Sexuality: A Quality-of-Life Issue for Cancer Survivors

A Scoping Review of Oncosexology Policy and Practice Tools Focused on Adolescents and Young Adults

Background: Despite being considered a key component of quality-of-life, sexual health concerns in adolescents and young adults (AYA) patients with cancer (aged 15-39 years old) are often unmet due to barriers from both patients and health care professionals (HCPs). Investigation into policy and practice tools in this scope of practice is also limited. Aim: To review the literature on policy and practice tools in AYA oncosexology. Method: A scoping review was conducted using four databases: Medline, EMCARE, EMBASE, and PsycINFO, based on the Joanna Briggs Institute Scoping Review methodology. Retrieved articles were extracted into Covidence, followed by two screening rounds. Descriptive and basic content analyses were performed for evidence synthesis. Results: Seventy-four articles were included after screening rounds and citation searches. Overall, oncosexology policy and practice tools were categorized into screening tools (11 articles), guidelines (38 articles), training programs (15 articles), service delivery initiatives (5 articles), and the evaluation of their feasibility/challenges to implementation (5 articles). Among these, only ten articles were specifically about the AYA population. They helped identify and resolve sexual health concerns in AYA patients with cancer by providing strategies to overcome communication barriers, treatment options, and information resources for patients, and by advocating for more HCP education on this topic. Conclusion: The results warrant the need for more research, implementation and expansion of policy and practice tools for sexual health issues in AYA patients with cancer.

Healthcare providers' experiences in providing sexual health care to breast cancer survivors: A mixed-methods systematic review

AIMS

To analyse healthcare providers' (HCPs) experiences in sexual health care through the mixed-methods systematic review (MMSR).

BACKGROUND

Sexual health for breast cancer survivors (BCSs) is becoming increasingly important as survivors live longer. HCPs are critical in providing sexual health care.

DESIGN

A mixed-methods systematic review.

METHODS

Literature searches were conducted in databases MEDLINE, CINAHL, Psychology & Behavioral Sciences Collection, Web of Science, Cochrane Library, Scopus, ClinicalTrials.gov and reference lists were searched from inception to 30 December 2022. Two independent reviewers extracted and analysed the data using the JBI guidelines for MMSR.

RESULTS

After screening for 2849 citations, 19 studies were eligible for MMSR, involving 2068 HCPs. Most HCPs believe that sexual health care is their responsibility. However, sexual health was not adequately addressed. A lack of knowledge was the most significant barrier to providing sexual health care. Moreover, HCPs would like to acquire more knowledge and felt that current sexual healthcare training was inadequate.

CONCLUSIONS

Findings suggest that HCPs did not frequently address sexual health in BCSs and that lack of knowledge was the most common barrier. Healthcare session administrators should allocate resources for sexual healthcare training that offer multiple formats, accessible content and convenience. They should also be multifaceted and proactive, meet the diverse needs of BCS at different stages and focus on effective communication.

RELEVANCE TO CLINICAL PRACTICE

This study highlights the importance of addressing sexual health in BCSs and the need for HCPs to receive training in this area. Training should be multifaceted, proactive and meet the diverse needs of BCSs at different stages, with a focus on effective communication. By addressing this issue, HCPs will be better equipped to support the sexual health needs of BCSs, ultimately improving their overall well-being and quality of life. PROSPERO Registration Number: CRD42022327018 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=327018).

Knowledge, practice and communication barriers for oncology doctors in Chile when addressing the sexuality of their patients

Introduction

Communication in a doctor-patient relationship constitutes a crucial aspect in medicine, and its multiple dimensions encompass a wide variety of ethical issues. Communication is particularly relevant in oncology, because it requires continually dealing with sensitive topics in one of the most highly vulnerable situations as a human: illness and proximity to death. Sexuality is one of these topics because it constitutes an area that is frequently affected by cancer and cancer treatment, which may include causing significant distress, the reinforcement of a negative self-image, relationship conflicts and a permanent memory of having cancer. The objective of this research is to describe the perception of knowledge and communications practices used by oncology doctors with respect to sexual health in the care of their patients, as well as the barriers found when it comes to confronting the topic.

Methods

An exploratory quantitative, descriptive and cross-sectional study was carried out, in which a self-administered questionnaire was given to oncology doctors who practise in Chile. This questionnaire had 41 closed questions with answers on a Likert scale and was previously validated by being reviewed and applied to a pilot group of five professionals (one medical bioethics expert and four doctors in the field of oncology). The data were analysed with the SPSS statistical program v. 20, using descriptive statistics.

Results

The main results show that the surveyed doctors consider sexuality to be an important part of patients' quality of life. However, this finding does not align with the practices given for including it as part of clinical care. The professionals refer as the main barriers those that are attributed to the structural functioning of the institution, giving little value to those barriers related to personal aspects or those associated with patient characteristics and/or behaviors.

Conclusion

The results of this study show that, despite oncology doctors seeing sexuality as an important aspect of the quality of life of their patients, they do not include the topic in clinical care. Given that one of the main barriers is obstacles relating to the institution, it is necessary to create political institutions that create the conditions for including this area as a relevant part of cancer patient care.

Sexual Function in Women Survivors of Hematologic Malignancy after Autologous Hematopoietic Stem Cell Transplantation

A multicenter, cross-sectional study was conducted to assess the sexual function of women survivors of hematologic malignancy after autologous hematopoietic stem cell transplantation (AHSCT), and to compare it with that of healthy women controls. Fifty-six sexually active women survivors of hematologic malignancy who underwent AHSCT were recruited through convenience sampling, as well as 60 healthy women. Demographic and clinical data questionnaires and the Female Sexual Function Index (FSFI) were completed. Survivors had a median age of 44 years and a median time since transplant of 3 years, while 48.2% had Hodgkin Lymphoma. Survivors reported an average level of sexual dysfunction, with a total score mean ± SD = 22.51 ± 8.95. The best sexual functioning domain was “pain” and the most affected was “orgasm”. There was a statistically significant association between survivors’ sexual function and age (p < 0.0005) in both the unifactorial and the multifactorial analysis. In addition, there was a statistically significant association between survivors’ sexual function and functional status (p < 0.0005), menopausal status (p < 0.0005), the presence of children (p = 0.002), education (p < 0.0005), and diagnosis (p < 0.0005). Healthy women had statistically significantly higher scores in all FSFI subscales (p < 0.0005). Women survivors of hematologic malignancy, treated by AHSCT, had impaired sexual function, implying the need to implement regular sexual health assessment in survivorship care.

