Constructions of masculinity following prostatectomy-induced impotence

Male Sexual Dysfunction and the Perpetration of Intimate Partner Violence

We contribute to our understanding of the social epidemiology of intimate partner violence (IPV) by developing a mediation model that frames IPV as an outcome of male sexual dysfunction (performance anxiety and erectile dysfunction) and the mechanisms of masculine discrepancy stress (the perceived failure to conform to internalized normative expectations of masculinity) and anger. Our mediation analyses of recently collected data from the 2021 Crime, Health, and Politics Survey (CHAPS), a national probability sample of 792 men, confirmed that sexual dysfunction was indirectly associated with the perpetration of any IPV, physical IPV, and sexual IPV through the compound path of masculine discrepancy stress and anger.

Prostate cancer-related sexual dysfunction - the significance of social relations in men's reconstructions of masculinity

Narrating illness experiences in a culturally acceptable manner is essential for retaining quality of life after the disruptive event of being diagnosed for prostate cancer. Psychological pressures caused by treatment side-effects such as erectile dysfunction require reinterpretation of the meanings and impacts of these side-effects on masculinity. This helps maintain coherence in men's lives. We studied how men employ culturally available discursive strategies (compensation, redefinition, recontextualisation, and normalisation) in reconstructing masculinity and sexuality. Our data consists of 22 interviews of heterosexual Finnish prostate cancer patients who had undergone surgery. The aim was to analyse the ways in which various life situations and social relations shaped and limited the use of these strategies. Discourse analysis revealed that older age, a supportive spouse, children, supportive male friends, and good health - were key elements men used in reconstructing a coherent new self-image and conception of life following cancer treatment. Men with sexually active male friends, men without families, younger men and men with new intimate relationships struggled to develop a new version of their masculinity. Being able to effectively utilise certain aspects of one's life situation in re-constructing masculinity is important in maintaining quality of life despite troublesome treatment side-effects.

"Dancing on the edge of the abyss": Posttraumatic growth in men cancer survivors

OBJECTIVE

Surviving cancer can lead to self-perceived beneficial changes and personal growth, commonly referred to as posttraumatic growth. However, the survivorship experience of men following cancer remains understudied. Thus, our objective was to obtain a comprehensive understanding of men's perceptions of the changes in their lives following cancer.

METHODS

Twenty-four Israeli men who completed cancer treatment participated in five focus group meetings. Data analysis was performed using the thematic analysis method.

RESULTS

Four themes were identified pertaining to both positive and negative changes in the men's lives following cancer: 1) negative manifestations of cancer survivorship; 2) changes in perceptions of life; 3) changes in perceptions of self; and 4) putting changes into action.

CONCLUSION

Whereas earlier research indicated a minimal impact of cancer on men survivors' lives, this study demonstrates multidimensional changes in the lives of such men. Findings revealed a dialectic post-cancer experience that consisted of negative manifestations of cancer survivorship co-existing with positive developments in different aspects of the men's lives. Additionally, prioritizing one's self was a novel finding of the current study.

Connecting Masculinities to Men's Illness Vulnerabilities and Resilience

Men's illness vulnerabilities and resilience are two predominant and regularly linked constructs in the masculinities and men's health literature. There has been a steady stream of men's strength-based vulnerabilities in the form of illness testimonials amid critiques that such disclosures are mere props for bolstering patriarchal power. The current article presents secondary analyses of case studies with four participants who took part in wide-ranging qualitative health studies to detail diverse connections between masculinities and men's illness vulnerabilities and resilience. Prostate cancer-related vulnerabilities feature in the first case study where Arthur's resilience for reclaiming his erectile function post-prostatectomy mobilizes an objection masculinity contesting his marginality. In the second case study, Chuck's vulnerabilities are conceded as permanent flowing from his severe mental illness, a positionality situating resilience as obligatory for his survival. Here, Chuck embodies a resignate masculinity that accepts but works to manage the harms of his subordinate status. In the aftermath of his young son's suicide, Jack laments that he did not model vulnerabilities. Resilience for understanding his loss influences a reimagined masculinity where Jack contemplates changes to gender norms for his and other men's lives. Lastly, Sami replaces maladaptive actions for dousing vulnerabilities incurred through a partner-initiated separation with resilience for self-growth. Aspiring progress masculinity, Sami deconstructs his emotions and behaviors to positively change how he shows up as a man, father, and partner. The case studies reveal connections between objection, resignate, reimagined, and progress masculinities and men's illness vulnerabilities and resilience to advance empirical, gender theory and methodological insights.

Men's Achilles' heel: prostate cancer and the reconstruction of masculinity

The aim of this study was to investigate how Swedish men diagnosed with prostate cancer understand the effects of their treatment in relation to sexual health and masculinity. Utilising a phenomenological and sociologically informed approach, the study involved interviews with 21 Swedish men who experienced problems following treatment. The results showed that participants' initial response post-treatment, involved the development of new bodily understandings and socially informed strategies to handle incontinence and sexual dysfunction. Due to impotence and the loss of ejaculatory ability following treatments such as surgery, participants re-articulated the meaning of intimacy, as well as their understanding of masculinity and themselves as ageing men. Unlike in previous research, such a re-articulation of masculinity and sexual health is understood as taking place within rather than in opposition to hegemonic masculinity.

"Your Diet Defines Who You Are, Especially as a Man": Masculinity in Online Media Focused on Healthy Eating for Men

In contexts marked by neoliberal ideology and a claimed "crisis" in men's health, men are responsibilized to be/come healthy. Eating has long been a gendered practice in Western cultures, and recent cultural shifts have produced ways of eating that are both masculinized and (claimed) healthy. Online healthy eating advice, which encourages and supports men to eat healthily, is an important information source. However, such information draws on, reproduces, and/or disrupts existing meanings about men and eating. To understand contemporary representations of men and healthy eating, we examined 30 online media articles oriented specifically to this topic. Using reflexive thematic analysis from a social constructionist position, we developed two themes: A lad's looks and lifestyle and Mind over matter: The masculine mindset. These themes together told an overarching story that healthy eating is effectively sold to men by drawing on traditional or hegemonic ideals of masculinity and effectively evoking access to an enhanced masculinity through healthy eating. While these representational practices may sell healthy eating to men, with likely positive health benefits, they also reinforce hegemonic ideals of masculinity which can be problematic from a health perspective.

'Out of the frying pan into the fire': a qualitative study of the impact on masculinity for men living with advanced prostate cancer

Background

Studies have highlighted how advanced prostate cancer causes biographical disruption and presents challenges to masculine identities for men. This article draws on a wider study that focused on the experiences of men living with advanced prostate cancer and their caregivers. Although men's experience of advanced illness is not overlooked in the literature, only a small body of work has taken an in-depth look at men's experiences with advanced prostate cancer and their caregivers in a non-Westernised cultural and social context.

Objective

To explore how advanced prostate cancer impacts on men's masculine identity from the perspective of patients and their caregivers.

