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Liu J, Bao T, Wang Q, Jiang H, Zhang X. Stigma and its associations with self-confidence and sexual relations in 4 types of premature ejaculation. Basic Clin Androl 2024; 34:11. [PMID: 38951750 PMCID: PMC11218248 DOI: 10.1186/s12610-024-00226-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/22/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Although men with premature ejaculation (PE) always show more negative emotions, including embarrassment, guilt and worry, this may be related to the stigma of PE. To investigated stigma and its associations with self-confidence and sexual relations in 4 PE syndromes, a survey was conducted in our hospital from December 2018 to December 2019 among 350 men with self-reported PE and 252 men without self-reported PE. The stigma, self-confidence and sexual relations were assessed by the Social Impact Scale (SIS) and Self-Esteem and Relationship questionnaire (SEAR), respectively. Ejaculation control, sexual life satisfaction and distress caused by PE were evaluated by the Index of PE. RESULTS Men with self-reported PE had higher internalized shame and social isolation scores and lower SEAR scores than control subjects. The highest score of internalized shame and social isolation and the lowest score of SEAR appeared in men with lifelong PE (LPE). After age adjustment, the positive relationships were stronger between distress about PE and internalized shame. Whereas, the stronger negative associations were found between social isolation and sexual satisfaction. The strongest association was observed between social isolation and sexual relationship. Therefore, the stigma associated with PE adversely affects the self-confidence, self-esteem, and sexual relationships of men with PE. CONCLUSION Men with PE, especially LPE, have a high level of stigma and disharmonious sexual relations, and often lack self-confidence and self-esteem, which have a certain negative impact on their physical and mental health and life. These will be the key issues to be considered when we formulate a personalized treatment plan for PE.
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Affiliation(s)
- Jishuang Liu
- Department of Urology, Anhui Province Key Laboratory of Genitourinary Diseases, The Institute of Urology, The First Affiliated Hospital of Anhui Medical UniversityAnhui Medical University, Hefei, Anhui, China
- Department of Urology, Anqing Municipal Hospital, Anqing Medical Center of Anhui Medical University, Renmin Road No. 352, Yingjiang District, Anqing, 246003, Anhui, People's Republic of China
| | - Tong Bao
- Department of Urology, Anqing Municipal Hospital, Anqing Medical Center of Anhui Medical University, Renmin Road No. 352, Yingjiang District, Anqing, 246003, Anhui, People's Republic of China
| | - Qunfeng Wang
- Department of Urology, Anqing Municipal Hospital, Anqing Medical Center of Anhui Medical University, Renmin Road No. 352, Yingjiang District, Anqing, 246003, Anhui, People's Republic of China
| | - Hui Jiang
- Department of Urology, Peking University First Hospital Institute of Urology, Peking University Andrology Center, Peking University First Hospital, No. 8 Xishiku Street Xicheng District, Beijing, China.
| | - Xiansheng Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
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2
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Rajasegaran S, Chandrasagran RA, Tan SK, Ahmad NA, Lechmiannandan A, Sanmugam A, Tan WS, Tan YW, Nah SA. Experiences of youth growing up with anorectal malformation or Hirschsprung's disease: a multicenter qualitative in-depth interview study. Pediatr Surg Int 2024; 40:119. [PMID: 38700671 DOI: 10.1007/s00383-024-05709-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 05/21/2024]
Abstract
PURPOSE Patients with anorectal malformation (ARM) and Hirschsprung's disease (HD) live with long-term impact of these diseases even into adulthood. We aimed to explore the physical, social and emotional impact of these diseases in adolescents and young adults to develop best practices for transition care. METHODS We conducted one-on-one in-depth interviews with ARM and HD patients aged ≥ 11 years who had undergone surgery at four tertiary referral centers. All interviews were audio-recorded and transcribed verbatim. We analyzed transcripts for recurring themes, and data were collected until data saturation was reached. Three researchers independently coded the transcripts for major themes using thematic analysis approach. RESULTS We interviewed 16 participants (11 males) between October 2022 and April 2023. Ages ranged from 11 to 26 years. Five major themes emerged: (1) personal impact (subthemes: physical, emotional and mental health, social, school), (2) impact on family, (3) perceptions of their future (subthemes: relationships, career, state of health), (4) sources of support (subthemes: family, peers, partner), and (5) transition care (subthemes: concerns, expectations). Only females expressed concerns regarding future fertility. CONCLUSION This study highlights the evolving problems faced by adolescents and young adults with ARM and HD, especially gender-specific concerns. Our findings can inform efforts to provide individualized care.