Exploring the moderated role of two psychological programs on sexual pleasure from physical symptoms, body image distortion and emotional problems of Hispanic women with breast cancer

Decreased sexual pleasure is a common problem in women with breast cancer. The aim of this study was to evaluate the effect of psychoeducation vs. acceptance and commitment therapy to improve sexual pleasure according to the predictive role of physical, cognitive and emotional factors. Results of 139 Hispanic women (Mexico and Spain) diagnosed with breast cancer reveal that only the emotional factor of depression predicts decreased sexual pleasure. Although women who participated in the psychoeducation program presented greater physical symptomatology, body image distortions and emotional distress, the results seem to indicate that psychoeducational guidelines are relevant to improve sexual pleasure in those women who manifest higher levels of previous depression. Future research is required to clarify these issues.

Sexual Function of Male Survivors of Hematological Malignancy Treated by Autologous Hematopoietic Stem Cell Transplantation: A Multicenter Controlled Observational Study

A multicenter, observational, cross-sectional study was conducted to assess the sexual function of male survivors of hematological malignancy treated by autologous hematopoietic stem cell transplantation (AHSCT) and to compare it with that of healthy male controls. By convenience sampling, 71 sexually active male survivors of hematological malignancy who underwent AHSCT were recruited, as well as 74 healthy men. A questionnaire with demographic and clinical data and the International Index of Erectile Function (IIEF) were completed. Survivors had a median age of 47 years, a median time since transplant of 3 years, and 46.5% had Hodgkin lymphoma. Based on the IIEF, they had a high level of sexual function, with best functioning domain "erection" and worst "overall satisfaction". Healthy men had statistically significantly higher scores in all domains of the IIEF, except for "orgasm" (p = 0.205). There was a statistically significant association between sexual function and age (p < 0.0005), years since transplantation (p = 0.006), functional status (p < 0.0005), having children (p < 0.0005), relationship status (p = 0.001), education (p < 0.0005), diagnosis (p < 0.0005) and disease relapse (p = 0.017). Multivariate analysis showed that only age was a strong prognostic factor of sexual function (p < 0.0005). After age was excluded from the model, because of the strong effect it had on the dependent variable, functional status (p = 0.015), education (p = 0.002) and diagnosis (p = 0.001) had a statistically significant association with sexual function. These findings indicate the importance of sexual function for survivors' well-being and the need for implementation of integrated care plans for survivors of hematological malignancy.

Sexual Dysfunction of Patients with Diffuse Low-Grade Glioma: A Qualitative Review of a Neglected Concern

Simple Summary

Patients suffering from diffuse Low-Grade Glioma (LGG) are usually young adults and present long life expectancy thanks to multimodal therapeutic management. In this context, the preservation of quality of life (QoL) is essential, and sexual health is part of it. We reviewed here the current knowledge about sexual dysfunction in LGG patients. We highlighted how this issue has been largely neglected, despite an incidence from 44 to 62% in the rare series of the literature. Thus, there is a need to assess more systematically the occurrence of SD in clinical routine in order to adapt cancer treatments accordingly, to manage actively these troubles, and finally to improve patients’ QoL in the long run.

Abstract

Diffuse low-grade gliomas (LGG) commonly affect young adults and display a slow evolution, with a life expectancy that can surpass 15 years, thanks to multimodal therapeutic management. Therefore, preservation of quality of life (QoL), including sexual health, is mandatory. We systematically searched available medical databases of Pubmed, Cochrane, and Scopus for studies that reported data on sexual activity or dysfunction (SD) in LGG patients. We analyzed results to determine incidence of SD and its association with QoL in this population. Three studies focused on SD incidence in patients presenting specifically LGG, or brain tumors including LGG. They comprised 124 brain tumor patients, including 62 LGG, with SD incidence ranging from 44 to 63%. SD was reported by more than 50% of interrogated women in the three studies. Regarding QoL, two out of the three studies found significant associations between SD and alterations of QoL parameters, particularly in the field of social and functional wellbeing. Finally, we discussed those results regarding methods of evaluation, inherent biases, and therapeutic implications regarding antiseizure medications and also planning of surgery, chemo-, and radiotherapy. Our review showed that SD is highly prevalent but still poorly studied in LGG patients. As those patients are usually young and enjoy an active life, there is a need to assess more systematically the occurrence of SD in clinical routine, in order to adapt cancer treatments accordingly, to manage actively these troubles, and finally to improve patients’ QoL in the long run.

Body image among adolescents and young adults diagnosed with cancer: A scoping review

OBJECTIVE

Cancer and treatment can produce temporary or permanent body changes, which may affect the body image (BI) of adolescents and young adults diagnosed with cancer (AYAs). This evidence has not been comprehensively summarized. A scoping review was conducted to explore the available evidence on BI among AYAs and identify the definitions, theories, models, frameworks, measures, and methods used to assess BI.

METHODS

Databases MEDLINE, EMBASE, PsycINFO (via Ovid) and CINAHL and Gender Studies (via EBSCO) were searched to identify published studies from 1 January 2000 to 25 November 2019. Inclusion criteria were: qualitative, quantitative, or mixed methodology; at least one BI-related measure or theme; published in English; and majority of the sample between 13 and 39 years at diagnosis and a mean age at diagnosis between 13 and 39 years. Two authors screened the titles, abstracts, and full-text articles and data were extracted and summarized.

