Breast cancer surgery: comparing surgical groups and determining individual differences in postoperative sexuality and body change stress

Women diagnosed and surgically treated for regional breast cancer (N = 190) were studied to determine the sexual and body change sequelae for women receiving modified radical mastectomy (MRM) with breast reconstruction in comparison with the sequelae for women receiving breast-conserving therapy (BCT) or MRM without breast reconstruction. The sexuality pattern for women receiving reconstructive surgery was one that was significantly different--with lower rates of activity and fewer signs of sexual responsiveness--than that for women in either of the other groups. Significantly higher levels of traumatic stress and situational distress regarding the breast changes were reported by the women receiving an MRM in contrast to the women treated with BCT. Using a model to predict sexual morbidity, regression analyses revealed that individual differences in sexual self-schema were related to both sexual and body change stress outcomes.

Breast cancer surgery: comparing surgical groups and determining individual differences in postoperative sexuality and body change stress

Women diagnosed and surgically treated for regional breast cancer (N = 190) were studied to determine the sexual and body change sequelae for women receiving modified radical mastectomy (MRM) with breast reconstruction in comparison with the sequelae for women receiving breast-conserving therapy (BCT) or MRM without breast reconstruction. The sexuality pattern for women receiving reconstructive surgery was one that was significantly different--with lower rates of activity and fewer signs of sexual responsiveness--than that for women in either of the other groups. Significantly higher levels of traumatic stress and situational distress regarding the breast changes were reported by the women receiving an MRM in contrast to the women treated with BCT. Using a model to predict sexual morbidity, regression analyses revealed that individual differences in sexual self-schema were related to both sexual and body change stress outcomes.

Beyond artificial, sex-linked distinctions to conceptualize female sexuality: comment on Baumeister (2000)

The authors comment on three aspects of R. F. Baumeister's (2000) theoretical article on female sexuality. Questioning the predominance of nature versus cultural factors in accounting for sexual outcomes for men and women, the authors draw attention to the similarities (as opposed to differences) in the sexual attitudes, behaviors, and responses of men and women, and directly question the suggestion of "controlling" women's sexual attitudes, behaviors, responses, etc. to meet social needs for change.

Beyond artificial, sex-linked distinctions to conceptualize female sexuality: comment on Baumeister (2000)

The authors comment on three aspects of R. F. Baumeister's (2000) theoretical article on female sexuality. Questioning the predominance of nature versus cultural factors in accounting for sexual outcomes for men and women, the authors draw attention to the similarities (as opposed to differences) in the sexual attitudes, behaviors, and responses of men and women, and directly question the suggestion of "controlling" women's sexual attitudes, behaviors, responses, etc. to meet social needs for change.

Surviving cancer: the importance of sexual self-concept

Sexual self-schemas are cognitive generalizations regarding sexual aspects of the self; they represent a core component of one's sexuality. We contend that individual differences in sexual self-view are an important cognitive diathesis for predicting sexual difficulty or dysfunction. We illustrate the role of sexual self-schemas in sexual behavior and responsiveness in healthy female and male samples. Next, we examine the diathetic properties of sexual self-schemas. Finally, we discuss an empirical test of the proposed diathesis-stress interaction, reviewing the role of women's sexual self-views on sexual morbidity following diagnosis and treatment for gynecologic cancer.

Men's sexual self-schema

Sexual self-schemas are cognitive generalizations about sexual aspects of oneself. In Part 1, a measure of men's sexual self-schema is developed. Studies of test-retest and internal consistency reliability and validity studies of factor analysis, internal structure, convergent and discriminant validity, process, group difference, and change are provided. The construct consists of 3 dimensions: passionate-loving, powerful-aggressive, and open-minded-liberal traits. In Part 2, the data suggest that men's sexual schema is derived from past sexual experience, is manifest in current sexual experience, and guides future sexual behavior. In Part 3, the data document the cognitive processing aspects of sexual schema. Consistent with the investigators' schema research with women, these data substantiate the importance of cognitive representations of sexuality.

Men's sexual self-schema

Sexual self-schemas are cognitive generalizations about sexual aspects of oneself. In Part 1, a measure of men's sexual self-schema is developed. Studies of test-retest and internal consistency reliability and validity studies of factor analysis, internal structure, convergent and discriminant validity, process, group difference, and change are provided. The construct consists of 3 dimensions: passionate-loving, powerful-aggressive, and open-minded-liberal traits. In Part 2, the data suggest that men's sexual schema is derived from past sexual experience, is manifest in current sexual experience, and guides future sexual behavior. In Part 3, the data document the cognitive processing aspects of sexual schema. Consistent with the investigators' schema research with women, these data substantiate the importance of cognitive representations of sexuality.