Methods

A qualitative study of men living with advanced prostate cancer (n = 23) and family caregivers (n = 23) in Ghana. We used the Consolidated Criteria for Reporting Qualitative Studies (COREQ) as the reporting guideline.

Results

The findings from this study highlight profound challenges for most men to their masculine identities, from both the treatment and the symptoms of advanced prostate cancer within a non-Westernised, patriarchal society. Four main themes were developed. These were the impact on masculinity in terms of: (1) physical changes, (2) sexual ability, (3) socio-economic roles and (4) expressing emotions. Changes in physical appearance, feeling belittled, having no active sexual life and the inability to continue acting as provider and protector of the family made some men describe their situation as one of moving out of the 'frying pan into the fire'.

Conclusion

This study revealed the impact of advanced prostate cancer on masculine identity. These narratives add a new dimension to what is already known about the impacts on men's masculine identities when dealing with advanced prostate cancer. This knowledge can help improve the care provided to men with advanced prostate cancer with emphasis on the cultures, beliefs and aspirations of these men and their caregivers.

Discussion and Optimization of the Male Breast Cancer Patient Experience

Breast cancer in men is rare and often overlooked as there is a misconception that it is a gendered disease that affects women only. The feminization, or "pinkification," of the disease has been socially constructed to raise awareness, improve screening, and empower women but has not addressed the occurrence of the illness in men. Men may therefore experience unique psychosocial difficulties when faced with a disease that predominantly affects women, including feelings of disbelief and embarrassment that impact their sense of self and challenge their masculinity. The lack of mammographic screening in men, lack of public awareness, and the shame that develops during the time of diagnosis can result in treatment avoidant behaviors, a delayed presentation, and worse prognosis in men. Although male breast cancer (MBC) is uncommon, the incidence is increasing; therefore, efforts should be made to enhance education for health care professionals and the general public in order to lessen the stigma, with the goal of improving outcomes. Furthermore, special attention to the unique medical needs and hurdles encountered by transgender males can break down health care barriers in this marginalized patient population. This article offers male perceptions on breast cancer, the psychosocial implications of being diagnosed with a gendered disease, and suggestions on how to improve the MBC experience.

Black men's experiences of support following treatment for prostate cancer in England: A qualitative study

PURPOSE

Prostate cancer is a leading cause of death in black men in the United Kingdom (UK). Evidence suggests that unmet supportive care needs are prevalent in contemporary healthcare, particularly for men with advanced prostate cancer, whilst less has been written specifically about the supportive care needs of black men. Therefore this study will examine black men's experiences of support following prostate cancer treatment in England.

METHOD

A qualitative research design was employed. Twenty black African and black Caribbean men were interviewed on a face-to-face basis to obtain insightful information about their experiences of prostate cancer. Interviews were recorded and transcribed. Data were analysed using thematic analysis which allowed for emergent themes.

RESULTS

In this study there were six emergent themes. These were: dealing with the treatment effect, support from loved ones, individuals and organisations, healthcare support, spirituality, and positivity. Black men used different coping strategies to deal with the side effects of treatment.

CONCLUSION

Black men experienced a range of supportive care needs. Some men felt that their individual needs as black men were not met by healthcare professionals, although no specific reasons were forthcoming as to why they felt this way. Healthcare professionals should be aware of the support mechanisms that black men have used throughout the prostate cancer journey and to consider these approaches when treating and caring for black men.

The impact of radical prostatectomy on the social well-being of prostate cancer survivors: A qualitative meta-synthesis

INTRODUCTION

The impact of radical prostatectomy on the social well-being of survivors remains poorly understood. This meta-synthesis therefore aimed to integrate the findings of qualitative research evaluating the impact of surgery on the patient relationships with partners, family and wider societal interactions.

METHODS

Medline, CINAHL, PsycINFO and Embase were searched for qualitative studies evaluating social well-being dimensions. A thematic meta-synthesis was conducted to inductively construct descriptive themes and overarching analytical themes.

RESULTS

Thirty-one articles were included, with seven descriptive themes under two analytical themes generated to describe the experiences of 469 participants. 'Pathway to Conversion' encompassed three themes on the evolving social behaviour of men with both partners and family to adapt to their new normality postoperatively. 'A Man on My Own' discussed four themes focussing on both intimate and wider social relations, describing the stigma, shame and embarrassment felt by patients due to changes in their perceived body image and physical function. This resulted in men feeling alone, unsupported and seeking isolation.

CONCLUSION

Radical prostatectomy's impact on survivors' social well-being extends beyond surgery and causes a shift in their relationship dynamics with partner and family, highlighting the importance of preoperative and postoperative clinician's counselling to both patient and partner.

Body image, self-esteem, and sense of masculinity in patients with prostate cancer: a qualitative meta-synthesis

PURPOSE

Body image, self-esteem, and masculinity are three interconnected constructs in men with prostate cancer, with profound effects on quality of life. This meta-synthesis aimed to evaluate all known qualitative studies published studying the effect of prostate cancer on these constructs.

METHODS

A systematic review utilising PubMed, Embase, MEDLINE, and PsycINFO databases up to May 2020 was conducted in line with PRISMA and ENTREQ guidelines. All qualitative studies of men's experiences with body image, self-esteem, and masculinity whilst living with prostate cancer were included. A thematic meta-synthesis was conducted to identify emergent descriptive and analytical themes under the main study constructs.

RESULTS

Of 2188 articles identified, 68 were included. Eight descriptive themes were identified under two analytical themes: 'Becoming a Prostate Cancer Patient' and 'Becoming a Prostate Cancer Survivor'. These described the distress caused by changes to body image, sexual functioning, sense of masculinity, and self-esteem, and the subsequent discourses men engaged with to cope with and manage their disease. A key element was increased flexibility in masculinity definitions, and finding other ways to re-affirm masculinity.

CONCLUSIONS

Prostate cancer has an important effect on men's health post-diagnosis, and we identified strong relationships between each construct evaluated. The role of hegemonic masculinity is important when considering men's coping mechanisms and is also a key factor when addressing these constructs in counselling post-treatment.

IMPLICATIONS FOR CANCER SURVIVORS

This meta-synthesis provides key topics that uniquely affect prostate cancer survivors, enabling these patients to be effectively counselled, and have their concerns recognised by clinicians.

Redefining masculinity - Men's repair work in the aftermath of prostate cancer treatment

Treatments for prostate cancer have many potential side effects such as a loss of erection, weaker orgasms, and incontinence. These are all bodily changes that may challenge dominant masculine ideals. In this article, I use Persson's repair work to describe how men tackle these side effects, and I describe the trouble their repair work elicits in terms of masculinity. I analyse interviews with eleven Swedish men, all treated for prostate cancer, and show that such work is done in three ways. Bodily repair work elicits the work men do to restore bodily functions, often through medical technologies. Relational repair work describes how relations with (potential) others shape men's bodily and sexual concerns, and the ways relations redefine such concerns. Age marking as repair emphasises how age is used in the redefinitions of norms about masculinities and aging bodies, both in relation to oneself and others. The analysis highlights how men's repair work is multifaceted, and is performed against the backdrop of dominant discourses on masculinity, medicine and old age. The analysis of such repair work is valuable to research on how masculinity is constructed in the light of treatment side effects and older age.

