Sylvie Marshall-Lucette

Discussing the sexual consequences of treatment in radiotherapy and urology consultations with couples affected by prostate cancer

Study Type – Attitude/patient experience analysis (retrospective cohort)

A critical review of the Couvade syndrome: the pregnant male

The Couvade syndrome is a global phenomenon occurring in industrialised countries around the world and has a wide international variance. It affects biological fathers particularly during the first and third trimesters of pregnancy with cessation of symptoms upon birth or shortly within the postpartum period. It does not appear in the nosology of the Diagnostic Statistical Manual of Mental Disorders: DSM—Version 4 (American Psychiatric Association, 2000) on the ICD—Version 10 (WHO, 1993). Nevertheless, early accounts tended to medicalise it as a psychosomatic disorder. Its relationship with socio‐demographic factors is inconsistent, with the exception of ethnicity. International studies reveal some contradictory findings in the type of symptoms. This may reflect methodological problems in the syndromes definition or criteria and type of measurement across studies. A plethora of theories has been put forward to account for the origins of the syndrome. Psychoanalytical theories contend that it is a consequence of the mans envy of the womans procreative ability or foetal rivalry. Psychosocial theories propose that it occurs due to the marginalisation of fatherhood and as part of a transitional crisis to parenthood. Paternal theories suggest a connection between the mans involvement in pregnancy, role preparation and the syndrome. However, some of these theories have not been thoroughly investigated. Those which have reveal inconsistent findings. It is recommended that future investigators use qualitative approaches to further illuminate the syndromes characteristics, definition and perceptions as seen by male partners. This should be followed by quantitative approaches of large heterogeneous samples to investigate the type, incidence, severity and distress of symptoms of the syndrome and its relationship with socio‐demographic factors.

A qualitative exploration of the Couvade syndrome in expectant fathers

The aim of this qualitative study is to explore the nature and duration of male partners somatic and psychological symptoms, across gestation and parturition, collectively called the Couvade syndrome. Fourteen men with expectant partners aged 19–48 years from diverse social and ethnic backgrounds were interviewed. The data was processed using qualitative analytical software WinMAX Professional and the emerging themes and sub‐categories identified and analysed. The first was ‘Emotional Diversity in Response to Pregnancy’, which varied with time and other factors and also included mixed and polarised feelings such as excitement, pride, elation, worries, fears, shock and reluctance. The second was ‘Nature, Management and Duration of Symptoms’, which revealed the types and duration of physical and psychological symptoms experienced by men. Attempts at managing these were influenced by social and cultural factors. Physical symptoms were more common than psychological ones, and their time course demonstrated trends similar to those reported for the Couvade syndrome. Although the former were reported to their GPs, no definitive diagnosis was made despite medical investigations being performed. The third theme, ‘Explanatory Attempts for Symptoms’ was influenced by cultural beliefs and conventions like religion, alternative medical beliefs or through the enlightenment by healthcare professionals in the process. Some participants were unable to find explanations for symptoms but some perceived that they were related in some way to the altered physiology of their female partners during pregnancy. These findings highlight the need for further research to acquire deeper insight into mens experiences of, and responses to, pregnancy as a way of explaining the syndrome.

Co-constructing sexual recovery after prostate cancer: a qualitative study with couples

Background Men are likely to experience deterioration in sexual functioning as a consequence of treatment for prostate cancer. Indeed, sexual difficulties are common across all treatment modalities. Objective To determine the impact of treatment for prostate cancer on intimacy and sexual expression/relationships from the perspective of couples. Methods An observational study was conducted including in-depth interviews with 18 people affected by prostate cancer; comprising eight couples and two individual men. Results Four categories were identified that illustrated the impact of prostate cancer on intimacy and sexual recovery. These related to social influences and language used to describe the loss or recovery of sexual activities; difficulties in discussing sexual activity with clinicians; the clash of individual impact of prostate cancer recovery versus the impact on the couple, and the re-integration of sexual activities into the relationship. Conclusions Though only one person in a partnership experiences cancer, these data indicated the extent to which prostate cancer treatment also impacts on partners. The study indicates that adjustment to erectile dysfunction (ED) takes time, but is a highly significant event in couples’ lives and its importance should not be under-estimated. Consequently, we suggest that relational models of care should be considered, whereby side-effects are recognised as impacting on both members of the partnership (for example ED, or lack or ejaculate). Supportive care in this context, therefore, may best be based on a relational approach using language and interventions that are appropriate to the patient and their situation.