Psychological Effects in Men Who Have Undergone Treatment for Penile Cancer

The psychological effects of penile cancer surgery have been poorly researched, although it is relatively easy to speculate on the relevant issues. Mental illness has been observed in 20% of men who have undergone treatment for penile cancer, most commonly related to anxiety disorders. 1 3 The central theme relates to the patient's perception that masculinity has somehow been lost or diminished.4 There will be a notable change in the appearance of the penis, and a probable loss of length for those who have undergone penile surgery. As described earlier, penile size has historically been associated with attributes such as strength, virility, endurance, ability, courage, intelligence, and knowledge, and the psychological effects of any form of excisional surgery should not be underestimated.

Qualitative research suggests that one area of concern is the appearance.4 Even within a stable relationship, there may be reticence or embarrassment in showing the postoperative penis to their partner and particularly for single men this concern may result in a barrier to further relationships. The underlying concerns include fear of rejection or some form of sexual humiliation and therefore any surgical technique that produces a cosmetically acceptable appearance should theoretically alleviate this concern to some degree. There is some evidence that conservative surgery, including laser surgery has a lesser effect upon this problem. In one study 78% of men undergoing treatment with laser reported a satisfactory cosmetic result,12 while there are several studies suggesting that men undergoing penile-preserving surgery have a high satisfaction rate following surgery.14-16

Men who undergo surgery for penile cancer also have concerns in relation to the appearance of their penis in front of other men, as might be experienced in a urinal or in the communal showers of a sports club. Accordingly they often avoid the urinal and pass urine in private, while there is a tendency to avoid communal showers and changing rooms. Again the achievement of cosmetically acceptable outcomes by the use of more conservative surgical approaches should alleviate this, although data to support these techniques are limited.

It is in these areas of fear and anxiety regarding masculinity, sexual function, and voiding function that patient support is most important. It is important for the healthcare professional team to anticipate these concerns and to provide support, either verbal or written. Online resources for patients might be expected to help, but given the rarity of penile cancer, particularly in the Western world, the availability of good-quality patient information, written or electronic is currently limited. Healthcare professionals should provide support and information from the moment the patient first seeks medical attention. In the United Kingdom a dedicated penile cancer nurse specialist provides this support and acts as a point of contact for the patients as they make their journey through the treatment pathway (Fig. 15.1). They are able to explain the steps of investigation and treatment, while providing support for the practical problems and wound management issues (Figs. 15.2 and 15.3) outlined in this chapter. For those patients undergoing more radical surgery, patients can be introduced to the concept of phalloplasty reconstruction which can ultimately allow patients to improve their self-esteem and body image as well as allowing them to void standing (see Chap. 11).

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