Prostatectomy and sexual function.

Benign prostatic enlargement occurs almost universally in the male population, typically beginning at age forty years. It has been estimated that by age sixty more than 50 per cent of males experience some kind of prostate problem; this figure increases with advancing age. la2 As the number of males over age fifty-five in the population is increasing, one can expect a growing number of males to manifest symptoms of benign enlargement of the prostate. Surgery is the treatment of choice when symptoms become severe. All types of surgical procedures commonly disrupt sexual functioning, as does physical illness in general. In many instances, however, there is no identifiable organic cause and the nature of the mediational link between these events appears to be cognitive rather than physiologic.3,4 The aging process itself brings qualitative changes to the sexual response, as, indeed, it does to many physical abilities.5 However, physiologic aging, illness, and medication side effects do not adequately account for the frequently noted accelerated decline of sexual activity with age.6 This phenomenon appears to be related to North American attitudes regarding sexuality, specifically the cultural censure of sexual activity and the opinion held by society in general that sexual activity in older individuals is not desirable.7 Within the aging population itself, sexual attitudes, lack of knowledge concerning the effects of aging on sexual response as well as motivational factors have been implicated in the decline of sexual activity with age. ~9 Surgery involving the sexual organs may pose a serious hazard to an aging male population already vulnerable to sexual difficulties. In the case of prostatectomy, false beliefs and misinformation concerning the