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Affiliation(s)
- Suganthi Rajasegaran
- Division of Paediatric and Neonatal Surgery, Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | | | - Shung Ken Tan
- Paediatric Surgery Unit, Department of Surgery, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
| | - Nur Aini Ahmad
- Department of Paediatric Surgery, Sabah Women's and Children's Hospital, Kota Kinabalu, Sabah, Malaysia
| | | | - Anand Sanmugam
- Division of Paediatric and Neonatal Surgery, Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wei Sheng Tan
- Division of Paediatric & Neonatal Surgery, Department of Surgery, Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Yew-Wei Tan
- Division of Paediatric and Neonatal Surgery, Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shireen Anne Nah
- Division of Paediatric and Neonatal Surgery, Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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3
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Gerymski R, Latusek-Mierzwa M. Network Analysis of Sexual Well-Being in Women with Heart Failure: The Psychocardiological Perspective. Healthcare (Basel) 2024; 12:817. [PMID: 38667579 PMCID: PMC11050502 DOI: 10.3390/healthcare12080817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/25/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Sexuality is an important sphere of every person's life. Sexual dysfunctions and sexual dissatisfaction may also be present in cardiac diseases. Individuals affected by heart failure (HF) deserve special attention since it can be the final stage of many cardiac diseases. Therefore, it is important to verify potential correlates of sexual well-being in individuals with HF. This study was conducted online between 2019 and 2023, and 262 Polish women aged between 18 and 59 years (M = 45.48; SD = 7.65) participated in it. The Short Sexual Well-Being Scale, Depression Anxiety and Stress Scale, Fatigue Assessment Scale, and authors' questionnaire were used. Relationships between tested variables were verified with the use of network analysis performed with the EBICglasso estimator. Centrality assessment showed that sexual well-being had the highest values of betweenness, closeness and degree, followed by fatigue and depression measures. Sexual well-being was negatively related to the number of declared sexual dysfunctions, fatigue, stress and depression levels. Participants' age and HF duration were not related to the sexual well-being of tested women. Multiple additional partial correlations were detected. The obtained results show that sexuality may be a central sphere of life in women with HF and that one's sexuality should not be negated when working with cardiac patients.
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Affiliation(s)
- Rafał Gerymski
- Department of Health Psychology and Quality of Life, Institute of Psychology, Opole University, 45-040 Opole, Poland
| | - Maria Latusek-Mierzwa
- St. Hedwig’s Provincial Specialist Hospital, 45-221 Opole, Poland;
- Doctoral School of the University of Opole, 45-040 Opole, Poland
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4
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Reppucci ML, Harris KT, Wilcox DT, Peycelon M, Bischoff A. Adult urological outcomes for patients with anorectal malformation. J Pediatr Urol 2024; 20:193-199. [PMID: 38184446 DOI: 10.1016/j.jpurol.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 01/08/2024]
Abstract
Anorectal malformations (ARM) are rare congenital anomalies characterized by a spectrum of defects resulting in the absence of a normal anal opening with or without fistula. Urogenital involvement is common, and the fistulous tract may terminate in the genitourinary system in males or within gynecological structures in females. Surgical reconstruction occurs early in life and survival of these patients to adulthood is the norm. There has, therefore, been increased focus on their long-term outcomes to better anticipate and treat the sequelae that may impact their health and well-being as this population ages. For urologists, urinary health, sexual function, and fertility outcomes are of particular interest among this population. This article aims to provide a review of urological, sexual, and fertility outcomes for individuals born with ARM with a focus on key issues that may occur later in life to ensure adequate counseling, screening, and treatment.