Neglected sexual dysfunction symptoms amongst chronic patients during routine consultations in rural clinics in the North West province

BACKGROUND

Sexual dysfunction contributes to personal feelings of loss and despair and being a cause of exacerbated interpersonal conflict. Erectile dysfunction is also an early biomarker of cardiovascular disease. As doctors hardly ever ask about this problem, it is unknown how many patients presenting for routine consultations in primary care suffer from symptoms of sexual dysfunction.

AIM

To develop an understanding of sexual history taking events, this study aimed to assess the proportion of patients living with symptoms of sexual dysfunction that could have been elicited or addressed during routine chronic illness consultations.

SETTING

The research was carried out in 10 primary care facilities in Dr Kenneth Kaunda Health District, the North West province, South Africa. This rural area is known for farming and mining activities.

METHODS

This study contributed to a broader research project with a focus on sexual history taking during a routine consultation. A sample of 151 consultations involving patients with chronic illnesses were selected to observe sexual history taking events. In this study, the patients involved in these consultations completed demographic and sexual dysfunction questionnaires (FSFI and IIEF) to establish the proportions of patients with sexual dysfunction symptoms.

RESULTS

A total of 81 women (78%) and 46 men (98%) were sexually active. A total of 91% of the women reported sexual dysfunction symptoms, whilst 98% of men had erectile dysfunction symptoms. The youngest patients to experience sexual dysfunction were a 19-year-old woman and a 26-year-old man. Patients expressed trust in their doctors and 91% of patients did not consider discussion of sexual matters with their doctors as too sensitive.

CONCLUSION

Clinical guidelines, especially for chronic illness care, must include screening for sexual dysfunction as an essential element in the consultation. Clinical care of patients living with chronic disease cannot ignore sexual well-being, given the frequency of problems. A referral to a sexual medicine specialist, psychologist or social worker can address consequences of sexual dysfunction and improve relationships.

Coping strategies in active and inactive men with prostate cancer: a qualitative study

PURPOSE

Prostate cancer can result in a shift in the way men perceive their masculinity. Despite the interest in exercise as a treatment strategy to address masculinity concerns, there is insufficient information about how perceptions may differ in active and inactive men. The aim of this study was to explore how exercise might influence self-perceptions of masculinity in men across the exercise continuum (from active to inactive) and in men receiving different forms of treatment for their prostate cancer, including androgen deprivation therapy.

METHODS

Individual, semi-structured interviews were conducted with 15 men. Ten men met aerobic and/or resistance guidelines and were considered active, while five men, considered inactive, reached neither guideline. This study used a grounded theory approach to data analysis, examining masculinity issues in active men and compared them to inactive men.

RESULTS

Redefining masculinity emerged as an overarching theme. Subthemes were the various coping strategies men used to redefining masculinity and directly related to their exercise habits. Coping subthemes included re-establishing control, tapping into competition, remaining socially connected, rationalization, and acceptance.

CONCLUSIONS

In the active men, dominant coping strategies achieved from exercise included control through active participation, acceptance, competition, and leadership. In inactive men, control was observed with knowledge-seeking behaviors, rationalization, and acceptance.

IMPLICATIONS FOR CANCER SURVIVORS

A tailored approach to exercise counseling based upon specific masculine traits and motivations could lead to improved exercise engagement.

The role of body image in treatment decision-making and post-treatment regret following prostatectomy

Three main treatments are offered to men with localised prostate cancer: active monitoring, radiotherapy and prostatectomy. The aim of this research was to explore the role of body image in treatment decision-making and post-treatment regret following prostatectomy for localised prostate cancer. Data were collected via nine semi-structured interviews. Interviews underwent thematic analysis and four themes emerged: need to prolong life, loss of function and self, post-surgery effects on body image and confidence, and coping strategies. Participants revealed that loss of erectile function following surgery resulted in reduced self-confidence, and changes in their perception of their body.

Effects of resistance exercise in prostate cancer patients : A systematic review update as of March 2020

Purpose

The aim of this systematic review is to provide an update on the effects of resistance exercise (RE) in patients with prostate cancer (PCa), with special attention to the effects on sexual health.

Methods

A systematic search of the literature was conducted in March 2020 using the databases PubMed, MEDLINE, EMBASE, SCOPUS and the Cochrane Library. Only randomized, controlled trials published after 31 December 2016 were included in this update. Additionally, articles from current and previous reviews were utilized to provide a brief summary of the effects on sexual health.

Results

A total of 10 articles met the inclusion criteria, of which 5 were identified as independent studies. The remaining five articles presented additional data for studies, which have already been included. The identified studies further strengthened the evidence for positive effects on muscle strength, body composition and physical function. Positive effects on bone mineral density were apparent only when RE was combined with impact training. One article reported an improvement in fatigue and health-related quality of life. Only one study examined the effects of RE in isolation and three articles indicated positive effects of exercise on sexual health.

Conclusion

Recent evidence supports the use of RE in PCa patient rehabilitation as a countermeasure for treatment side effects. Further research is necessary to ascertain the optimal delivery methods and illuminate the effects on health-related quality of life (HRQOL), fatigue and sexual health.

Assessment of selected quality of life domains in patients who have undergone conservative or radical surgical treatment for penile cancer: an observational study

Background Surgery is the standard treatment for organ-restricted penile cancer, but it is also a disfiguring procedure that can profoundly affect quality of life. Using a survey, in this study we assessed the effect of different surgical invasiveness on satisfaction in selected life domains of patients who underwent penile-sparing surgery and partial penectomy.

METHODS

Forty patients who underwent penile-sparing surgery (n=13) or partial penectomy (n=27) were enrolled in the study. The response rate was 71%. Information was obtained after surgery on sexuality, self-esteem, masculinity and partner relationships using the International Index of Erectile Function, the Self-Esteem Scale and the Conformity to Masculinity Norms Inventory questionnaires. We evaluated the effect of primary surgery type on selected domains of quality of life and correlations between study variables after surgery.

RESULTS

High self-esteem, satisfactory erectile function and masculinity results in both groups were comparable to those in the published literature. Men who underwent less disfiguring treatment had a significantly higher sense of masculinity than those who underwent partial penectomy (P=0.05). No significant differences were observed in erectile dysfunction and self-esteem. The level of aggressiveness of a surgical procedure was a predictor of sense of masculinity (P=0.01), but was not associated with self-esteem and sexual dysfunction (P=0.28 and P=0.55 respectively); 83% of patients were able to satisfactorily maintain partner relationships.

CONCLUSIONS

Disfiguring treatments for penile cancer significantly interfere with the sense of masculinity, but sexual functioning and self-esteem do not differ according to the type of surgical procedure. Most men maintained stable partner relationships after surgery, regardless of surgery type.

Men's perceptions of the impact of the physical consequences of a radical prostatectomy on their quality of life: a qualitative systematic review

OBJECTIVE

To identify men's perceptions of the impact of the physical consequences of a radical prostatectomy on their quality of life.

