Sexual function is commonly affected after treatment for localised prostate cancer (PCa). Various sexual aids (SA) can be used to improve sexual function. The aim of this study is to report the prevalence of self-reported SA use after PCa treatment and correlate this with patient-reported sexual function at a population-based level.

We included men diagnosed with PCa between 2009 and 2022 in the Victorian Prostate Cancer Outcomes Registry (PCOR-VIC) in Australia, who had active treatment and completed the questionnaire on SA use and the Expanded Prostate Cancer Index Composite 26 (EPIC26) 12-months post-treatment. The primary outcomes were the prevalence of self-reported SA use, and correlation of SA use with the EPIC26 sexual function score. Multivariable logistic regressions were used to evaluate factors associated with SA use. Multivariable linear regressions were used to evaluate differences in EPIC26 sexual function score between men who used vs did not use SA.

Of the 8982 men included in this study, 4180 (47%) reported SA use. The type of SA use included: oral medications (3842/4180, 92%), intra-urethral suppositories (32/4180, 0.8%), penile injections (933/4180, 22%), and vacuum erection devices (924/4180, 23%). Of the men who reported SA use, 56% (2360/4180) reported that the SA were helpful. Men with high-risk PCa were less likely to use SA compared to men with low-risk PCa (30% vs 60%). 57% of men who had surgery, 27% who had radiotherapy alone, and 9% who had radiotherapy with androgen deprivation therapy reported SA use. 53% and 37% men who had treatment in private and public institutions, respectively, reported SA use. 52% men from highest socioeconomic quintiles and 38% men from lowest socioeconomic quintiles reported SA use. In multivariable analyses, age, NCCN risk categories, type of treatment, treatment institutions and socioeconomic status were independently associated with SA use. Men who reported SA use and found it helpful had significantly better sexual function score (median=43.0, IQR=20.8-66.7), compared to men who did not use SA (median=16.7; IQR=9.7-29.2), with adjusted mean differences of 16.1 (95%CI=14.7-17.4, P<0.001).

This is the largest population-based study on SA use after PCa treatment. 1-in-2 men reported SA use, with approximately half reported SA to be helpful and had improved sexual function. This highlights the importance of discussion on SA use after treatment for PCa.