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Affiliation(s)
- Marina L Reppucci
- Department of General Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Kelly T Harris
- Division of Pediatric Urology, Children's Hospital of Colorado, Aurora, CO, USA
| | - Duncan T Wilcox
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA
| | - Matthieu Peycelon
- Department of Pediatric Surgery and Urology, National Reference Center for Rare Urinary Tract Malformations (MARVU), Robert-Debré University Hospital, Assistance Publique, Hôpitaux de Paris (APHP), INSERM, UMR NeuroDev 1141, Université Paris Cité, Paris, France
| | - Andrea Bischoff
- International Center for Colorectal and Urogenital Care, Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA.
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5
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Yu LX, McGowan M, Bendle K, Mullins C, Streich-Tilles T, Breech LL. Sexual and Reproductive Health Concerns in Adults With Cloacal Anomalies: A Qualitative Study. J Pediatr Surg 2023; 58:2300-2307. [PMID: 37690871 DOI: 10.1016/j.jpedsurg.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/15/2023] [Accepted: 08/13/2023] [Indexed: 09/12/2023]
Abstract
STUDY OBJECTIVE Long-term gynecologic data are lacking to inform the care of patients with cloacal malformations. We seek to examine perceived sexual and reproductive health challenges of patients born with cloacal anomalies and characterize the experiences of patients as adults. DESIGN AND SETTING Virtual semi-structured focus groups and single-participant interviews were conducted using an online video platform. Retrospective chart review was performed to abstract available demographics and surgical history. PARTICIPANTS Adult patients were contacted from a database of 143 patients born with cloaca who had been seen at or referred to a tertiary care pediatric colorectal center. Participants were recruited until data collection reached thematic saturation. Twenty patients aged 18-53 years participated in 5 focus groups and 3 single-participant interviews. The hospital IRB determined the research activities to be exempt from IRB review and oversight. INTERVENTIONS AND MAIN OUTCOME MEASURES Interviews and focus groups were transcribed and analyzed using the constant comparative method to identify themes regarding sexual and reproductive health and compared with medical and surgical history abstracted from chart review. RESULTS Participants reported many perceived barriers to intercourse and intimacy including bowel and bladder continence management. All participants reported discussion of pregnancy and fertility with healthcare providers as important. Other common themes included concerns about independence and transitioning from pediatric to adult providers. CONCLUSION Anorectal malformations are associated with sexual and reproductive health concerns. Patients seek guidance on family building, intimacy, and transition to adult care. Future quantitative study of these topics is needed to develop best practices for counseling and clinical management of these patients. LEVEL OF EVIDENCE Level VI. TYPE OF STUDY Prognosis Study.
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Affiliation(s)
- Lissa X Yu
- Division of Pediatric and Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Michelle McGowan
- Biomedical Ethics Research Program, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA; Department of Women's, Gender, and Sexuality Studies, University of Cincinnati, Cincinnati, OH, USA
| | - Kara Bendle
- Division of Pediatric and Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Tara Streich-Tilles
- Division of Pediatric and Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lesley L Breech
- Division of Pediatric and Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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6
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de Beaufort CMC, Aminoff D, de Blaauw I, Crétolle C, Dingemann J, Durkin N, Feitz WFJ, Fruithof J, Grano C, Burgos CM, Schwarzer N, Slater G, Soyer T, Violani C, Wijnen R, de Coppi P, Gorter RR. Transitional Care for Patients with Congenital Colorectal Diseases: An EUPSA Network Office, ERNICA, and eUROGEN Joint Venture. J Pediatr Surg 2023; 58:2319-2326. [PMID: 37438237 DOI: 10.1016/j.jpedsurg.