INTRODUCTION

Prostate cancer is the most common male cancer and second most common cause of cancer death of men in the Western world. Compared to other prostate cancer treatments, trials report worse urinary incontinence and sexual function and similar bowel function among men with prostate-specific antigen detected prostate cancer who underwent radicalized prostatectomy.

INCLUSION CRITERIA

This review included men of all ages and nationalities who had undergone a radical prostatectomy as treatment for any stage of prostate cancer. It considered studies that investigated:Any setting where the topic was addressed with participants meeting the inclusion criteria was included. The review considered studies that focused on qualitative data including, but not limited to: phenomenology, grounded theory, ethnography and action research. Studies were included if they reported results relating to one or more of the phenomena of interest. Studies not written in English were excluded.

METHODS

The search strategy aimed to find published studies from six databases from database inception to November 2017. Methodological quality of studies was independently assessed by two reviewers using the standardized JBI Critical Appraisal Checklist for Qualitative Research. For data extraction, the standardized Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI) data extraction tool was used. A meta-aggregation was undertaken and the final synthesis of the findings was reached through discussion. Results are presented as five aggregated qualitative syntheses.

RESULTS

Nineteen qualitative studies were included in the review. The five synthesized findings were: CONCLUSIONS:: Urinary incontinence and erectile dysfunction are significant side-effects of radical prostatectomy which have a negative impact on men's quality of life for which they feel ill prepared, and physical and psychosocial support is essential.

Maintaining masculinity: Moral positioning when accounting for prostate cancer illness

This article explores men's experiences following treatment for prostate cancer through the lens of chronic illness. Recent empirical work suggests prostate cancer may be better understood as a chronic illness. Prostate cancer offers a case study to examine how older men's masculinities are disrupted by chronic illness experience. Qualitative interviews with 29 men, recruited from two prostate cancer support groups, explored prostate cancer and post-treatment experiences. Men's experiences are examined by drawing on the works of Steve Robertson and Kathy Charmaz for understanding masculinities in relation to health and illness. Aspects of chronic illness experience are identified in men's accounts, particularly concerns with loss of moral status resulting from ongoing and potentially stigmatising treatment side effects. Four forms of moral positioning are identified that align with Steve Robertson's empirically derived model theorising the relationship between health and hegemonic masculinity. These findings facilitate discussion of the interaction between chronic illness experience, morality and masculinities, providing insight into how older men maintain their masculinity in the wake of illness.

Gay men's experiences of sexual changes after prostate cancer treatment-a qualitative study in Sweden

Background: The needs of gay men after prostate cancer treatment are becoming visible. This patient group reports a more negative impact of treatment than heterosexual men. Yet, gay men's experiences of post-treatment sexual changes are still little explored. This study aims to determine specific concerns of gay men's post-treatment sexual practices. Methods: A qualitative study design was deployed using semi-structured interviews as data. Participants were purposefully sampled through advertisements and the snowball method. Eleven self-identifying gay men aged 58-81 years and treated for prostate cancer participated in interviews during 2016-2017. The interviews were transcribed, coded and thematically analysed. Results: The analysis highlights sexual changes in relation to the physical body, identity and relations. Problematic physical changes included loss of ejaculate and erectile dysfunction. Some respondents reported continued pleasure from anal stimulation and were uncertain about the role of the prostate. These physical changes prompted reflections on age and (dis)ability. Relationship status also impacted perception of physical changes, with temporary sexual contacts demanding more of the men in terms of erection and ejaculations. Conclusions: Gay prostate cancer survivors' narratives about sexual changes circle around similar bodily changes as heterosexual men's, such as erectile problems and weaker orgasms. The loss of ejaculate was experienced as more debilitating for gay men. Men who had anal sex were concerned about penetration difficulties as well as sensations of anal stimulation. Additional studies are required to better understand the role of the prostate among a diversity of men, regardless of sexuality.

Participation in a prostate cancer support group and health literacy

BACKGROUND

To cope with prostate cancer (PC) and its consequences and to be certain about therapeutic alternatives, some patients seek mutual help in prostate cancer support groups (PCSGs), where they share information and find social support. Our study was intended to assess whether group participation is associated with health literacy (HL).

METHODS

We compared PCSG members (n = 441) with PC patients without support group experiences (n = 135) in a cross-sectional design. For this purpose, HL was operationalized through PC-specific knowledge, noncancer-specific knowledge about health care, guideline awareness, and skills needed to apply health information to meet own needs. Binary logistic regression models were calculated. Socio-demographic data and disease-related characteristics were used as control variables.

RESULTS

Knowledge about PC (OR, 2.2; CI, 1.3-3.7), the fact of having heard of guidelines (OR, 3.7; CI, 2.1-6.8) and having read one (OR, 5.1; CI, 2.8-9.4), and competencies regarding health service navigation (OR, 1.8; CI, 1.0-3.1) are associated with PCSG membership. No statistically significant associations could be found between PCSG membership and further skills questioned, as well as between membership and knowledge about noncancer-specific health care.

CONCLUSION

PCSG membership is associated with HL in some areas only. In particular, the groups seem to provide an important platform for information exchange in the field of PC. The potentially conflicting results on PC knowledge and the application skills may arise from the different forms of measurement-knowledge was tested; skills were self-assessed.

A fertility needs assessment survey of male cancer patients

OBJECTIVE

To describe fertility-related informational needs and practices, and to examine if demographic characteristics are related to these needs and practices.

METHODS

A needs assessment survey was conducted at three Canadian cancer centres.

RESULTS

192 male cancer patients (Mage = 33.6) completed the survey. Most patients (70%) recalled having had a discussion with a health care provider regarding their fertility and 44% banked their sperm. Patients reported not getting all the information that they wanted, eg, the risk that a future child may have the same type of cancer (78%), and what was covered by insurance plans (71%). Barriers to sperm preservation were urgency to begin cancer treatment (49%), not planning to have a child in the future (47%) and worries that cancer could be passed on to future children (38%). Participants' age and being the parent of a child were significantly associated with having had a discussion about fertility. Participants' age, province, being the parent of a child and the desire for future children were significantly associated with fertility preservation.

CONCLUSIONS

Discussions with health care providers were more frequent, and fertility preservation rates were higher than in past studies, but still not all patients' questions were answered. Misconceptions about passing on cancer to one's child, and that sperm preservation will delay treatment, should be dispelled. Health care providers can ask patients if they have any desire to have children in the future as a way to initiate a discussion of fertility preservation. Key information gaps and psychosocial resource needs are suggested to fully meet male cancer patients' fertility-related concerns.