RESULTS

The search yielded 11,347 articles and 82 met inclusion criteria. Articles included 45 quantitative, 33 qualitative, and four mixed-methods studies. The majority of studies used cross-sectional designs, while BI definitions, theories, models, frameworks, and measures were varied. Studies explored descriptive, psychological, physical, coping, and social factors, with BI being described most often as an outcome rather than a predictor.

CONCLUSIONS

Theory-based research that employs a holistic BI definition and uses longitudinal or intervention study designs or a qualitative methodology is needed to better understand the BI experience of AYAs and inform the development of strategies and programs to reduce BI concerns and increase positive body experiences.

'These Discussions Aren't Happening': Experiences of People Living with Inflammatory Bowel Disease and Talking About Sexual Well-being with Health Care Professionals

BACKGROUND

Inflammatory bowel disease [IBD] affects all aspects of life, yet little is known about the impact of the condition on intimacy and sexuality and if such concerns should be discussed with health care professionals. This hermeneutical phenomenological study aimed to explore the experiences of people living with inflammatory bowel disease and discussing their sexuality concerns with health care professionals.

METHODS

Participants [n = 43] aged 17-64 years were recruited. Data were collected via in depth interviews and anonymous narrative accounts [Google Forms]. Thematic analysis was used to analyse the data.

RESULTS

An overarching theme 'These discussions aren't happening' with four main themes were generated. The main themes were: 'I can't image talking about sex'; 'I am a person, not my IBD'; 'We need to talk about sex'; and 'Those who talked about sex, talked badly'. Participants described the lack of conversations with their health care professionals on sexual well-being issues, in spite of the importance they gave to the topic, and identified barriers to having such conversations. They made suggestions for future clinical practice that would better meet their needs. The few who had discussed sexual well-being issues with health care professionals reported negative experiences.

CONCLUSIONS

Patients' needs and preferences, about addressing during clinical appointments concerns related to their sexual well-being, should be addressed routinely and competently by health care professionals. Understanding the implications of inflammatory bowel disease for intimate aspects of the lives of those living with the condition could improve the quality of the care provided.

Pelvic floor disorders and sexuality in women with ovarian cancer: A systematic review

INTRODUCTION

Pelvic floor disorders (PFD) are common conditions impacting quality of life and sexuality may worsen after ovarian cancer therapies. Our objective was to describe the prevalence of PFD and sexuality in women with ovarian cancer (OC).

METHODS

We reviewed articles indexed in the MEDLINE database until June 2020 and selected articles assessing UI, POP, FI and sexual dysfunction in a population of women with OC.

RESULTS

Of 360 articles, 18 were included: four assessed UI, two assessed POP, three FI, and 13 sexual dysfunction. PFD findings were highly heterogeneous due to the definitions used and the populations studied. The prevalence of any type of UI in patients with OC before treatment is around 50%, and about 17% report feeling a bulge in their vagina. These rates are similar to those reported in women without cancer. Similarly, the main post-treatment UI scores were not significantly different from women without cancer. Fecal incontinence has been less studied in women with OC but reported as affecting 4% of patients preoperatively and 16% postoperatively. About half of the women are sexually active after surgical treatment with high reported rates of dyspareunia (40-80%) and vaginal dryness (60-80%). Compared with healthy women, some authors found that OC patients had greater problems with loss of desire and poorer sexual function scores; other authors did not find a significant difference.

CONCLUSIONS

While PFD seem to be common in women after treatment for OC, the rates are not higher than in the general population. Overall, there is a higher prevalence of UI and sexual dysfunction compared with bowel dysfunction. More prospective studies are needed to explore the impact of gynecologic cancers and their treatments on pelvic floor function and pelvic health-related quality of life.

Spousal sexual life issues after gynecological cancer: a qualitative study

PURPOSE

Sexual life is a multidimensional issue that can be affected negatively after gynecological cancer. The aim of this study was to reveal what sexuality life difficulties Iranian women with gynecological cancers experience.

METHODS

A qualitative approach was conducted through face-to-face semi-structured interviews with 16 Iranian women with gynecological cancer and then analyzed with conventional content analysis.

RESULTS

Three themes emerged from the data: (1) participant's struggle to maintain the sexual monopoly of the husband, (2) deterioration of intimacy, and (3) unpleasant bed-life experiences. Most women are ashamed to talk about their sexual relationships problems, and on the other hand, nurses and physicians ignore to talk about their sexual problems, so these women are alone in the face of this problem.

CONCLUSION

Although women with gynecological cancer experience sexual problems such as reluctant to have sex and lack of enjoyment, they struggle to maintain sexual life with their husbands. These women do not have enough support. They believe that sexuality is a shameful issue, and they are reluctant to ask questions about it. Health professionals need to talk about the possibility of sexual problems due to changes in their bodies caused by cancer. These women need to be encouraged to talk about these problems, with consideration to their religious and cultural differences.

Sexuality post gynaecological cancer treatment: a qualitative study with South African women

OBJECTIVES

This study investigated women's experiences of their sexuality post gynaecological cancer treatment. Using a holistic sexuality framework, the study explored how women felt their sexual functioning, sexual relationships and sexual identity had been affected by treatment.

DESIGN

The study was qualitative in nature and made use of an interpretive descriptive design. Data were analysed using thematic analysis.

SETTING

Data collection took place at a follow-up clinic within the gynaeoncology unit at a public-sector tertiary hospital in Cape Town, South Africa.

PARTICIPANTS

Purposive sampling was used to recruit participants, and the final sample consisted of 34 women aged 29-70 ([Formula: see text]=52). All women had received a gynaecological cancer diagnosis and had been treated with either surgery, chemotherapy, radiation or a combination of these. On average, the participants were between 12 and 30 months post treatment.