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/30/2023] [Accepted: 06/11/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Transition of care (TOC; from childhood into adulthood) of patients with anorectal malformations (ARM) and Hirschsprung disease (HD) ensures continuation of care for these patients. The aim of this international study was to assess the current status of TOC and adult care (AC) programs for patients with ARM and HD. METHODS A survey was developed by members of EUPSA, ERN eUROGEN, and ERNICA, including patient representatives (ePAGs), comprising of four domains: general information, general questions about transition to adulthood, and disease-specific questions regarding TOC and AC programs. Recruitment of centres was done by the ERNs and EUPSA, using mailing lists and social media accounts. Only descriptive statistics were reported. RESULTS In total, 82 centres from 21 different countries entered the survey. Approximately half of them were ERN network members. Seventy-two centres (87.8%) had a self-reported area of expertise for both ARM and HD. Specific TOC programs were installed in 44% of the centres and AC programs in 31% of these centres. When comparing centres, wide variation was observed in the content of the programs. CONCLUSION Despite the awareness of the importance of TOC and AC programs, these programs were installed in less than 50% of the participating centres. Various transition and AC programs were applied, with considerable heterogeneity in implementation, content and responsible caregivers involved. Sharing best practice examples and taking into account local and National Health Care Programs might lead to a better continuation of care in the future. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Cunera M C de Beaufort
- Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Department of Pediatric Surgery, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Dalia Aminoff
- Italian Patient's Organization for ARM (AIMAR) - Patient Organization, Via Nomentana, Rome, Italy
| | - Ivo de Blaauw
- Department of Surgery - Division of Pediatric Surgery, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Célia Crétolle
- Necker-Enfants Malades University Hospital, Paris, France
| | - Jens Dingemann
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Natalie Durkin
- Stem Cell and Regenerative Medicine, DBC and BRC NIHR, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Wout F J Feitz
- Department of Urology, Division of Pediatric Urology, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands
| | - JoAnne Fruithof
- EAT - Esophageal Atresia Global Support Groups, Stuttgart, Germany; VOKS - Vereniging voor Ouderen en Kinderen met een Slokdarmafsluiting, Hellendoorn, the Netherlands
| | - Caterina Grano
- Department of Psychology, Faculty of Medicine and Psychology, University of Rome Sapienza, Rome, Lazio, Italy
| | - Carmen Mesas Burgos
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Nicole Schwarzer
- SoMA, The German Patient Support Organization for Anorectal Malformations and Hirschsprung Disease, Munich, Germany
| | - Graham Slater
- EAT - Esophageal Atresia Global Support Groups, Stuttgart, Germany; Lead ePAG (Patient Representative), ERN ERNICA
| | - Tutku Soyer
- Department of Pediatric Surgery, Hacettepe University, Ankara, Turkey
| | | | - Rene Wijnen
- Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Paolo de Coppi
- Stem Cell and Regenerative Medicine, DBC and BRC NIHR, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Ramon R Gorter
- Emma Children's Hospital Amsterdam UMC, Location University of Amsterdam, Department of Pediatric Surgery, Meibergdreef 9, Amsterdam, the Netherlands
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7
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Eleuteri S, Aminoff D, Midrio P, Leva E, Morandi A, Spinoni M, Grano C. Talking about sexuality with your own child. The perspective of the parents of children born with arm. Pediatr Surg Int 2022; 38:1665-1670. [PMID: 36129534 DOI: 10.1007/s00383-022-05217-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Evaluate whether parents have ever discussed sexuality with their children with anorectal malformations (ARM), which sexuality issues they think should be addressed and who, in their opinion, should address these issues. METHODS Parents from the Italian Parents' and Patients' Association for Anorectal Malformation participated in meetings organized by the Association together with local Pediatric Surgical Units and were asked to fill in a questionnaire. RESULTS 103 parents participated. Overall, 66% of parents had never talked about sex with their children. Children's age was marginally correlated with occasions to talk about sexuality (r = .202, p = 0.53) indicating that the older were the children, the more the parents talked about sexuality. The majority of parents reported that their children should have the possibility to talk about sex with them (72%), psychologists (57%), gynecologists/andrologists (47%), pediatric surgeons (33.5%), surgeons specialized in ARM (39.8%), friends (28%), nurses (24.7%) and teachers (20.4%), respectively. The most important topic they thought their children should address was handling serene sexuality, although the most common topic effectively discussed with them was the conception. CONCLUSION Psychologists, gynecologists/andrologists, and pediatric surgeons are seen as key resources for talking about sexuality. A great number of parents express the wish that their children had more opportunities to discuss sexual topics with pediatric surgeons.