The Connections Between Work, Prostate Cancer Screening, Diagnosis, and the Decision to Undergo Radical Prostatectomy

Prostate cancer diagnosis can occur at a time when men's work and careers are central to their masculine identity, sense of purpose, and family life. In Canada, an aging male population, along with medical advances, has resulted in increasing numbers of working men being diagnosed with, and treated for, prostate cancer. Little is known about the linkages between men's work and their experiences of prostate cancer. In this qualitative study, 24 Western Canadian men were interviewed to distil the connections between work, prostate cancer screening, diagnosis, and the decision to undergo radical prostatectomy. Data were analyzed using constant comparison in the context of masculinities theory. The findings demonstrated that work was central to men's masculine identities and afforded financial security, social status, and a sense of personal growth. However, work-related strain and demands were also found to affect participants' health and distance them from their families. A diagnosis of prostate cancer tended to diminish the importance of work, wherein participants focused on optimizing their health and strengthening family relations. In deciding on radical prostatectomy as a treatment to eradicate prostate cancer, few men considered the implications for returning to work. The current study findings indicate that clinicians and patients should explicitly explore and discuss how surgery side effects may affect work and career plans during treatment decision-making.

"I Want to Feel Like a Full Man": Conceptualizing Gay, Bisexual, and Heterosexual Men's Sexual Difficulties

Current understandings of sexual difficulties originate from a model that is based on the study of heterosexual men and women. Most research has focused on sexual difficulties experienced by heterosexual men incapable of engaging in vaginal penetration. To better understand men's perceptions and experiences of sexual difficulties, seven focus groups and 29 individual interviews were conducted with gay (n = 22), bisexual (n = 5), and heterosexual (n = 25) men. In addition, the extent to which difficulties reported by gay and bisexual men differ from heterosexual men was explored. Data were analyzed using thematic analysis applying an inductive approach. Two intercorrelated conceptualizations were identified: penis function (themes: medicalization, masculine identity, psychological consequences, coping mechanisms) and pain (themes: penile pain, pain during receptive anal sex). For the most part, gay, bisexual, and heterosexual men reported similar sexual difficulties; differences were evident regarding alternative masculinity, penis size competition, and pain during receptive anal sex. The results of this study demonstrate the complexity of men's sexual difficulties and the important role of sociocultural, interpersonal, and psychological factors. Limitations and suggested directions for future research are outlined.

Seeking certainty through narrative closure: men's stories of prostate cancer treatments in a state of liminality

Radical treatments of prostate cancer often lead to a pervasive liminal state that is characterised by multiple uncertainties that relate both to a possible recurrence of cancer and recovery from side effects, such as erectile and urinary dysfunctions. Liminality can make it difficult for cancer patients to narrate their experiences, as their stories lack a definite ending. After interviews with 22 Finnish men who had undergone radical prostatectomy, we analysed how men produce closure in their illness narratives. Focusing on the timelines of control visits or their anticipated recovery from side effects, these interviewees sought provisional certainty within a seemingly chaotic future. By locating erectile dysfunction in the wider context of a life-course and interpreting their fading sexuality as a 'natural' consequence of ageing, these men were adjusting to their post-operative lives. Our study further shows that the inability to adjust personal experiences to positive culturally available storylines that provide a chance for the narrative reconstruction of life, can cause materialised negative consequences, such as relationship breakdowns.

Sexual Recovery Following Prostate Cancer: Recommendations From 2 Established Canadian Sexual Rehabilitation Clinics

INTRODUCTION

Supportive sexual health care is much-needed adjuvant care to oncologic management for men with prostate cancer (PCa).

AIM

To inspire the initiation of biopsychosocial sexual health programming where it does not exist and to inform program enhancement in existing sexual rehabilitation clinics (SRCs).

METHODS

This article reviews the combined 30-year experience of 2 well-established Canadian SRCs for men and their partners after PCa treatments, interwoven with empirical evidence.

MAIN OUTCOME MEASURE

To comprehensively review the biopsychosocial approach to sexual health assessment of men with PCa and their partners to direct the practicalities of running a successful and sustainable SRC.

RESULTS

A full description of the biomedical and psychosocial approaches, inclusive of comprehensive sexual function, the penile rehabilitation controversy, and other medical and relationship issues affecting sexual adjustment, is provided to highlight the relevance of proper assessment and follow-through for sexual adaptation and adjustment. 10 recommendations for a successful SRC are discussed, including the principles behind developing a sustainable business plan, staff acquisition and training, budget, integration of treatment and research priorities, respectful and multidisciplinary approaches to care, and suggestions of visit formats, protocols, and questionnaires. We recommend a phased approach of an SRC into usual care with the option to provide accessible and equitable care to patients not within proximal access of treating institutions.

CONCLUSION

Sexual rehabilitation after treatment for PCa requires a complex treatment process. Providing sustainable sexual rehabilitation programming under the financially strained environment of the Canadian medical system is a challenge; therefore, to provide Canadian patients and their partners with comprehensive cancer care, they deserve a biopsychosocial approach combined with a creative and systematic implementation strategy. Elliott S, Matthew A. Sexual Recovery Following Prostate Cancer: Recommendations From 2 Established Canadian Sexual Rehabilitation Clinics. Sex Med Rev 2018;6:279-294.

Intimacy, intercourse and adjustments: Experiences of sexual life of a group of people with physical disabilities in South Africa

There is a growing recognition of the sexual and reproductive rights of people with disabilities, and since the World Health Organisation's World Report on Disability, increased international attention has been given to these issues. Past research, however, suggests that this group encounter barriers to sexual and reproductive rights, which are both physical and attitudinal. Against this backdrop, this article employs a sequential mixed qualitative methodology to explore the practical and subjective experiences of 13 people with physical disabilities in South Africa, with regard to their sexual lives and experiences of sexuality. These experiences were marked by concerns about their 'fitness' as sexual beings and indicated that social forces were key in shaping their expectations for their own sexual life.

Ambiguity in a masculine world: Being a BRCA1/2 mutation carrier and a man with prostate cancer

OBJECTIVE

Increased risk of prostate cancer (PCa) is observed in men with BRCA1/BRCA2 mutations. Sex and gender are key determinants of health and disease although unequal care exists between the sexes. Stereotypical male attitudes are shown to lead to poor health outcomes.

METHODS

Men with BRCA1/2 mutations and diagnosed with PCa were identified and invited to participate in a qualitative interview study. Data were analysed using a framework approach. "Masculinity theory" was used to report the impact of having both a BRCA1/2 mutation and PCa.

RESULTS

Eleven of 15 eligible men were interviewed. The umbrella concept of "Ambiguity in a Masculine World" was evident. Men's responses often matched those of women in a genetic context. Men's BRCA experience was described, as "on the back burner" but "a bonus" enabling familial detection and early diagnosis of PCa. Embodiment of PCa took precedence as men revealed stereotypical "ideal" masculine responses such as stoicism and control while creating new "masculinities" when faced with the vicissitudes of having 2 gendered conditions.

CONCLUSION

Health workers are urged to take a reflexive approach, void of masculine ideals, a belief in which obfuscates men's experience. Research is required regarding men's support needs in the name of equality of care.

