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Denes A, Ussher JM, Power R, Perz J, Ryan S, Hawkey AJ, Dowsett GW, Parton C. LGBTQI Sexual Well-Being and Embodiment After Cancer: A Mixed-Methods Study. JOURNAL OF SEX RESEARCH 2024:1-18. [PMID: 39073073 DOI: 10.1080/00224499.2024.2378884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
This study examined lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) cancer patients' sexual well-being post-cancer, and the associations between sexual well-being and social support, physical concerns, distress, quality of life (QOL), and coping. We used a mixed-methods approach, including 430 surveys and 103 interviews, representing a range of tumor types, sexual and gender identities, age groups, and intersex status. The findings indicated that LGBTQI people with cancer experience declines in sexual well-being following cancer, which are associated with reduced QOL, greater physical concerns, and lower social support. The perceived helpfulness of coping mechanisms was associated with greater sexual well-being across genders, with cisgender men reporting the sharpest declines in sexual well-being and highest use of coping mechanisms. Across all groups, searching for information online was the most frequently used coping mechanism, with support groups and counseling the most under-utilized. Qualitative findings facilitated interpretation of these results, providing examples of ways in which cancer impacted sexual well-being and how physical changes influence sexual embodiment or desire to engage in sex. Concerns about reduced sexual desire and activity, associated with changes to breasts, vulva, vagina, penis, erectile dysfunction, incontinence, scarring, and stoma, reflect previous findings in the non-LGBTQI cancer population. Unique to this population are the impact of physical changes on LGBTQI embodiment, including disruption to sexual and gender identities, and feelings of disconnection from queer communities. Addressing LGBTQI sexual well-being within oncology healthcare is a matter of sexual and reproductive justice, for a population whose needs are often overlooked within cancer care.
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Affiliation(s)
- Amanda Denes
- Department of Communication, University of Connecticut
| | - Jane M Ussher
- Translational Health Research Institute, Western Sydney University
| | - Rosalie Power
- Translational Health Research Institute, Western Sydney University
| | - Janette Perz
- Translational Health Research Institute, Western Sydney University
| | - Samantha Ryan
- Translational Health Research Institute, Western Sydney University
| | | | - Gary W Dowsett
- Australian Research Centre in Sex, Health and Society, La Trobe University
| | - Chloe Parton
- School of Health, Te Herenga Waka - Victoria University of Wellington
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Donz R, Russia B, Barbaret C, Braybrook D, Perceau-Chambard E, Reverdy T, Economos G. What contributes to promote sexual health in cancer palliative care? A realist review. Sex Med Rev 2024; 12:334-345. [PMID: 38508856 DOI: 10.1093/sxmrev/qeae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Sexuality is an important determinant of the overall health of a population and remains so at the end of life and in patients with advanced cancers. Despite the abundant literature on sexuality and intimacy, these topics have been rarely discussed in the context of cancer palliative care, and very few interventions to promote sexual health in patients undergoing cancer palliative care have been explored. OBJECTIVES In this study we sought to identify which factors and mechanisms contribute to promoting sexual health in cancer palliative care. METHODS A realist review was performed according to the guidelines of the realist and meta-narrative evidence synthesis method guidelines. Articles published between January 2010 and June 2021 were searched in 4 databases. Records were screened for their relevance regarding a predefined list of context-mechanism-outcome (CMO) configurations. Abstracts were independently screened by 2 authors before the data were extracted from the full-text articles selected for inclusion. With the use of abductive and retroductive reasoning techniques, each article was examined for evidence of its contribution to one of the CMO configurations, which could be refined when relevant. The data were summarized according to the final CMO configurations. RESULTS Of the 2056 articles identified, 38 articles were included in the review. The data reported in these articles contributed to 7 CMO hypotheses: (1) improving communication skills, (2) healthcare provider training, (3) reorganizing the patient environment in care settings or at home, (4) managing sexual symptoms and also general symptoms, (5 and 6) patient-centered counseling or couple counseling, and (7) lifting the taboo. CONCLUSIONS The findings reported here highlight various ways to improve sexual health for patients in cancer palliative care but are limited to genital cancers. Further research should consider all types of cancer rather than being restricted to genital cancers.