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Affiliation(s)
- S Eleuteri
- Italian Patients' and Parents' Association for Anorectal Malformations, Rome, Italy.
| | - D Aminoff
- Italian Patients' and Parents' Association for Anorectal Malformations, Rome, Italy
| | - P Midrio
- Pediatric Surgery Unit, Cà Foncello Hospital, Treviso, Italy
| | - E Leva
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
| | - A Morandi
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Spinoni
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - C Grano
- Italian Patients' and Parents' Association for Anorectal Malformations, Rome, Italy.,Department of Psychology, Sapienza University of Rome, Rome, Italy
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Sundgren M, Damiris I, Stallman H, Kannis-Dymand L, Millear P, Mason J, Wood A, Allen A. Investigating psychometric measures of sexual wellbeing: a systematic review. SEXUAL AND RELATIONSHIP THERAPY 2022. [DOI: 10.1080/14681994.2022.2033967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Madison Sundgren
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Isabella Damiris
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Helen Stallman
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Lee Kannis-Dymand
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Prudence Millear
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Jonathan Mason
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, Australia
- Sunshine Coast Mind & Neuroscience – Thompson Institute, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Andrew Wood
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, Australia
- Sunshine Coast Mind & Neuroscience – Thompson Institute, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Andrew Allen
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, Australia
- Sunshine Coast Mind & Neuroscience – Thompson Institute, University of the Sunshine Coast, Sunshine Coast, Australia
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9
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Bicelli N, Trovalusci E, Zannol M, Gamba P, Bogana G, Zanatta C, Midrio P. Gynecological and psycho-sexual aspects of women with history of anorectal malformations. Pediatr Surg Int 2021; 37:991-997. [PMID: 33900437 PMCID: PMC8241745 DOI: 10.1007/s00383-021-04905-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Women with anorectal malformation (ARM) are expected to have a normal life span, therefore, gynecological and psycho-sexual issues are also important. Aim of the study was to assess these aspects in adult females with history of ARM. METHODS Thirty-seven women from two ARM referral centers, aged ≥ 16, were identified. Gynecologic visit, cervicovaginal swab, pelvic ultrasound, FSH, LH, prolactin, progesterone, 17-β-estradiol, DHEAS, testosterone, TSH during follicular and luteal phases, and administration of FSFI questionnaire to screen the female sexual functioning were performed. Data were compared with six controls. RESULTS Nineteen patients, mean age 21.7 (16-45), participated to the study. Associated anomalies, mostly affecting limbs, vertebrae and genitalia, were present in 57.8% of cases. Mullerian anomalies were retrieved in 36.8%. Hormones' levels were normal. Concerning sexual functioning, four women (21%) reported dyspareunia or impossible penetration, four did not answer the FSFI questionnaire due to lack of confidence about their sexuality, and three scored lower than the cut-off value for female sexual function. CONCLUSION This study confirms the importance of a multidisciplinary long-term follow-up for ARM patients, including a careful study of the reproductive tract to detect and treat those conditions that could affect the fertility. Moreover, an appropriate psychological support should be provided.