RESULTS

Women expressed how their sexual functioning post treatment was both nuanced and complex, how heteronormative gender expectations influenced their intimate relationships, and how they experienced a re-embodiment of their sexual subjectivity post treatment. Participants felt that more sexual functioning information from healthcare providers, as well as peer support groups, would assist them in navigating the sexuality changes they experienced.

CONCLUSIONS

The findings of this study broaden conceptualisations of sexuality post treatment by detailing the ways that it is complex, nuanced, relational and ever shifting. More research is needed about how to incorporate holistic psychosexual support post treatment into the public healthcare system in South Africa.

Body image concerns of young adult cancer survivors: A brief report

BACKGROUND

The purpose of this study was to describe body image among young adult (YA) cancer survivors and examine relationships between body image and personal, medical, and psychosocial variables. Methods: YAs (n = 522; M_age = 34 ± 6 years) completed an online survey and data were analyzed using descriptive statistics, bivariate correlations, and appropriate tests of mean differences. Results: Higher body image concerns were related to less time since diagnosis, lower post-traumatic growth and social support, greater distress, and a higher number of treatments received (rs = .09 to .42; ps < .05). Body image concerns were higher for those currently on treatment (p < .05). Conclusions: Findings suggest greater attention to YAs' body image is necessary. Specifically, longitudinal research and the development of strategies dedicated to reducing body image concerns among YAs are needed.

Sexuality After Treatment of Diffuse Large B-cell Lymphoma: Patients' Experiences and Psychometric Testing of the Sexual Adjustment Questionnaire-Swedish Version II

Background

Sexuality is an important part of health-related quality of life. To ensure adequate supportive interventions, valid and reliable instruments specific to sexual changes and adjustments after cancer treatment are needed.

Objectives

The aims of this study were to test the psychometric properties of the Sexual Adjustment Questionnaire-Swedish version II (SAQ-SII) in patients treated for diffuse large B-cell lymphoma and to describe and explore patients' experiences of sexuality after treatment.

Methods

A cross-sectional study was conducted in 2019, using SAQ-SII and data from the National Quality Registry for Leukemia–subregistry for Lymphoma, which included 257 patients (25% response rate). An exploratory factor analysis was performed for psychometric evaluation. Internal consistency was assessed by Cronbach's α. Independent t tests, analysis of variance, and multiple regression were used to describe patients' experiences of sexuality.

Results

The exploratory factor analysis resulted in a 4-factor structure, explaining 65.7% of the total scale variance (SAQ-SII). The Cronbach's α for the SAQ-SII was 0.88 and varied between 0.70 and 0.89 across subscales. Sexuality was affected in various ways and extent. Sexual Interest was most affected, whereas Sexual Function was least affected. Being male, of younger age, without comorbidities, and in a relationship were associated to a higher Sexual Interest.

Conclusions

The SAQ-SII is a valid and reliable instrument to measure changes and adjustments in sexuality in patients treated for lymphoma.

Implications for Practice

Assessments of sexuality in a broad sense should be an integrated part of cancer care to ensure timely interventions for those who need and want support.

Priorities and Preferences of Patients With Head and Neck Cancer for Discussing and Receiving Information About Sexuality and Perception of Self-Report Measures

BACKGROUND

Head and neck cancer and its treatment can cause impairment in survivors' sexuality. Previous studies show a need for education and psychological support.

AIM

To examine patients' priorities and preferences for discussing and receiving information about sexuality and to examine patient perceptions of existing self-report measures used in research.

METHODS

This descriptive, cross-sectional, Web-based study recruited adults with a current or previous diagnosis of head and neck cancer. Participants answered questions about their priority and preference for receiving information about sexuality and reviewed 4 self-report measures commonly used in the research of this population.

RESULTS

More than 80% (n = 61) of participants reported that it was important to receive information about sexual issues. Participants chose "at the time of diagnosis" as the most frequent answer for preferred time to receive this information. Half of the participants (n = 35) indicated that they prefer discussing sexual issues with a health-care provider. The most frequent answer for the method of receiving information was through discussions. Participants endorsed 4 themes not addressed by self-report surveys: (i) elicitation of important information, (ii) symptom burden issues, (iii) psychological issues, and (iv) physical barriers.

CLINICAL IMPLICATIONS

Providers, regardless of specialty, must attempt or facilitate discussions around these issues at various times within the treatment and recovery phases.

STRENGTHS & LIMITATIONS

Although limited by sample representation and cross-sectional design, this study addresses an important patient-centered issue that is a critical aspect of quality of life.

CONCLUSIONS

Patients prefer to discuss sexual issues in person with their health-care providers at the time of diagnosis. Participants reacted positively to the self-report measures, but they felt that important issues faced by patients with head and neck cancer were not fully addressed. Rhoten BA, Davis AJ, Baraff BN, et al. Priorities and Preferences of Patients With Head and Neck Cancer for Discussing and Receiving Information About Sexuality and Perception of Self-Report Measures. J Sex Med 2020;17:1529-1537.

The experiences of individuals re-engaging in sexual relationships following a bone marrow transplant: A grounded theory study

PURPOSE

Sexual health is often neglected following a bone marrow transplant. The purpose of this study was to develop an in-depth explanation of the process that patients undergo when re-engaging in sexual relationships following a bone marrow transplant.

METHODS

A Straussian Grounded Theory methodology was employed. Ten bone marrow transplant patients (seven men, three women), participated in a semi-structured interview between October 2018 and April 2019.

RESULTS

A theoretical model of the process of re-engaging in a sexual relationship following a bone marrow transplant evolved over time. Four categories emerged from the data: identifying importance, taking responsibility, seeking resources, and navigating the partnered-relationship. Gender-specific details permeated all of these categories. These occurred in a non-linear process of 'seeking a new normal' and could apply at any time point during the treatment trajectory.