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Affiliation(s)
- Roxane Donz
- Centre de soins palliatifs, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Benite 69495, France
- Centre pour l'Innovation en cancérologie de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon Sud, EA 3738, 69921 Oullins
| | - Bruno Russia
- Hospitalisation à domicile, Centre Léon Bérard, Lyon 69008, France
| | - Cécile Barbaret
- Service de soins palliatifs, CHU de Grenoble, La Tronche 38700, France
| | - Debbie Braybrook
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London SE5 9PJ, United-Kingdom
| | - Elise Perceau-Chambard
- Centre de soins palliatifs, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Benite 69495, France
| | - Thibaut Reverdy
- Centre pour l'Innovation en cancérologie de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon Sud, EA 3738, 69921 Oullins
- Oncology Department, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Benite 69495, France
| | - Guillaume Economos
- Centre de soins palliatifs, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Benite 69495, France
- Centre pour l'Innovation en cancérologie de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon Sud, EA 3738, 69921 Oullins
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Haber L, Allen A, Rune KT. Sexual quality of life following a cancer diagnosis: a qualitative study. Support Care Cancer 2023; 31:125. [PMID: 36680658 PMCID: PMC9860240 DOI: 10.1007/s00520-022-07459-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 11/28/2022] [Indexed: 01/22/2023]
Abstract
Sexual quality of life (SQoL) challenges are prevalent and persistent for people with a cancer diagnosis. Using a qualitative design, this study investigated the impact of a cancer diagnosis on SQoL in participants (N = 18) with a current or past cancer diagnosis of various sites and severity. Thematic analysis identified three themes: gender attachment, vulnerability, and growth vs. fixed mindset. The theme of gender attachment related to the impact of understanding SQoL based on heteronormative definitions of masculinity and femininity. The second theme of vulnerability suggested that pre-existing relational or personal challenges can amplify the impact of a cancer diagnosis on SQoL. The third theme of growth vs. fixed mindset explored how cognitive flexibility and optimism can support SQoL, while a rigid and pessimistic mindset can exacerbate SQoL challenges. The findings of this study build on the traditional medical understanding of SQoL and can inform SQoL support in cancer care settings.
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Affiliation(s)
- Lauren Haber
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia
| | - Andrew Allen
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia
| | - Karina T Rune
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia.
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Hundie GY, Sendo EG, Habte T. Ethiopian women's sexual experiences and coping strategies for sexual problems after gynaecological cancer treatment: a qualitative study. BMJ Open 2022; 12:e057723. [PMID: 35361650 PMCID: PMC8971758 DOI: 10.1136/bmjopen-2021-057723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE This study explored women's sexual experiences and coping strategies for sexual problems after gynaecological treatment. SETTING The research was carried out at Tikur Anbessa Specialized Hospital, one of the two cancer centre hospitals in the country. STUDY DESIGN A phenomenological qualitative study design was employed in this study. STUDY PARTICIPANTS Participants were recruited using purposeful sampling. Thirteen eligible study participants were interviewed face to face. Data were collected from 2 February to 15 March 2019 and analysed at the same time. For data analysis, thematic analysis was used, which comprises three stages: data reduction, data display and data conclusion. RESULTS Four themes resulted from the analysis of individual interview data, including treatment side effects, sexual issues following radiation therapy, lack of awareness regarding cancer treatment and sexual dysfunction, and coping strategies for sexual dysfunction following gynaecological cancer treatment. Three subthemes emerged as coping mechanisms for managing sexual issues and dysfunction among Ethiopian women with gynaecological cancer: avoiding sexual intercourse, praying for healing and seeking professional help. These themes were identified as the rich and detailed account of the experiences of sexually active women who have received treatment for their cervical cancer. CONCLUSION This study has broadened the perspectives on sexuality in the setting of gynaecological cancer and challenged certain commonly held beliefs about sexuality after treatment. Researchers should look into how inclusive sexuality education and training may be better integrated into the training programmes of healthcare workers. More research is needed to learn how partners of women with gynaecological cancer cope with sexual changes after treatment, how the couple as a partnership negotiates changes after treatment, and the facilitators and barriers that healthcare providers face when discussing sexuality issues with patients.