Threat of Sexual Disqualification: The Consequences of Erectile Dysfunction and Other Sexual Changes for Gay and Bisexual Men With Prostate Cancer

Gay and bisexual (GB) men with prostate cancer (PCa) have been described as an "invisible diversity" in PCa research due to their lack of visibility, and absence of identification of their needs. This study examined the meaning and consequences of erectile dysfunction (ED) and other sexual changes in 124 GB men with PCa and 21 male partners, through an on-line survey. A sub-sample of 46 men with PCa and seven partners also took part in a one-to-one interview. ED was reported by 72 % of survey respondents, associated with reports of emotional distress, negative impact on gay identities, and feelings of sexual disqualification. Other sexual concerns included loss of libido, climacturia, loss of sensitivity or pain during anal sex, non-ejaculatory orgasms, and reduced penis size. Many of these changes have particular significance in the context of gay sex and gay identities, and can result in feelings of exclusion from a sexual community central to GB men's lives. However, a number of men were reconciled to sexual changes, did not experience a challenge to identity, and engaged in sexual re-negotiation. The nature of GB relationships, wherein many men are single, engage in casual sex, or have concurrent partners, influenced experiences of distress, identity, and renegotiation. It is concluded that researchers and clinicians need to be aware of the meaning and consequences of sexual changes for GB men when designing studies to examine the impact of PCa on men's sexuality, advising GB men of the sexual consequences of PCa, and providing information and support to ameliorate sexual changes.

The Sexual Adjustment Process of Cancer Patients and Their Partners: A Qualitative Evidence Synthesis

When confronted with cancer, a prominent challenge for patients and their partners is their changed sexual relationship. An empirically based theoretical model of the sexual adaptation process during cancer might be helpful in guiding the development of adequate interventions for couples who struggle with their sexual relationship. Therefore, the purpose of this study was to synthesize evidence from primary qualitative research studies and to arrive at a detailed description of the process of sexual adjustment during cancer. We conducted a qualitative evidence synthesis of a purposeful sample of 16 qualitative papers, using the meta-ethnography approach to synthesis. We found that the subsequent studies used different theoretical approaches to describe the sexual adaptation process. This led to three divergent sexual adaptation processes: (1) the pathway of grief and mourning, depicting sexual changes as a loss; (2) the pathway of restructuring, depicting the adjustment process toward sexual changes as a cognitive process with a strong focus on the social and cultural forces that shape the values and experiences of sexuality; and (3) the pathway of sexual rehabilitation, depicting sexual changes as a bodily dysfunction that needs treatment and specific behavioral strategies. All three pathways have their own opportunities and challenges. A greater awareness of these different pathways could help healthcare providers to better understand the ways a particular couple might cope with changed sexuality, offering them opportunities to discover alternative pathways for sexual adjustment.

Men's experiences after prostatectomy: A meta-synthesis

OBJECTIVE

The purpose of this review was to critically analyze, interpret, and synthesize the literature on men's experiences after prostatectomy.

DESIGN

A meta-synthesis was conducted.

DATA SOURCES

Six databases (PubMed, EMBASE, CINAHL, PsycINFO, AgeLine, and Sociological Abstract) were searched from the earliest year to 2016. From initial searches with main keywords (prostatectomy and qualitative study), 642 abstracts were retrieved. Based on inclusion criteria (English-language published qualitative study focusing on the experience of men after prostatectomy), this meta-synthesis included 15 studies.

REVIEW METHODS

Components of meta-study (meta-data-analysis, meta-method, and meta-theory) were employed to analyze, interpret, and synthesize the results of included studies. Three authors independently appraised the methodological quality of the included studies using a combined appraisal tool (The Critical Appraisal Skills Programme Qualitative Research Checklist and Paterson et al.'s Primary Research Appraisal Tool). The Enhancing Transparency in Reporting the Synthesis of Qualitative Research Statement was used to strengthen the completeness of reporting.

RESULTS

Fifteen studies met inclusion criteria and quality appraisal guidelines, however, most did not identify or relate their findings to theory. Through meta-synthesis, five themes emerged: facing a life-changing situation, experiencing changes and their impact, striving to manage and adjust to changes, coping with masculinity, and anticipating the future.

CONCLUSIONS

After prostatectomy, men experienced physical, psychological, and social changes. Many men are physically and psychologically ill-prepared and suffer from lack of information and support. Health care providers need to be sensitive to men's needs including perceptions of masculinity, realize the importance of support as an essential component of men's adaptation post-prostatectomy, and provide comprehensive and individualized patient-centered interventions. Future studies need to use rigorous research methods, clearly identify methodological approaches, and consider employing or developing theory.

Mastery, Isolation, or Acceptance: Gay and Bisexual Men's Construction of Aging in the Context of Sexual Embodiment After Prostate Cancer

Age is the predominant risk factor for developing prostate cancer, leading to its description as an "older man's disease." Changed sexual embodiment is a concern for men who develop prostate cancer, often compounding experiences of age-related sexual decline. Although research has examined heterosexual men's experiences of aging in the context of sexual embodiment after prostate cancer, gay and bisexual men have received little attention. This qualitative study used a material-discursive analysis, drawing on positioning theory and intersectionality, to explore constructions of aging following prostate cancer in 46 gay or bisexual men. Thematic decomposition of one-to-one interviews identified three subject positions: "mastering youth," involving maintaining an active sex life through biomedical interventions, accessing commercial sex venues, or having sex with younger men; "the lonely old recluse," involving self-positioning as prematurely aged and withdrawal from a gay sexual scene; and "accepting embodied aging," involving the incorporation of changed sexual function into intimate relationships and finding pleasure through nonsexual activities. These subject positions are conceptualized as the product of intersecting masculine and gay identities, interpreted in relation to broader cultural discourses of "new aging" and "sexual health," in which sexual activity is conceptualized as a lifelong goal.

The clinical communication and information challenges associated with the psychosexual aspects of prostate cancer treatment

RATIONALE

Prostate cancer and its treatment have significant sexual side effects that necessitate timely patient information and open communication with healthcare professionals. However, very little is known about men's experiences of talking to clinicians about the psychosexual difficulties associated with the disease.

OBJECTIVE

This study aims to advance understanding of men's perceptions of the communication and information challenges associated with the psychosexual aspects of prostate cancer and its treatment.

METHOD

Between October 2013 and April 2014, semi-structured interviews were conducted with 21 men from the UK who had been treated for prostate cancer. Interview transcripts were analysed using thematic analysis.

RESULTS

Three themes describe the communication challenges men face: (1) It can be too soon to talk about sex; (2) the psychology of sex is missing; (3) communication is not individually tailored.

CONCLUSIONS

Clinicians might usefully (1) consider and discuss with patients how their psychosexual communication needs and information processing abilities may fluctuate across the cancer timeline; (2) initiate discussions about the consequences of treatment that extend beyond biological and mechanical aspects to include emotional and relational factors; (3) tailor communication to the dynamic mix of attributes that shape men's individual psychosexual needs, including their relationship status, sexual orientation, sexual motivations and values. Skills-based training in communication and psychosexual awareness may facilitate the proactive and permissive stance clinicians need to discuss sexual side effects with a heterogeneous group of patients.