CONCLUSIONS

The model offers an explanation of the process participants went through during their illness and identifies ways that participants navigated change. Having intimate conversations often helped in targeting sexual recovery and affected the ease of transition in dealing with the transition to a 'new normal'.

Do radiation oncologists talk about sexual health and dysfunction with their cancer patients? Results of the igls-vienna-sexmed-survey

Background and purpose

The aim of this survey was to invite radiation oncologists to self-assess whether sexual health care and sexual dysfunction are an issue in daily routine.

Materials and Methods

At the annual congress of the Austrian Society of Radiation Oncology in 2017 doctors were asked about their care for sexual health in cancer patients by using questionnaires. No exclusion criteria were employed. Forty-one questionnaires were answered and statistically analysed so 44.5% of doctors participated.

Results

Only 4.9% of the participants self-assessed to routinely explore sexual health issues in 61-80% of their patients. Thirty-one point seven percent of the doctors suspected sexual problems in about half of their patients but did not raise the issue. The most common reason for not raising sexual issues by the patients was assumed by the doctors "other problems are more important" (73.2%), followed by "lack of time" (36.6%). Participants were also asked about additional medical qualifications: none of the physicians had training in sexual medicine.

Conclusion

The main reason for not talking about sexual problems was the impression of the participating doctors that other problems were more important for the patients. Another reason for not bringing up the topic of sexual issues by the patients was assumed by the doctors: lack of time. As doctor shortage is a problem in the observed country other kind of networks and counselling possibilities should be evaluated. An interesting finding was that survey participants show a higher awareness for male sexual problems than for female issues.

A Pilot Intervention Study to Improve Sexuality Outcomes in Breast Cancer Survivors

Objective:

The main objective of the study is to assess the efficacy of the Permission, Limited information, Specific Suggestion, and sexual therapy (PLISSIT) model directly with breast cancer survivor (BCS) on sexual function and quality of life (QOL) domains.

Methods:

A pilot control trial was conducted comparing the PLISSIT model intervention to usual care. The intervention was delivered by two health professionals (nurse and professional sexual therapist) consisted of five sessions on counseling, genitalia anatomy, human sexual response, and sexual function. Data were collected before and 3 months after the intervention using the Female Sexual Function Index and the World Health Organization QOL-BREF questionnaire.

Results:

The sample consisted of 19 BCS (11 intervention, 8 controls) with a mean age of 54.5 8 years (standard deviation = 7.14) and the majority were married, Black or mixed Brazilian, received chemotherapy, radiation and/or hormonal therapy, and education varied from high school to college. There was significant improvement in physical health (P = 0.031), social relationships (P = 0.046), orgasm (P = 0.055), and pain (P = 0.049) over time and the intervention resulted in improved arousal (P = 0.038).

Conclusions:

The results suggest that the PLISSIT model may be an effective intervention for BCS in coping with and managing changes in sexuality and sexual function after treatment. It is important that nurses are aware of sexual intimacy concerns for BCS and integrate assessment into their nursing care.

Informing patients about the negative effect of nephrectomy on sexual function

OBJECTIVE

The quality-of-life concept has increasingly gained attention, but an important aspect has been neglected, which is the sexual function of patients with kidney cancer after surgery. The aim of this study was to explore the impact of nephrectomy on sexual function in patients with kidney cancer and the information patients received with this regard.

MATERIAL AND METHODS

We conducted a retrospective study of patients who underwent nephrectomy or nephro-ureterectomy within a 5-year period at the Department of Urology, Odense University Hospital, Denmark. Among 310 patients having undergone surgery, 226 were still alive and eligible for participation. Their records were reviewed, and a validated questionnaire concerning their sex life was mailed to them. All participants were invited to take part in a semi-structured interview in person or by phone.

RESULTS

Of 154 former patients who replied, 95 were men (mean age, 66 years, range 37-89), 59 were women (mean age 63 years, range 26-87). A significant difference was observed regarding problems with sexual relationships prior to operation compared after (P<0.0001). Seven patients (5%) had been informed about potential effects and changes in their sex life following operation. Both male and female participants were worried about their sex life (61.4%). Among sexually active male responders, 54.7% reported having some degree of erectile dysfunction.

CONCLUSION

Patients experience significantly more problems in their sexual relationships after surgery. Very few were informed about this, showing the need to offer sex counselling before surgery. More research is required to fully comprehend the magnitude of the problem.

Stress, Social Support, and Sexual Adjustment in Married Female Patients with Breast Cancer in Korea

OBJECTIVE

This study identified the level of stress, social support, and sexual adjustment in married women with breast cancer in Korea.

METHODS

This study used a subgroup analysis, prospective, cross-sectional, and descriptive correlation design. Data were obtained using the perceived stress scale, multidimensional scale of perceived social support, and sexual adjustment subscale of the Korean version of the psychosocial adjustment to illness scale. From May 2015 to April 2016, 272 married female patients who had been diagnosed with breast cancer were recruited at a university hospital in Korea. Data were analyzed using SPSS Win 21.0.

RESULTS

The mean score of stress level was 17.53 ± 4.13, social support was 5.37 ± 1.07, and sexual adjustment was 6.36 ± 3.29. A significant positive correlation emerged between sexual adjustment and stress (r = 0.161, P = 0.008). Significant negative correlations were observed among sexual adjustment and family support (r = -0.177, P = 0.003) and friends' support (r = -0.205, P = 0.001).

CONCLUSIONS

The assessment of stress level and social support may be used in planning sexual-adjustment interventions appropriate for married female breast cancer patients in Korea.

Muslim transplant recipients' family experiences following organ transplantation

Background

Despite the importance of family and its relationship to positive transplant outcomes, little is known about family experiences following organ transplantation from the perspective of the transplant recipients. The literature is also devoid of information that describes the family experiences of Muslim transplant recipients.

Aims

The purpose of this study was to describe Muslim transplant recipients' family experiences following organ transplantation.