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Affiliation(s)
| | | | - Teshome Habte
- Nursing, Addis Ababa University, Addis Ababa, Ethiopia
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Jonsdottir JI, Vilhjalmsson R, Svavarsdottir EK. Effectiveness of a couple-based intervention on sexuality and intimacy among women in active cancer treatment: A quasi-experimental study. Eur J Oncol Nurs 2021; 52:101975. [PMID: 34020136 DOI: 10.1016/j.ejon.2021.101975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the effectiveness of a strenghts-oriented therapeutic conversation intervention on confidence about how illness beliefs affect sexuality and intimacy and on perceived relationship quality among women in active cancer treatment and their partners. METHODS A quasi-experimental single-group pre-post-follow-up design was used. Women in active cancer treatment and their intimate partners were randomly assigned to a nurse-managed couple-based intervention (experimental group, n = 30 couples) or wait-list (delayed intervention) control group (n = 27 couples) plus 4 additional couples who pilot tested feasibility of the intervention, prior to the RCT. However, baseline differences in demographic and clinical variables prevented comparisons between groups. Therefore, a repeated-one-group pre-post test setup was used, comparing women with cancer and their partners over three time points. The intervention consisted of three Couple-Strengths-Oriented Therapeutic Conversations (CO-SOTC) sessions. The participants also had access to web-based evidence-based educational information. Data were collected before intervention (T1, baseline), one to two weeks post-intervention (T2), and after a follow-up session at three months (T3). Data from 60 couples (N = 120) were analyzed. RESULTS Significant differences were observed, for both women and intimate partners, over time in more confidence about how illness beliefs affected sexuality and intimacy (T1 versus T2, and T1 versus T3), and increased overall quality of the relationship (T1 versus T2, and T1 versus T3). No differences were found between dyad members' scores on illness beliefs or relationship quality at any time point. CONCLUSIONS The CO-SOTC intervention was effective in supporting sexual adjustment among women in cancer treatment and their intimate partners. TRIAL REGISTRATION NUMBER NCT03936400 at clinicaltrials.gov.
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Affiliation(s)
- Jona Ingibjorg Jonsdottir
- Landspitali-The National University Hospital of Iceland, Hringbraut, 101, Reykjavik, Iceland; School of Health Sciences, Faculty of Nursing, University of Iceland, Eirberg, Eiríksgata 34, 101, Reykjavík, Iceland.
| | - Runar Vilhjalmsson
- School of Health Sciences, Faculty of Nursing, University of Iceland, Eirberg, Eiríksgata 34, 101, Reykjavík, Iceland.
| | - Erla Kolbrun Svavarsdottir
- Landspitali-The National University Hospital of Iceland, Hringbraut, 101, Reykjavik, Iceland; School of Health Sciences, Faculty of Nursing, University of Iceland, Eirberg, Eiríksgata 34, 101, Reykjavík, Iceland.