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Affiliation(s)
- Noemi Bicelli
- grid.413196.8Pediatric Surgery, Cà Foncello Hospital, Treviso, Italy ,grid.5608.b0000 0004 1757 3470Pediatric Surgery, Università Di Padova, Padova, Italy
| | - Emanuele Trovalusci
- grid.413196.8Pediatric Surgery, Cà Foncello Hospital, Treviso, Italy ,grid.5608.b0000 0004 1757 3470Pediatric Surgery, Università Di Padova, Padova, Italy
| | - Monica Zannol
- grid.413196.8Obstetrics&Gynecology, Cà Foncello Hospital, Treviso, Italy
| | - Piergiorgio Gamba
- grid.5608.b0000 0004 1757 3470Pediatric Surgery, Università Di Padova, Padova, Italy
| | - Gianna Bogana
- grid.411474.30000 0004 1760 2630Obstetrics&Gynecology, Azienda Ospedaliera, Padova, Italy
| | - Cinzia Zanatta
- grid.413196.8Pediatric Surgery, Cà Foncello Hospital, Treviso, Italy
| | - Paola Midrio
- grid.413196.8Pediatric Surgery, Cà Foncello Hospital, Treviso, Italy ,grid.5608.b0000 0004 1757 3470Pediatric Surgery, Università Di Padova, Padova, Italy
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10
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Bjoersum-Meyer T, Kaalby L, Lund L, Christensen P, Jakobsen MS, Baatrup G, Qvist N, Ellebaek M. Long-term Functional Urinary and Sexual Outcomes in Patients with Anorectal Malformations-A Systematic Review. EUR UROL SUPPL 2021; 25:29-38. [PMID: 34337501 PMCID: PMC8317805 DOI: 10.1016/j.euros.2021.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2021] [Indexed: 11/01/2022] Open
Abstract
Context Long-term urinary and sexual outcomes after repair of anorectal malformations (ARMs) are currently affected by concomitant malformations of the urinary tract and genitalia, sacral anomalies, and the surgical approach. However, the overall prevalence of urinary and sexual dysfunction remains unclear. Objective To evaluate the prevalence of urinary and sexual dysfunction in patients aged >10 yr after repair of ARM in infancy. Evidence acquisition A systematic literature review was performed using the Medline, Embase, and Cochrane databases. Selected studies were reviewed according to the Consolidated Standards of Reporting Trials (CONSORT) and Standards for the Reporting of Diagnostic Accuracy Studies (STARD) criteria. We included studies reporting the prevalence of the following outcomes: urinary incontinence (UI), lower urinary tract symptoms (LUTS), neurogenic bladder dysfunction (NBD), sexual dysfunction (SD), erectile dysfunction (ED), ejaculatory dysfunction, and birth rate. We initially identified 588 studies, of which 17 were included for evidence synthesis. Evidence synthesis A probabilistic meta-analysis on each subgroup revealed the following combined prevalence estimates: UI 16% (95% confidence interval [CI] 7-27%), LUTS/NBD 36% (95% CI 13-62%), SD among women 50% (95% CI 34-66%), ED 12% (95% CI 7-18%), ejaculatory dysfunction 16% (95% CI 9-25%), and birth rate 20% (95% CI 7-38%). Subgroup analysis showed a higher prevalence of ED and ejaculatory dysfunction among patients with high ARM severity when compared to low ARM severity. Conclusions Among patients undergoing ARM repair, we found a high prevalence of long-term impairment of UI, ED, and SD. We stress the need for larger multicentre trials with more comparable populations to optimise treatment and follow-up regimens. Patient summary We reviewed long-term outcomes for patients with anorectal malformations who underwent surgery and found that both urinary incontinence and sexual dysfunctions are common for both males and females.
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Affiliation(s)
- Thomas Bjoersum-Meyer
- Department of Surgery, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lasse Kaalby
- Department of Surgery, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lars Lund
- Department of Urology, Odense University Hospital, Odense, Denmark
| | | | | | - Gunnar Baatrup
- Department of Surgery, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Niels Qvist
- Department of Surgery, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mark Ellebaek
- Department of Surgery, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Long-term urologic and gynecologic follow-up and the importance of collaboration for patients with anorectal malformations. Semin Pediatr Surg 2020; 29:150987. [PMID: 33288143 PMCID: PMC8570052 DOI: 10.1016/j.sempedsurg.2020.150987] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Anorectal malformations (ARM) are well recognized to be associated with anomalies in other organ systems. The introduction of screening protocols has increased the diagnosis of these anomalies and greater collaboration with other specialties has influenced the treatment and follow-up of patients with ARMs. Much of the medical literature regarding the treatment of anorectal malformations has focused on technical details of operations and early post-surgical outcomes. Recently, an increase in published data regarding the long-term sequelae of an ARM diagnosis has resulted in an emphasis extended follow up in this population. Patient support groups have highlighted complex issues in ARM patients persist into adulthood have advocated for improved transitional care. This article describes the benefits of long-term follow-up and identifies key issues in ARM patients with respect to urologic and gynecologic health. A collaborative model of care is outlined and suggested timings of screening for potential problems is described.
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