The role of sexual self-schema in a diathesis-stress model of sexual dysfunction

Sexual self-schemas are cognitive generalizations regarding sexual aspects of the self that represent a core component of one's sexuality. We contend that individual differences in the sexual self-view represent an important cognitive diathesis for predicting sexual difficulty or dysfunction. We illustrate the role of sexual self-schemas on sexual behavior and responsiveness in healthy female and male samples. Next, we describe how diathesis-stress models of psychopathology have been applied to the sexual arena, and discuss the critical features of clinically useful diathesis variables. Drawing from these criteria, we examine the diathetic properties of sexual self-schemas. Finally, we discuss an empirical test of the proposed diathesis-stress interaction, reviewing the role of women's sexual self-views on sexual morbidity following diagnosis and treatment for gynecologic cancer.

Schemas, sexuality, and romantic attachment

One's self-views are powerful regulators of both cognitive processing and behavioral responding. Sexual self-schemas are cognitive generalizations about sexual aspects of the self. The bivariate sexual self-schema model, which posits independent effects of positive and negative components of women's sexual self-views, was tested. Three hundred eighteen female undergraduates completed anonymous questionnaires, including the Sexual Self-Schema Scale and assessments of sexual responses and romantic attachment patterns. Results extended knowledge of positive-negative schema group contrasts and distinguished the response patterns of the aschematic and co-schematic groups. As predicted, aschematics reported low levels of sexual desire, arousal, and anxiety, and weak romantic attachments, whereas co-schematics endorsed conflicting positive and negative responses to sexual-romantic cues. In addition, path analyses supported the bivariate model. Finally, findings are related to theories of attachment representations within the cognitive hierarchy of the self.

Schemas, sexuality, and romantic attachment

One's self-views are powerful regulators of both cognitive processing and behavioral responding. Sexual self-schemas are cognitive generalizations about sexual aspects of the self. The bivariate sexual self-schema model, which posits independent effects of positive and negative components of women's sexual self-views, was tested. Three hundred eighteen female undergraduates completed anonymous questionnaires, including the Sexual Self-Schema Scale and assessments of sexual responses and romantic attachment patterns. Results extended knowledge of positive-negative schema group contrasts and distinguished the response patterns of the aschematic and co-schematic groups. As predicted, aschematics reported low levels of sexual desire, arousal, and anxiety, and weak romantic attachments, whereas co-schematics endorsed conflicting positive and negative responses to sexual-romantic cues. In addition, path analyses supported the bivariate model. Finally, findings are related to theories of attachment representations within the cognitive hierarchy of the self.

Stress and immune responses after surgical treatment for regional breast cancer

BACKGROUND

Adults who undergo chronic stress, such as the diagnosis and surgical treatment of breast cancer, often experience adjustment difficulties and important biologic effects. This stress can affect the immune system, possibly reducing the ability of individuals with cancer to resist disease progression and metastatic spread. We examined whether stress influences cellular immune responses in patients following breast cancer diagnosis and surgery.

METHODS

We studied 116 patients recently treated surgically for invasive breast cancer. Before beginning their adjuvant therapy, all subjects completed a validated questionnaire assessing the stress of being cancer patients. A 60-mL blood sample taken from each patient was subjected to a panel of natural killer (NK) cell and T-lymphocyte assays. We then developed multiple regression models to test the contribution of psychologic stress in predicting immune function. All regression equations controlled for variables that might exert short- or long-term effects on these responses, and we also ruled out other potentially confounding variables.

RESULTS

We found, reproducibly between and within assays, the following: 1) Stress level significantly predicted lower NK cell lysis, 2) stress level significantly predicted diminished response of NK cells to recombinant interferon gamma, and 3) stress level significantly predicted decreased proliferative response of peripheral blood lymphocytes to plant lectins and to a monoclonal antibody directed against the T-cell receptor.

CONCLUSIONS

The data show that the physiologic effects of stress inhibit cellular immune responses that are relevant to cancer prognosis, including NK cell toxicity and T-cell responses. Additional, longitudinal studies are needed to determine the duration of these effects, their health consequences, and their biologic and/or behavioral mechanisms.

Sexual self-schema and sexual morbidity among gynecologic cancer survivors

Longitudinal research indicates that approximately 50% of women treated for gynecologic cancer have sexual dysfunctions as they recover and become cancer survivors. This outcome occurs in the context of satisfactory quality of life in other domains. This study, comparing gynecologic cancer survivors (n = 61) and gynecologically healthy women (n = 74), documents the reliability of the latter observations with measures of quality of life (general, depressive symptoms, social contacts, and stress), sexual functioning, and health. Of added importance are analyses focused on variables that may predict risk for sexual morbidity. Specifically, sexual self-schema is tested as an important, sexually relevant individual difference. In regression analyses that controlled for estimates of precancer sexual behavior (intercourse frequency), extent of disease-treatment, and menopausal symptoms, sexual self-schema accounted for significant variance in predicting current sexual behavior and responsiveness.