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Che Ya SN, Muhamad R, Mohd Zain N, Zakaria R, Ishak A, Hassan II, Ab Hadi I, Yahya MM, Low WY, Liamputtong P. Coping Strategies for Sexual Problems and Sexual Dysfunction Amongst Malay Women With Breast Cancer. A Qualitative Study. Sex Med 2021; 9:100336. [PMID: 33794448 PMCID: PMC8240168 DOI: 10.1016/j.esxm.2021.100336] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Women’ sexuality becomes complex after breast cancer diagnosis and sexual health is highly neglected in the management of the illness. Aims To explore the coping and strategies to overcome sexuality problems and sexual dysfunction among women with breast cancer. Material and Methods Using the in-depth and photo-elicitation interview methods, this qualitative study following phenomenological analysis was conducted on fourteen married female respondents with breast cancer and had the positive result for female sexual dysfunction (FSD) screened by Female Sexual Function Index (FSFI-6 items) from Kelantan, Malaysia. The interviews data were audio-recorded, transcribed verbatim and managed in analytic computer software NVivo11 Pro. The transcriptions were analyzed using thematic analysis by referring to the meaning-making theory. Main Outcome Measures We identified overlapping themes of coping and strategies among women with breast cancer to overcome sexual problems and sexual dysfunction which correspond with meaning-making theory. Results Three themes have emerged. Women with breast cancer that developed sexuality problem and sexual dysfunction strived to accept the illness using religious belief and conform by altering sexual practices. These individuals positively look for a solution by seeking formal healthcare advice, modify their physical appearance, active discussion with the husband and support from other survivors. A few of them passively struggle with the subject by averting the intimacy and receptive toward polygamy. Conclusion This study highlighted the various mechanisms that emphasized the pivotal role of religious belief and relationship context as key factors in the coping strategies among women with breast cancer in Malaysia. The finding may not be generalized to other countries. Che Ya SN, Muhamad R, Zain NM, et al. Coping Strategies for Sexual Problems and Sexual Dysfunction Amongst Malay Women With Breast Cancer. A Qualitative Study. Sex Med 2021;9:100336.
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Affiliation(s)
- Siti Nuryati Che Ya
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Rosediani Muhamad
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia; BesTaRi Unit, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
| | - Norhasmah Mohd Zain
- Nursing Program, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Rosnani Zakaria
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Azlina Ishak
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Intan Idiana Hassan
- Nursing Program, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Imisairi Ab Hadi
- Department of Surgery, Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia
| | - Maya Mazuwin Yahya
- BesTaRi Unit, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia; Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Wah Yun Low
- Department of Medicine and Asia-Europe Institute, University of Malaya, Kuala Lumpur, Malaysia
| | - Pranee Liamputtong
- Translational Health Research Institute (THRI), Western Sydney University, Cambelltown, Locked Bag 1797, Penrith, NSW 2751, Australia
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Logue CA, Pugh J, Jayson G. Psychosexual morbidity in women with ovarian cancer. Int J Gynecol Cancer 2020; 30:1983-1989. [PMID: 33115791 PMCID: PMC7788483 DOI: 10.1136/ijgc-2020-002001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 12/18/2022] Open
Abstract
Increasing numbers of women are surviving for longer with epithelial ovarian cancer. Consequently, there is increased focus on long-term quality of life in national guidance. Psychosexual morbidity including vaginal dryness, pain during intercourse (dyspareunia), reduced libido, and negative perceived body image exacerbate stress and anxiety and impact intimate relationships. Although a priority for women with epithelial ovarian cancer, clinicians seldom discuss sexual problems. Therefore, psychosexual morbidity and the associated distress remain unaddressed. We synthesize evidence from primary qualitative and quantitative research studies exploring psychosexual morbidity in women with epithelial ovarian cancer to identify potential risk factors and common symptoms, to facilitate the identification and management of sexual problems in clinic. Literature (2008–19) from 10 databases identified 29 suitable publications (4116 patients). The papers were assessed to answer the question: “What are the key potential risk factors and presentations of psychosexual morbidity in women with epithelial ovarian cancer?” Current literature lacks consensus in defining clinically significant psychosexual morbidity in women with epithelial ovarian cancer. Discrepancies in measurement tools, questionnaires, and primary outcome measures confound result interpretation, limiting wider application. Key potential risk factors identified included: younger age (<53 years); pre-menopausal status at diagnosis; aim of treatment; extent of surgery; more courses of chemotherapy; cardiovascular co-morbidities; and anxiety and depression. Up to 75% of women with epithelial ovarian cancer reported adverse changes in their sex lives following diagnosis and, of the sexually active, vaginal dryness affected 81–87% and pain 77%. Other prevalent symptoms included: reduced sexual desire and activity, impaired orgasm, diminished perceived body image, and reduced partner intimacy. Psychosexual morbidity represents a significant unmet need for women with epithelial ovarian cancer. Effective treatment necessitates a multimodal approach encompassing medical, psychoeducational, and physiotherapy-based strategies. Future studies need agreement in their questionnaires, definitions, thresholds, and primary outcome measures for meaningful interstudy comparisons to be drawn.
