Background: Male sexual dysfunction is extremely common after cancer treatment, particularly for prostate, bladder, or rectal cancer, but also after high-dose chemotherapy. Most men do not seek medical help. Only a minority achieve satisfying outcomes. The sexual partner is rarely included. To overcome these barriers, we are creating and evaluating a multimedia, interactive web site: Hard Times: Cancer and Men’s Sexual Health, presenting education, advice on finding medical care, and cognitive-behavioral sex therapy exercises for men or couples.

Methods: Information is presented in text, graphics, and animations, with photos of people varying in ethnicity, videotaped interviews with survivors, and video vignettes using actors. Content includes male sexual physiology; sexual side-effects of treatments for all common cancers; issues for adolescent and young adult survivors; dealing with central lines, ostomies, incontinence, or changed body image; advice on dating; medical and self-help strategies for problems with desire, erections, orgasm, and sexual pain; ways to prevent sexual problems, including penile rehabilitation; dealing with relationship issues, including sexual communication; avoiding unintended pregnancy or sexually-transmitted infections; religious and cultural issues; and special sections for partners, parents or friends of men with cancer.

In a randomized trial, 360 men seeking help from a urologist in the Sexual Medicine Clinic at MD Anderson Cancer Center will be assigned either to usual care, web site and phone counseling, or the intervention plus a patient-reported outcome measure to monitor satisfaction with the new treatment for erectile dysfunction. Partners will be invited to participate, Questionnaires will be completed at baseline, 12, and 24 weeks with sexual function/satisfaction as the primary outcome.

Future Goals: Our goal for Hard Times is to have an evidence-based intervention available for men worldwide who are concerned about or coping with cancer-related sexual dysfunction. Results from the randomized trial will shape the way we disseminate it.

Collaborators: Paul Martinetti, MD, Digital Science Technologies, LLC, Run Wang, MD, and Evan Odensky, MPH, UT MD Anderson Cancer Center; National Cancer Institute grant 5 R42 CA139822