Oral terbinafine in toenail dermatophytosis. A double-blind, placebo-controlled multicenter study with 12 months' follow-up

The treatment of onychomycosis has previously often been protracted and unsuccessful. Terbinafine has been shown to be effective in short-term regimens. In this double-blind, placebo-controlled study, 148 patients with toenail dermatophytosis were randomized to treatment with either 250 mg terbinafine daily or placebo for 3 months. An additional treatment was given for 3 months to patients whose infection had not responded. The patients were followed clinically and mycologically through 12 months. After 3 months 82% of the terbinafine-treated group, versus 5% of the placebo group, showed significant improvement, i.e. negative culture and growth of unaffected nail more than 2 mm (p = < 0.0001). After 12 months clinical and mycological cure was seen in 40% of the patients treated with terbinafine for 3 or 6 months, while 67-81% were clinically cured, but with positive microscopy. Side-effects occurred in 13.5% of the terbinafine group, versus 5.4% of the placebo group, and were mild. 250 mg terbinafine daily for 3 months was significantly more effective than placebo. The efficacy did not appear to improve with additional treatment for 3 months.

Women's sexuality: behaviors, responses, and individual differences

Classic and contemporary approaches to the assessment of female sexuality are discussed. General approaches, assessment strategies, and models of female sexuality are organized within the conceptual domains of sexual behaviors, sexual responses (desire, excitement, orgasm, and resolution), and individual differences, including general and sex-specific personality models. Where applicable, important trends and relationships are highlighted in the literature with both existing reports and previously unpublished data. The present conceptual overview highlights areas in sexual assessment and model building that are in need of further research and theoretical clarification.

Stress and quality of life following cervical cancer

Significant progress has been made in understanding the psychologic and behavioral aspects of cervical cancer. Descriptive data indicate acute trauma and disruption with the diagnosis and treatment, yet the majority of women return to precancer life. The notable exception to this is sexual functioning, which remains an area of significant morbidity. Future research will need to test variables that predict which women will be vulnerable to sexual dysfunction. Sexual self-concept (sexual self-schema), which is the extent to which a woman has a positive view of her own sexuality, appears to provide valuable information. The identification of such variables is an important step toward designing interventions for enhancing quality of life for patients with cervical cancer.

Women's sexuality: behaviors, responses, and individual differences

Classic and contemporary approaches to the assessment of female sexuality are discussed. General approaches, assessment strategies, and models of female sexuality are organized within the conceptual domains of sexual behaviors, sexual responses (desire, excitement, orgasm, and resolution), and individual differences, including general and sex-specific personality models. Where applicable, important trends and relationships are highlighted in the literature with both existing reports and previously unpublished data. The present conceptual overview highlights areas in sexual assessment and model building that are in need of further research and theoretical clarification.

Delay in seeking a cancer diagnosis: delay stages and psychophysiological comparison processes

Two analyses of patient delay in seeking a medical diagnosis are considered. In the first, a model of delay is presented. Specifically, delay is comprised of four stages (appraisal, illness, behavioural and scheduling delay intervals), each governed by a conceptually distinct set of decisional and appraisal processes beginning with the initial day that an unexplained symptom is detected to the day the individual appears before a physician. The second analysis is a social psychological one of the attributions individuals draw when relating their symptoms to their expectations and knowledge about physiological bodily processes. The eight principles of Psychophysiological Comparison Theory (PCT) provide the basis for clarifying the psychological processes of symptom interpretation and appraisal. Two studies were conducted with women seeking diagnostic evaluations for prevalent cancers: breast or gynaecological tumours. Regarding the delay model, results indicated that the delay intervals were independent (i.e. uncorrelated). Also, appraisal delay constituted the majority (at least 60 per cent) of the total delay. In the test of PCT, support was found across measures of symptoms, the context in which the symptoms arose, and the inferences people made about the symptoms.

Quality of life for women with gynecologic cancer

For the majority of women, gynecologic cancer is a survivable disease. A brief overview of the recent findings on the psychological and behavioral aspects of gynecologic cancer is provided. The discussion is organized by disease-relevant time points, from prevention to recovery or death. Recognition of the positive results that have been achieved by behavioral sciences can be important in reducing the psychological and behavioral burden of gynecologic cancer.