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Affiliation(s)
- Chloe Alice Logue
- Gynaecological Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester, UK
| | - Julia Pugh
- Gynaecological Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Gordon Jayson
- Gynaecological Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK .,Division of Cancer Sciences, University of Manchester Faculty of Biology, Manchester, UK
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Skorupska K, Rechberger T, Wrobel A, Winkler I, Miotla P. Long-Term Follow-Up of Sexual Dysfunction in Women Following Allogeneic Hematopoietic Stem Cell Transplantation. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:667-671. [PMID: 30132158 PMCID: PMC6373238 DOI: 10.1007/s10508-018-1296-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/30/2018] [Accepted: 08/11/2018] [Indexed: 06/08/2023]
Abstract
Chronic graft-versus-host disease is the most common late complication following allogeneic hematopoietic stem cell transplantation. The aim of this study was to present the outcomes of two successful vaginal reconstructions. Patient 1 received chemotherapy for leukemia and underwent bone marrow transplantation (BMT). The patient was sexually inactive for 9 years. In 2012, she was diagnosed with complete vaginal obliteration and underwent vaginal reconstruction. Patient 2 underwent chemotherapy (myeloablative therapy), was sexually inactive for 3 years and was then diagnosed with complete vaginal obliteration. In January 2013, she had vaginal reconstruction with cervical dilatation. Hormonal replacement therapy was administered to both patients. The results of dedicated questionnaires revealed decent quality-of-life and normal sexual functioning and continence status after surgery. Obliteration of the vagina after BMT can be prevented, but if it occurs, vaginal reconstruction surgery should be offered to any patients suffering from obliteration. Our results show that this therapy enables patients to have normal sexual lives without compromising their continence status.
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Affiliation(s)
- Katarzyna Skorupska
- 2nd Department of Gynecology, Medical University in Lublin, Jaczewskiego Street 8, 20-954, Lublin, Poland
| | - Tomasz Rechberger
- 2nd Department of Gynecology, Medical University in Lublin, Jaczewskiego Street 8, 20-954, Lublin, Poland
| | - Andrzej Wrobel
- 2nd Department of Gynecology, Medical University in Lublin, Jaczewskiego Street 8, 20-954, Lublin, Poland
| | - Izabela Winkler
- St. John's Cancer Center Lublin II Clinic of Gynecology, Lublin, Poland
| | - Pawel Miotla
- 2nd Department of Gynecology, Medical University in Lublin, Jaczewskiego Street 8, 20-954, Lublin, Poland.
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Collaço N, Rivas C, Matheson L, Nayoan J, Wagland R, Alexis O, Gavin A, Glaser A, Watson E. Prostate cancer and the impact on couples: a qualitative metasynthesis. Support Care Cancer 2018; 26:1703-1713. [PMID: 29511952 DOI: 10.1007/s00520-018-4134-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 02/25/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE To review and interpret existing qualitative literature on the experiences of couples affected by prostate cancer (PCa). METHODS A metasynthesis was carried out which included a systematic search of seven databases between 2000 and 2016. A modified version of Noblit and Hare's meta-ethnographic approach was used to synthesise qualitative study findings and inform overarching interpretations. RESULTS Thirty-seven studies focusing on the experiences of men with PCa and their partner dyad were included producing seven interconnected constructs. The construct accepting change vs seeking continuity reflects the range of ways individuals within the dyad and couples adjust to the diagnosis. Cultivating connection vs disengaging illustrates how couples seek to manage the impact of PCa and its treatment on their relationship, which may lead to a threatened identity, including sexual insecurities. Shielding me, you and us reflects the ways in which couples strive to protect themselves as individuals and/or each other from the impact of PCa. Being a partner and its challenges highlights the responsibilities partners assume and the impact of their supporting role. Yet, partners sometimes report feeling unsupported and side-lined both by the man they are caring for and by healthcare professionals. Couples often recognise the value of facing PCa together. CONCLUSIONS PCa affects both members of the dyad as individuals, as well as the couple's relationship. How best to support couples and how to overcome difficulties in expressing their concerns to one another requires further consideration. Healthcare professionals should endeavour to employ a couple-focused approach where appropriate.