Methods

A hermeneutical phenomenological approach was employed to determine the emergent themes present in the data. The sample was composed of 12 Muslim organ transplant recipients (heart, kidney and liver) living in Iran. Semi-structured interviews were conducted with each participant.

Results

The primary constitutive pattern that emerged from the interview data was 'Altered Family Relationships' and three themes: fear in relationships, abnormal relationships, and the family at the centre of organ transplant issues.

Conclusions

There are several important findings in this study, notably that Muslim transplant recipients describe their family experiences following organ transplantation as 'altered' and not as they were pre-transplant. More research is needed that focuses on the family experience post-transplant, and how Muslim transplant recipient families are impacted by the transplant experience.

The Self-Efficacy to Communicate about Sex and Intimacy (SECSI) scale: psychometric assessment in women treated for cancer

PURPOSE

The purpose of this study was to conduct a preliminary validation of the psychometric performance of the newly developed Self-Efficacy to Communicate about Sex and Intimacy (SECSI) scale in a sample of women treated for cancer.

METHODS

Partnered women (n = 250) who had received treatment for cancer completed an online survey that included the SECSI scale and measures of health-related quality of life, depression, anxiety, sexual function, sexual distress, self-efficacy for sexual functioning, sexual behaviors, relationship satisfaction, and satisfaction with sexual communication. Sociodemographic and clinical cancer characteristics data were collected.

RESULTS

High internal consistency and strong test-retest reliability of the SECSI scale were shown with a Cronbach's alpha coefficient of 0.94 and test-retest reliability of r = 0.82, respectively. Construct validity of the SECSI scale, including discriminant, convergent, and divergent validity, was supported except regarding hypothesized relationships between SECSI scores and participant age and time since treatment.

CONCLUSIONS

The SECSI scale is a valid, reliable measure for use with partnered women treated for cancer. Clinicians working with cancer survivors who may be at risk for difficulties communicating about sex and intimacy needs after cancer treatment may use this scale to identify women who would benefit from interventions to increase their confidence to communicate with their partner. The SECSI scale fills an important gap in ability to assess self-efficacy to communicate about sex and intimacy.

Sexual function and quality of life of patients affected by ovarian cancer

INTRODUCTION

The sexual function (SF) in patients affected by malignancies represents an important aspect influencing the quality of life (QoL). The most frequent symptoms reported are the decreased sexual desire, dyspareunia, and/or problems with arousal or achieving orgasm. The present study is aimed at analyzing the available scientific evidence regarding the QoL and especially SF of patients affected by ovarian cancer who underwent surgical and medical treatment.

EVIDENCE ACQUISITION

A preliminary research was conducted using Pubmed database with specific keywords combinations regarding SF, QoL and ovarian cancer. The principal findings considered in the present review were: the study design, the number of patients included in each study, the information about the malignancy (histology and stage of disease), the questionnaires administered and the principal findings concerning SF and QoL.

EVIDENCE SYNTESIS

The studies selected were 5 prospective series and 3 case control cross-sectional studies. The scores used were focused on SF, QOL, fatigue and psychological aspects. All studies reported a decreased SF and QOL. Different factors coexist in the influence on outcomes such as physical, hormonal, psychological, self body image, and mechanic outcomes.

CONCLUSIONS

SF represents a fundamental aspect strictly related with QoL. Patients with ovarian cancer (as well all oncological patients) experience a reduction in their SF after diagnosis of malignancy and they should receive adequate counseling regarding this aspect.

Adaptation of the Sexuality Scale for Women with Gynecologic Cancer for Turkish Patients

Objective:

Diagnosis and treatment of gynecologic cancers can have a negative impact on sexuality. Identification of sexual problems and concerns is key to enable appropriate management. Therefore, there is a need for a valid and reliable instrument for evaluating the sexuality of patients. This study aimed to adapt the sexuality scale for women with gynecologic cancer for Turkish patients with gynecologic cancer.

Methods:

A cross-sectional study of 150 volunteer patients with gynecologic cancer was undertaken in Turkey. The patients completed a semi-structured demographic data form and the sexuality scale for women with gynecologic cancer. We assessed the reliability, language accuracy, and content and construct validities of the Turkish version of the scale.

Results:

Exploratory and confirmatory factor analyses showed that the scale had four factors. In the exploratory factor analysis, seven items were discarded from the scale because their load values were <0.3. In the confirmatory factor analysis, the coefficients were higher than 0.3. The total Cronbach's α was 0.72.

Conclusions:

The sexuality scale for women with gynecologic cancer (Turkish version) is a valid and reliable instrument for evaluating the sexuality of Turkish patients with gynecologic cancer.

Holistic sexuality post gynaecological cancer treatment: A review of recent literature

Background: Sexual difficulties post gynaecological cancer treatment are commonplace and can impact multiple aspects of a woman’s life. Yet, health care practitioners remain reluctant to discuss sexuality from a holistic perspective with their patients.Aim: This article reviewed the literature on sexuality post gynaecological cancer treatment from the last 10 years. The aim was to understand research trends as well as identify gaps in the field.Methods: The review was framed using the neo-theoretical framework of sexuality. A comprehensive literature search, using the electronic databases EBSCOHost, Ovid, Clinical Key and PubMed, was conducted for articles concentrating on sexuality after gynaecological cancer treatment, published from 2007 to 2017 in English.Results: The results showed that the majority of the literature still approaches sexuality post treatment from a biomedical perspective with a focus on physical sexual functioning. However, there has been a slight shift towards understanding sexuality from a comprehensive standpoint, although there is a dearth of research relating to the psychological and relational aspects of sexuality.Conclusion: Comprehensive sexuality post treatment should be given further consideration in South Africa, and our unique socio-cultural context ought to be taken into consideration. Additionally, interventions at multiple levels should be explored, such as broadening sexual health training within the medical curriculum, considering the development of holistic cancer clinics and widening the scope of research relating to gynaecological cancer care.

