court.
The primary objective of the study is to assess the sexual functions of the PD patient's partner before and after surgical curvature correction treatment.
The secondary objective is to evaluate the sexual sphere of the man and the pain perceived during penetration by the patient before and after treatment
Study design, materials and methods
This is a prospective observational study, accepted by the local ethics committee. Inclusion criteria: female partners aged >18 years of PD patients undergoing corporoplasty with multiple pleating.
Male partners >18 years of age with a penile curvature between 60° and 20° that has been onset for at least 12 months, in the absence of pain in erection, underwent corporoplasty with multiple pleating. The couple had to have a sexual relationship ≥6 months. 
Exclusion criteria: female partner of PD patients undergoing pelvic surgery within one year, a male partner with penile curvature >60° or persistent curvature for less than 12 months, watch slide curvature, an International Index of erectile function 15 (IIEF15) questionnaire with evaluation of erectile function subdomain, males <18 years old, and a male patient who underwent previous penile surgery.Upon enrollment, all participants signed an informed consent. Demographic and clinical data of male partners and demographic and clinical data of female partners were collected. 
The preoperative evaluation of PD patients included: anamnesis, local objective examination, measurement and deviation of penile curvature while having an erection obtained by intracavular injection of Alprostadil 10 mcg and measured with a goniometer, B mode ultrasound to measure plaque length, and administration of the Visuo analogic scale (VAS) questionnaire to quantify penile pain during vaginal penetration.
In addition, the IIEF 15 questionnaire was administered to assess the following domains: erectile function (items 1-5 and 15), orgasmic function (items 9-10), sexual desire (items 11-12), intercourse satisfaction (items 6-8), overall satisfaction (questions 13-14). During the preoperative phase, the female partner was given the Functional Sexual Function Index (FSFI) made up of 19 items encompassing the six domains: desire (items 1-2), arousal (items 3-6), lubrication (items 7-10), orgasm (items 11-13), satisfaction (items 14-16), and pain (items 17-19). 
Single domain scores on the FSFI range from 0 to 6, with a higher score indicating better sexual function and less pain, and a score of zero indicating no sexual activity during the previous four weeks.An FSFI total score of 26.55 or less indicates that the woman may have sexual dysfunction.The surgical procedure was performed by two seniors surgeons. The follow-up was performed by a surgeon other than the one who performed the surgical procedure.Statistical analysis was performed using the McNemar Chi-Square test to compare paired categorical variables and the paired T-test for continuous parametric variables, the Wilcoxon and Kruskal-Wallis test for quantitative variables and for mean and median values, respectively. All calculations were performed using IBM-SPSS® version 22.0 (IBM Corp., Armonk, NY, USA, 2013). We considered p <0.05 to be statistically significant.
Results
The average age of female partners was 54.5±11.9 years and male partners 57.5±11.4 years. 
Of the couples, 65.7% were married, 22.8% were unmarried, and 11.4% were cohabiting; 60% of the women had a secondary school diploma, 34.3% a university degree, 5.7% a secondary school diploma; 22.9% of the women worked, while 2.9% were unemployed. Of the working women, 22.9% were employed in the public administration, 20% were businessmen, and 14.3% were teachers or pensioners. The remaining professions were not relevant. 34.2% of the men were executives, 28.5% were businessmen, and 22.8% were teachers. 
The mean curvature was 53.4±9.1 degrees, mostly dorsal (51.4%) with plates 1-2 cm in size. FSFI in women prior to surgical correction of La Peyronie's disease in partners had a median of 25.5 (range 63 - 10), with greater impairment of the orgasmic phase and the presence of pain during sexual intercourse. Three months after the surgical procedure, all FSFI domains improved statistically significantly (p <0.0001), achieving satisfaction with sexual intercourse and decreasing pain and discomfort in women (Table 1). Moreover, in the male partners at the follow-up visit, there was an improvement in four domains of the IIEF-15, particularly in desire (p = 0.003) and both general and sexual satisfaction (p <0.0001) (Table 2). After surgery, there was no statistically significant improvement in erectile function (p=0.05). Patients with persistent erectile dysfunction were treated with PDE5i and obtained satisfactory sexual intercourse. Pain decreased significantly, with a median VAS value from 6 to 2.5 (p<0.05). Three months after surgical treatment, 97.1% of the patients had no residual curvature. In one patient, a residual curvature of <20° persisted but did not require further treatment.
Interpretation of results
Our study has shown that La Peyronie's disease also has a negative impact on the sexuality of the female partner as well as the patient himself, and that surgical treatment improves the sexual sphere of the couple.
In our study, all patients showed impairment of sexual function prior to surgical treatment. Patients with PD, in fact, felt embarrassment towards themselves, loss of their virility as a consequence of penile deformity, and fear of not satisfying their partner sexually. Coital pain remains at the base of the "vicious circle" and the consequent "sexual crisis" of the couple. In fact, dyspareunia in this case is a "couple's pain". 
Dyspareunia directly interferes with the excitement. In fact, pain is the most powerful reflex inhibitor of genital arousal, and also of the lubrication and congestion phase.This causes vaginal dryness and makes penetration even more painful, difficult, or impossible.Indirectly, lower congestion reduces or prevents the formation of the orgasmic platform, so that orgasm, especially coital, it becomes difficult or impossible.
Pain, dissatisfaction, and disappointment then provoke a progressive braking of desire and of all sexual function, leading to a frank avoidance of erotic intimacy.
The patient has pain due to PD, often during ejaculation, when the erection peaks; the woman likely has pain when the partner attempts penetration
Concluding message
Our study shows that La Peyronie's Disease, like other male sexual dysfunctions, has a negative impact on female sexual function. Disease treatment leads to improved sexual function in both partners. Therefore, urologists have the task of always investigating the sexual function of the couple, if stable. The approach to the couple rather than to the patient alone could, in fact, improve the perception of the pathology by both, with better functional and psychological results.
Figure 1
Figure 2
Disclosures
Funding None Clinical Trial No Subjects Human Ethics Committee CEAS Helsinki Yes Informed Consent Yes
24/07/2024 05:20:08