How Did Erectile Dysfunction Become "Natural"? A Review of the Critical Social Scientific Literature on Medical Treatment for Male Sexual Dysfunction

This article reviews the multidisciplinary social science literature assessing the social consequences of medical treatment for male sexual dysfunction. This literature applies medicalization theory and social constructionist approaches to gender to assert that Euro-American cultural ideals of masculinity and sexuality, as well as ageism and ableism, determine which sexual changes and experiences get defined as "dysfunction" and shape the marketing and use of medical treatments for those changes. These medical responses assuage the suffering of men who become unable to meet cultural ideals for sexuality but in the process make reductive norms for male sexuality seem biologically natural. In addition, the critical social science research suggests that an economic logic underlies the process of redefining diversity and change in men's sexual function as medical pathology. However, comparative qualitative data on men's and their sexual partners' experiences of sexuality and aging across world regions suggest that people do not universally accept the narrow ideals of male sexuality embedded in medical discourse regarding men's sexual dysfunction. The diversity in people's sexual desires across the life course and their responses to sexual function change highlight the cultural nature of medical definitions of sexual dysfunction.

Erectile dysfunction, masculinity, and psychosocial outcomes: a review of the experiences of men after prostate cancer treatment

Prostate cancer (PC) treatment side-effects such as erectile dysfunction (ED) can impact men’s quality of life (QoL), psychosocial and psycho-sexual adjustment. Masculinity (i.e., men’s identity or sense of themselves as being a man) may also be linked to how men respond to PC treatment and ED however the exact nature of this link is unclear. This review aims to provide a snapshot of the current state of evidence regarding ED, masculinity and psychosocial impacts after PC treatment. Three databases (Medline/PsycINFO, CINHAL, and EMBASE) were searched January 1st 1980 to January 31st 2016. Study inclusion criteria were: patients treated for PC; ED or sexual function measured; masculinity measured in quantitative studies or emerged as a theme in qualitative studies; included psychosocial or QoL outcome(s); published in English language, peer-reviewed journal articles. Fifty two articles (14 quantitative, 38 qualitative) met review criteria. Studies were predominantly cross-sectional, North American, samples of heterosexual men, with localised PC, and treated with radical prostatectomy. Results show that masculinity framed men’s responses to, and was harmed by their experience with, ED after PC treatment. In qualitative studies, men with ED consistently reported lost (no longer a man) or diminished (less of a man) masculinity, and this was linked to depression, embarrassment, decreased self-worth, and fear of being stigmatised. The correlation between ED and masculinity was similarly supported in quantitative studies. In two studies, masculinity was also a moderator of poorer QoL and mental health outcomes for PC patients with ED. In qualitative studies, masculinity underpinned how men interpreted and adjusted to their experience. Men used traditional (hegemonic) coping responses including emotional restraint, stoicism, acceptance, optimism, and humour or rationalised their experience relative to their age (ED inevitable), prolonged life (ED small price to pay), definition of sex (more than erection and penetration), other evidence of virility (already had children) or sexual prowess (sown a lot of wild oats). Limitations of studies reviewed included: poorly developed theoretical and context-specific measurement approaches; few quantitative empirical or prospective studies; moderating or mediating factors rarely assessed; heterogeneity (demographics, sexual orientation, treatment type) rarely considered. Clinicians and health practitioners can help PC patients with ED to broaden their perceptions of sexual relationships and assist them to make meaning out of their experience in ways that decrease the threat to their masculinity. The challenge going forward is to better unpack the relationship between ED and masculinity for PC patients by addressing the methodological limitations outlined so that interventions for ED that incorporate masculinity in a holistic way can be developed.

Let's talk about sex – what do older men and women say about their sexual relations and sexual activities? A qualitative analysis of ELSA Wave 6 data

In 2012/2013 the English Longitudinal Study of Ageing (ELSA) included a comprehensive Sexual Relationships and Activities Questionnaire (SRA-Q). A total of 7,079 men and women mainly aged 50 to >90, primarily heterosexual and in a coupled relationship, completed the SRA-Q, answering a series of questions about their attitudes to sexual relationships, their own sexual activities, problems and concerns with sexual functioning, and quality of intimate relationships. The questions aimed to gain insights into the ways in which sexual relations and activities related to health, wellbeing and other lifestyle factors change as people grow older. The primary mode of data collection was a tick box response to a series of questions. However, at the end of the questionnaire an open comment box was provided, which asked respondents whether there was anything else that they would like to say; 1,084 respondents provided additional information and these comments created a unique qualitative data-set. The analysis of the data then illustrated how people's health, relationships, experiences and perceptions of ageing, along with sexual satisfaction, impact on sexual relationships and activities.

Maintaining intimacy for prostate cancer patients on androgen deprivation therapy

PURPOSE OF REVIEW

Androgen deprivation therapy (ADT) causes erectile dysfunction and increases patients' emotionality while diminishing their sexual interest. ADT has been linked to erosion of spousal bonds; however, this is not an invariant outcome. Understanding the factors that lead to these various outcomes may help couples deal with ADT.

RECENT FINDINGS

A subset of couples report that they became closer as a result of the patients going on ADT. Recent data suggest that what helps couples most is preemptive awareness of ADT's side-effects and congruence in how patients and their partners understand and accept the psychosexual impact of ADT. Sex therapy for prostate cancer patients divides along gendered lines, with distinctly 'male' (recovery of erections) and 'female' (promoting sexual practices that are not erection dependent) approaches. Unfortunately, neither is very effective for couples when the patient is on ADT. Options beyond the standard gendered framework, such as use of an external penile prosthesis, may be worth offering to ADT patients trying to find a 'new normal' that is sexually rewarding for them.

SUMMARY

Intimacy is sharing something with someone that one shares with no one else. Exploring novel sexual practices can help couples stay intimate, even when the patient is on ADT.

An online psychological intervention can improve the sexual satisfaction of men following treatment for localized prostate cancer: outcomes of a Randomised Controlled Trial evaluating My Road Ahead

BACKGROUND

Prostate cancer treatment often results in significant psycho-sexual challenges for men following treatment; however, many men report difficulty in accessing appropriate care.

METHODS

A randomized controlled trial was undertaken to assess the efficacy of a 10-week self-guided online psychological intervention called My Road Ahead (MRA) for men with localized prostate cancer in improving sexual satisfaction. Participants were randomized to 1 of 3 conditions MRA alone or MRA plus online forum, or forum access alone. Pre, post, and follow-up assessments of overall sexual satisfaction were conducted. Mixed models and structural equation modeling were used to analyze the data.

RESULTS

One hundred forty-two men (mean age 61 y; SD = 7) participated. The majority of participants had undergone radical prostatectomy (88%) and all men had received treatment for localized prostate cancer. Significant differences were obtained for the 3 groups (P = .026) and a significant improvement in total sexual satisfaction was observed only for participants who were allocated to MRA + forum with a large effect size (P = .004, partial η²  = 0.256). Structural equation modeling indicated that increases in sexual function, masculine self-esteem, and sexual confidence contributed significantly to overall sexual satisfaction for the MRA + forum plus forum condition.

CONCLUSIONS

This study is the first, to our knowledge, that has evaluated a self-guided online psychological intervention tailored to the specific needs of men with prostate cancer. The findings indicate the potential for MRA to deliver support that men may not otherwise receive and also highlight the importance of psychological intervention to facilitate improved sexual outcomes.