The course of sexual interest and enjoyment in head and neck cancer patients treated with primary (chemo)radiotherapy

INTRODUCTION

The aim of this prospective study was to investigate the course of sexual interest and enjoyment in relation to sociodemographic and clinical factors, health-related quality of life (HRQOL), and symptoms of psychological distress in head and neck cancer (HNC) patients treated with primary (chemo)radiotherapy.

METHODS

HNC patients (n = 354) completed patient-reported outcome measures (PROMs) on HRQOL (EORTC QLQ-C30 and QLQ-H&N35, including the sexuality subscale covering less sexual interest and enjoyment), and psychological distress (HADS) pretreatment, at 6-week follow-up and at 3-, 6-, 12-, 18-, and 24-month follow-up (i.e., after treatment). Linear mixed models were used to analyze the course of sexuality from pretreatment to 24-month follow-up, and to investigate its relation to sociodemographic and clinical factors, HRQOL, and psychological distress as measured at baseline, and to investigate the course of sexuality from 6- to 24-month follow-up in relation to these factors measured at 6-month follow-up.

RESULTS

Before start of treatment, 37% of patients reported having less sexuality, which increased to 60% at 6-week follow-up, and returned to baseline level from 12-month follow-up onwards. Older age (p = 0.037) and trouble with social contact (p < 0.001), weight loss (p = 0.013), and constipation (p = 0.041) before treatment were associated with less sexuality over time. Female gender (p = 0.021) and poor social functioning (p < 0.001) at 6-month follow-up were associated with less sexuality from 6- to 24-month follow-up.

DISCUSSION

Less sexuality is often reported in HNC patients treated with (chemo)radiotherapy. Using PROMs in clinical practice may help identify patients who might benefit from supportive care targeting sexuality.

Health-care professionals' perspective on discussing sexual issues in adult patients after haematopoietic cell transplantation

The majority of adult patients have sexual concerns after post-haematopoietic cell transplantation. Even so, health-care professionals (HCP) do not routinely discuss these problems. We, therefore, surveyed all the members of the European Society for Blood and Marrow Transplantation to evaluate the barriers and facilitators to discussing sexual issues. The 73-item web-survey was completed by 166 registered nurses (RNs) and 126 medical doctors (MDs). Sixty-eight percent reported that they seldom discussed sexual issues. Younger MDs (p < 0.001) and those who work in non-western European countries (p = 0.003), RNs with probably less sexual education themselves (p = 0.002), MDs and RNs who have limited knowledge about sexual complications (p < 0.001) and MDs and RNs who feel uncomfortable discussing sexual issues (p < 0.001) are all less likely to discuss these matters. The major perceived barriers were that patients might be embarrassed if sexual issues were discussed in the presence of a relative (60% RNs, 67% MDs) and that professionals prefer patients to raise sexual issues themselves (54% RNs, 44% MDs). The most important perceived facilitator was for the patient to initiate discussion (≥ 90% for RNs and MDs). Overall, haematopoietic cell transplantation survivors may not be receiving the support on sexual issues they probably need.

TrueNTH sexual recovery study protocol: a multi-institutional collaborative approach to developing and testing a web-based intervention for couples coping with the side-effects of prostate cancer treatment in a randomized controlled trial

BACKGROUND

Over half of men who receive treatment for prostate suffer from a range of sexual problems that affect negatively their sexual health, sexual intimacy with their partners and their quality of life. In clinical practice, however, care for the sexual side effects of treatment is often suboptimal or unavailable. The goal of the current study is to test a web-based intervention to support the recovery of sexual intimacy of prostate cancer survivors and their partners after treatment.

METHODS

The study team developed an interactive, web-based intervention, tailored to type of treatment received, relationship status (partnered/non-partnered) and sexual orientation. It consists of 10 modules, six follow the trajectory of the illness and four are theme based. They address sexual side effects, rehabilitation, psychological impacts and coaching for self-efficacy. Each includes a video to engage participants, psychoeducation and activities completed by participants on the web. Tailored strategies for identified concerns are sent by email after each module. Six of these modules will be tested in a randomized controlled trial and compared to usual care. Men with localized prostate cancer with partners will be recruited from five academic medical centers. These couples (N = 140) will be assessed prior to treatment, then 3 months and 6 months after treatment. The primary outcome will be the survivors' and partners' Global Satisfaction with Sex Life, assessed by a Patient Reported Outcome Measure Information Systems (PROMIS) measure. Secondary outcomes will include interest in sex, sexual activity, use of sexual aids, dyadic coping, knowledge about sexual recovery, grief about the loss of sexual function, and quality of life. The impact of the intervention on the couple will be assessed using the Actor-Partner Interaction Model, a mixed-effects linear regression model able to estimate both the association of partner characteristics with partner and patient outcomes and the association of patient characteristics with both outcomes.

DISCUSSION

The web-based tool represents a novel approach to addressing the sexual health needs of prostate cancer survivors and their partners that-if found efficacious-will improve access to much needed specialty care in prostate cancer survivorship.

TRIAL REGISTRATION

Clinicaltrials.gov registration # NCT02702453 , registered on March 3, 2016.

Management of sexuality, intimacy, and menopause symptoms in patients with ovarian cancer

Issues of sexuality, intimacy, and early menopause significantly impact the quality of life of patients following the diagnosis and treatment of ovarian cancer. These are undertreated problems. Successful treatment requires the provider's awareness of the problem, ability to identify it, and willingness to treat it. Unfortunately many providers do not address these issues in the pretreatment or perioperative period. Furthermore, patients do not often alert their providers to their symptoms. While systemic hormone therapy may improve many of the issues, they are not appropriate for all patients given their action on estrogen receptors. However, other nonhormonal treatments exist including selective serotonin reuptake inhibitors, antiepileptics, natural remedies, and pelvic floor physical therapy. In addition psychological care and the involvement of the partner can be helpful in managing the sexual health concerns of these patients. At the time of diagnosis or at initial consultation, women should be informed of the potential physiologic, hormonal, and psychosocial effects of ovarian cancer on sexuality and that there is a multimodal approach to dealing with symptoms.