Surviving cancer

Research trends on quality of life outcomes for cancer survivors are discussed. Epidemiologic data indicate that female cancer survivors, coming primarily from patient groups with gynecologic, breast, and colorectal cancers, will outnumber male survivors 3 to 1. Male survivors will come from the ranks of patient groups with colorectal and other digestive tumors (such as stomach cancer), prostate, and bladder cancers. With the exception of breast cancer, there have been few well controlled descriptive, longitudinal studies of cancer survivors, with data on men being notably absent. A strategy for identifying differential levels of risk for psychologic morbidity for cancer survivors is proposed. Other important psychologic individual difference variables were identified: control, optimism, and stable coping strategies may be useful in the prediction of mental health outcomes; conscientiousness in the prediction of health behaviors; and sexual self-schema in the prediction of sexual outcomes. Finally, data suggest that psychologic and behavioral outcomes can be improved with psychologic interventions, but it is likely that even greater gains could be achieved if health behavior components were added. New directions for research include study of individual differences, examination of active components of multifaceted interventions, and study of the health consequences of interventions. In the latter regard, a biobehavioral model of stress and cancer is offered to integrate psychologic, behavioral, biologic, and disease factors into testable new research directions.

A biobehavioral model of cancer stress and disease course

Approximately 1 million Americans are diagnosed with cancer each year and must cope with the disease and treatments. Many studies have documented the deteriorations in quality of life that occur. These data suggest that the adjustment process is burdensome and lengthy. There is ample evidence showing that adults experiencing other long-term stressors experience not only high rates of adjustment difficulties (e.g., syndromal depression) but important biologic effects, such as persistent downregulation of elements of the immune system, and adverse health outcomes, such as higher rates of respiratory tract infections. Thus, deteriorations in quality of life with cancer are underscored if they have implications for biological processes, such as the immune system, relating to disease progression and spread. Considering these and other data, a biobehavioral model of adjustment to the stresses of cancer is offered, and mechanisms by which psychological and behavioral responses may influence biological processes and, perhaps, health outcomes are proposed. Finally, strategies for testing the model via experiments testing psychological interventions are offered.

A biobehavioral model of cancer stress and disease course

Approximately 1 million Americans are diagnosed with cancer each year and must cope with the disease and treatments. Many studies have documented the deteriorations in quality of life that occur. These data suggest that the adjustment process is burdensome and lengthy. There is ample evidence showing that adults experiencing other long-term stressors experience not only high rates of adjustment difficulties (e.g., syndromal depression) but important biologic effects, such as persistent downregulation of elements of the immune system, and adverse health outcomes, such as higher rates of respiratory tract infections. Thus, deteriorations in quality of life with cancer are underscored if they have implications for biological processes, such as the immune system, relating to disease progression and spread. Considering these and other data, a biobehavioral model of adjustment to the stresses of cancer is offered, and mechanisms by which psychological and behavioral responses may influence biological processes and, perhaps, health outcomes are proposed. Finally, strategies for testing the model via experiments testing psychological interventions are offered.

A biobehavioral model of cancer stress and disease course

Approximately 1 million Americans are diagnosed with cancer each year and must cope with the disease and treatments. Many studies have documented the deteriorations in quality of life that occur. These data suggest that the adjustment process is burdensome and lengthy. There is ample evidence showing that adults experiencing other long-term stressors experience not only high rates of adjustment difficulties (e.g., syndromal depression) but important biologic effects, such as persistent downregulation of elements of the immune system, and adverse health outcomes, such as higher rates of respiratory tract infections. Thus, deteriorations in quality of life with cancer are underscored if they have implications for biological processes, such as the immune system, relating to disease progression and spread. Considering these and other data, a biobehavioral model of adjustment to the stresses of cancer is offered, and mechanisms by which psychological and behavioral responses may influence biological processes and, perhaps, health outcomes are proposed. Finally, strategies for testing the model via experiments testing psychological interventions are offered.

Patterns and trends of sexual behavior, HIV testing, and HIV prevalence among all sexually transmitted disease clinic attenders in Denmark

BACKGROUND AND OBJECTIVES

Persons attending a sexually transmitted disease (STD) clinic have shown to be at a higher risk for HIV infection than the population in general. We evaluate the patterns of HIV prevalence and testing in relation to reported risk behavior.

STUDY DESIGN

Data have been collected on all new attenders at the Danish STD clinics. The study period was January 1, 1990 through March 1992.

RESULTS

Testing for HIV was accepted by 74% and more often by women than men and more outside Copenhagen than in the city itself. Acceptance was lowest among homo/bisexual men seen in Copenhagen. The HIV prevalence was highest among homo/bisexual men with drug use (10.0%) and lowest among heterosexual men (0.3%) and women (0.2%). Among heterosexuals the test activity increased over time, and the test activity increased and the prevalence of HIV antibodies decreased with the number of reported sex partners. Among heterosexuals HIV infection was associated with not being born in Denmark and age (> or = 30 years old in women and > or = 35 years old in men).

CONCLUSION

These results are relevant for the national HIV surveillance programs and campaigns, and stress the importance of offering HIV testing to all persons attending for an STD examination.