Psychosocial screening for patients with prostate cancer: The development and validation of the psychosocial distress questionnaire-prostate cancer

We describe the psychosocial distress questionnaire-prostate cancer (PDQ-PC), a psychosocial screening list developed and validated specifically for prostate cancer patients. An existing screening list, the psychosocial distress questionnaire-breast cancer (PDQ-BC), was used as a starting point. Two focus groups were then implemented to investigate which items of the PDQ-BC were relevant for the PDQ-PC and which new items were needed. Validity and reliability of the questionnaire were assessed on 278 prostate cancer patients. Factor analysis showed that the 36-item PDQ-PC comprises eight subscales, for which the internal consistency ranged from α = 0.48-0.88. Moreover, moderate to high convergent validity was found.

[Functional results and treatment of functional dysfunctions after radical prostatectomy]

OBJECTIVE

To describe the functional results and treatment of functional dysfunctions after radical prostatectomy for localized prostate cancer.

MATERIAL AND METHOD

Bibliography search was performed from the database Medline (National Library of Medicine, Pubmed) selected according to the scientific relevance. The research was focused on continence, potency, les dyserections, couple sexuality, incontinence, treatments of postoperative incontinence, dysrection and trifecta.

RESULTS

Radical prostatectomy is an elaborate and challenging procedure when carcinological risk balances with functional results. Despite recent developments in surgical techniques, post-radical prostatectomy urinary incontinence (pRP-UI) continues to be one of the most devastating complications, which affects 9-16% of patients. Sphincter injury and bladder dysfunction are the most common causes or pRP-UI. The assessment of severity of pRP-UI that affects the choice of treatment is still not well standardized but should include at least a pad test and self-administered questionnaires. The implantation of an artificial urinary sphincter AMS800 remains the gold standard treatment for patients with moderate to severe pRP-UI. The development of less invasive techniques such as the male sling of Pro-ACT balloons has provided alternative therapeutic options for moderate and slight forms of pRP-UI. Most groups now consider the bulbo-urethral compressive sling as the treatment of choice for patients with non-severe pRP-UI. The most appropriate second-line therapeutic strategy is not clearly determined. Recent therapies such as adjustable artificial urinary sphincters and sling and stem cells injections have been investigated. Maintenance of a satisfying sex life is a major concern of a majority of men facing prostate cancer and its treatments. It is essential to assess the couple's sexuality before treating prostate cancer in order to deliver comprehensive information and consider early therapeutic solutions adapted to the couple's expectations. Active pharmacological erectile rehabilitation (intracavernous injections or phosphodiesterase type 5 inhibitors [PDE5i] on demand, during in the month following surgery) or passive (daily PDE5i after surgery) might improve the quality of erections especially in response to PDE5i. Unimpaired aspects of sexual response (orgasm) may, when the erection is not yet recovered, represent an alternative allowing the couple to preserve intimacy and complicity. Androgen blockade is a major barrier to maintain or return to a satisfying sex. Trifecta is a simple tool to present in one way the results of radical prostatectomy: in case of bilateral neurovascular preservation, Trifecta is 60% whatever the surgical approach.

CONCLUSION

Radical prostatectomy is an elaborate and challenging procedure when carcinological risk balances with functional results. Various treatments of postoperative incontinence and dysrections exist. Functional disorders after surgery have to be treated to ameliorate quality of life of patients.

Gender accommodation in online cancer support groups

The postings made to Internet forums by relatives and friends of people with breast and prostate cancer are described. Women post very frequently on the prostate cancer forum and assume a communication style that is similar to women elsewhere, prioritizing emotional forms of communication over the informational forms preferred by men and showing only mild signs of accommodation to a male style. Men on the breast cancer forum are in a minority and are often responding to the current or anticipated loss of a partner. Their communication behaviour is radically different from that required by dominant conceptions of masculinity. They prioritize emotional communication and the emotional welfare of family members. They experience this new form of communication as unsettling to their conceptions of traditional masculinity. Internet cancer support groups thus favour a form and content of communication generally associated with women’s culture

Development of an explanatory model of sexual intimacy following treatment for localised prostate cancer: A systematic review and meta-synthesis of qualitative evidence

RATIONALE

Prostate cancer is a leading cause of cancer in men, affecting one in eight. An ageing population coupled with increased testing indicates that the incidence of early-stage prostate cancer is rising rapidly. Treatments are effective, but all can result in chronic sexual side effects and impact on the psychological, emotional and relational components of sexual functioning. Whilst the physical consequences of treatment are well documented, we lack a comprehensive picture of the effects of localised prostate cancer treatment on men's experience of sexual intimacy and how this may affect survivorship and recovery.

OBJECTIVE

This study synthesises the qualitative literature related to men's experience of sexual intimacy in the context of localised prostate cancer.

METHODS

A systematic search strategy identified 12 studies, which were assessed using a modified version of the Critical Appraisal Skills Programme. Using Noblit and Hare's (1988) approach, a meta-synthesis was conducted.

RESULTS

Findings are organised within four inter-related themes that form the basis of a new conceptual explanatory model: (i) Loss and grief: Destroyed intimacy; (ii) Going through the motions: Artificial intimacy; (iii) Fear of failure: Avoiding intimacy and (iv) Breaking barriers: Constructing an alternative intimacy.

CONCLUSION

The LMAC (Loss, Motions, Avoidance and Construction) model provides a new way of conceptualising sexual recovery following prostate cancer treatment and opportunities for health care professionals to support men and their partners.

Quality of life in penile carcinoma patients - post-total penectomy

INTRODUCTION

Total amputation, as a treatment for advanced penile cancer, significantly debilitates the patient's quality of life and sexual function. The aim of the study was to assess the quality of life in patients who had undergone total penectomy.

MATERIAL AND METHODS

The questionnaires EORTC QLQ C-30, SES, CMNI, and a modified IIEF-15 questionnaire, were sent to 11 patients.

RESULTS

A total of 10 patients returned the questionnaires completed. The results of the overall quality of life, the median result in individual domains, as assessed by the EORT QLQ C-30 questionnaire, were clearly lower than the reference results. There were statistically significant differences in the results of the QLQ C-30, concerning the role-functioning domain in relation to age (p = 0.008) and education (p = 0.032), in the domain of emotional functioning in relation to education (p = 0.008) and in the domains of physical functioning in relation to the partner relationship (p = 0.032). A significant number of patients were sexually inactive. Sexual activity as defined by touching the area of the pubic symphysis at the scars of the penis, touching and fondling perianal areas or the scrotum and watching things/people that cause excitement was observed in 2/10, 1/10 and 2/10 of patients respectively. In 5/6 of these patients, partnership relationships did not deteriorate, including one patient for whom the relationship actually improved.

CONCLUSIONS

The results obtained indicate that total amputation of the penis significantly affects one's sex life and overall quality of life. However, this does not have negative implications in terms of partnership relations, self-assessment or the evaluation of masculinity.