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Affiliation(s)
- Nicole Collaço
- Faculty of Health and Life Sciences, Oxford Brookes University, Jack Straws Lane, Oxford, OX3 0FL, UK.
| | - Carol Rivas
- Faculty of Health Sciences, University of Southampton, S017 1BJ, Southampton, UK
| | - Lauren Matheson
- Faculty of Health and Life Sciences, Oxford Brookes University, Jack Straws Lane, Oxford, OX3 0FL, UK
| | - Johana Nayoan
- Faculty of Health Sciences, University of Southampton, S017 1BJ, Southampton, UK
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, S017 1BJ, Southampton, UK
| | - Obrey Alexis
- Faculty of Health and Life Sciences, Oxford Brookes University, Jack Straws Lane, Oxford, OX3 0FL, UK
| | - Anna Gavin
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Public Health, Queen's University, Belfast, BT12 6BA, UK
| | - Adam Glaser
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, Worsley Building, Leeds, LS2 9NL, UK
| | - Eila Watson
- Faculty of Health and Life Sciences, Oxford Brookes University, Jack Straws Lane, Oxford, OX3 0FL, UK
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Wassersug R, Wibowo E. Non-pharmacological and non-surgical strategies to promote sexual recovery for men with erectile dysfunction. Transl Androl Urol 2017; 6:S776-S794. [PMID: 29238658 PMCID: PMC5715194 DOI: 10.21037/tau.2017.04.09] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 03/30/2017] [Indexed: 12/22/2022] Open
Abstract
Erectile dysfunction (ED), the most commonly reported sexual problem for men, reduces the quality of life for both patients and their partners. Even when physiologically effective, long-term adherence to ED treatments is poor. We review here the implication of having patients' partners involved in ED treatment, starting with treatment selection. We suggest that having partners engaged from the outset may promote an erotic association of the treatment with the partner, i.e., conceptually linking the aid to the sexual pleasure that the partner provides. We hypothesize that this erotic association should enhance the sexual aid's effectiveness and might potentially help improve long-term adherence. The primary focus of this review, though, is non-pharmacological and non-surgical options for maintaining sexual activity for men with ED. Though not ED treatments per se, anecdotal data suggest that these options may be effective for some patients and their partners in regaining a satisfying sex life. The aids discussed include external penile prostheses, penile sleeves, and penile support devices. These devices can allow men to participate in penetrative sexual intercourse despite moderate to severe ED. External penile prostheses can be personalized so they match in size and shape a man's normal full erection. Penile sleeves can similarly be customized with a lumen that fits best a patient's penis for optimal tactile stimulation. We review how multi-sensory integration can enhance sexual arousal for men who use such devices, allowing them to achieve orgasm despite intractable ED. Patients are not always advised within ED clinics about these options nor why and how they can facilitate non-erection dependent sexual recovery. Clinicians need to be aware of these devices and their positive attributes, so they can objectively counsel and encourage couples to explore their use as an alternative to more invasive treatments. The most commonly promoted non-medical ED aid offered to patients is the vacuum erection device. We discuss how erections achieved with the vacuum erection device have a "hinge effect", that is an underappreciated barrier to the effectiveness of the erection. With a hinged erection, the penis points downward rather than upward. We show how the normal kinematics of the penis during coitus is not strictly linear (i.e., not uniaxial; not just in-and-out), and is impeded by hinging. Positional adjustment, such as the receptive partner being on top, may help overcome this problem for some couples. Lastly, we suggest that, in the case where ED can be anticipated from a pending medical treatment, such as a prostatectomy, pre-habilitative approaches may potentially improve adherence to sexual aid use in the long-term. In conclusion, non-pharmacological and non-surgical options for sexual recovery are available. Scientific studies on the effectiveness of these interventions in restoring satisfying sex are warranted.
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Affiliation(s)
- Richard Wassersug
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Erik Wibowo
- British Columbia Cancer Agency, Vancouver, Canada
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