Sexual Health Before Treatment in Women with Suspected Gynecologic Malignancy

OBJECTIVES

Sexual health in survivors of gynecologic cancer has been studied; however, sexual health in these women before treatment has not been thoroughly evaluated. The objective of our study was to describe the pretreatment characteristics of sexual health of women with suspected gynecologic cancer before cancer treatment.

MATERIALS AND METHODS

We performed a cross-sectional analysis of women with a suspected gynecologic cancer, who were prospectively enrolled in a hospital-based cancer survivorship cohort from August 2012 to June 2013. Subjects completed the validated Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction Questionnaire. Pretreatment sexual health was assessed in terms of sexual interest, desire, lubrication, discomfort, orgasm, enjoyment, and satisfaction.

RESULTS

Of 186 eligible women with suspected gynecologic cancer, 154 (82%) completed the questionnaire pretreatment. Mean age was 58.1 ± 13.3 years. Sexual health was poor: 68.3% reported no sexual activity, and 54.7% had no interest in sexual activity. When comparing our study population to the general U.S. population, the mean pretreatment scores for the subdomains of lubrication and vaginal discomfort were similar, while sexual interest was significantly lower and global satisfaction was higher. In a linear regression model, controlling for cancer site, age remained significantly associated with sexual function while cancer site did not.

CONCLUSIONS

Problems with sexual health are prevalent in women with suspected gynecologic malignancies before cancer treatment. Increasing awareness of the importance of sexual health in this population will improve quality of life for these women.

Perioperative sexual interest in women with suspected gynecologic malignancies

OBJECTIVES

For women with gynecologic cancer, the impact of surgery on sexual interest and desire in the immediate and later postoperative period is not well characterized. The objective of this study was to report the perioperative trends of changing sexual interest and desire in a cohort of women undergoing surgery for suspected gynecologic malignancies.

METHODS

This is an ancillary analysis of a cohort study analyzing health-related outcomes in women who underwent primary surgical management of a suspected gynecologic malignancy between 10/2013 and 10/2014. Subjects completed the Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction Questionnaire (PROMIS-SFQ) preoperatively and questions on sexual interest and desire at one, three, and six months postoperatively. Bivariate tests and multiple linear regression were used to analyze data.

RESULTS

Of 231 women who completed a baseline PROMIS-SFQ, 187 (81%) completed one-month, 170 (74%) three-month, and 174 (75%) six-month follow-up interviews. Following surgery, 71% of enrolled subjects were diagnosed with a malignancy. Women age <55 had a greater decrease in sexual interest from baseline to one month than women age >55 (-5.5±1.0 vs -2.3±0.9, p=0.02). In a multivariable analysis, age <55 remained associated with a larger decrease in sexual interest at one month postoperatively (-4.6, 95% CI: -1.8, -7.4), as did having cancer vs benign disease for women of all ages (-5.6, 95% CI: -9.6, -1.5).

CONCLUSIONS

This study provides new data regarding the timing and magnitude of changes in sexual interest following gynecologic oncology procedures.

Changes in Sexuality, Body Image and Health Related Quality of Life in Patients Treated for Hematologic Malignancies: A Longitudinal Study

Longitudinal studies exploring sexuality, body image and health-related quality of life (HRQoL) are lacking in patients treated with chemo- or chemoimmuno-therapy for hematologic malignancies. The aim was to describe and explore changes in sexuality, body image and HRQoL in patients treated for hematologic malignancies, from baseline until 6 months after treatment. Twenty patients above 45 years (median age 62) treated for DLBCL, CLL or AML participated. Data were collected at baseline, 1- and 6-months after treatment by means of three instruments: SAQ-S, BIS and EORTC QLQ-C30. The results showed that patients' sexuality was negatively affected 1 month after treatment, but after 6 months the patient reported scores had returned almost entirely to baseline scores. Body image was slight negatively affected after 1 month and after 6 months, 50 % reported that body image was not affected at all. Regarding HRQoL, patients reported gradually improved scores during the study period. Regression analysis showed that changes in sexuality and body image seemed to influence changes in HRQoL. This study has shown changes in sexuality, body image and HRQoL over time in patients above age 45 treated for hematologic malignancies. One month after treatment all three areas becomes negatively affected, and thereafter the patients' scores recovered to a great extent regarding these issues within 6 months. Sexuality and body image seem to be important aspects of HRQoL for these patients and need to be integrated in the cancer rehabilitation during and after treatment.

Psychosocial distress and its effects on the health-related quality of life of primary brain tumor patients

All cancer patients experience distress from the diagnosis, the effects of the disease or the treatment. Clinically significant distress decreases overall quality of life and the recognition of distress with prompt intervention is essential. The National Comprehensive Cancer Network distress thermometer (NCCN-DT) is a validated measuring tool that has been utilized in the primary brain tumor population to detect psychologic distress thereby provoking a referral process to the appropriate support system. Brain tumor patients commonly reported emotional and physical distress encompassing: fatigue, fears, memory and concentration and worry. More research is needed to identify the stressors of all primary brain tumor patients and their caretakers and integrate appropriate interventions to improve health-related quality of life in both groups.

Reimagining care for adolescent and young adult cancer programs: Moving with the times

Literature regarding the development of adolescent and young adult (AYA) cancer programs has been dominantly informed by pediatric centers and practitioners. However, the majority of young adults are seen and treated at adult cancer centers, in which cancer volumes afford the development of innovative supportive care services. Although the supportive care services in adult cancer centers are helpful to AYAs, some of the most prominent and distinct issues faced by AYAs are not adequately addressed through these services alone. This article describes how the AYA Program at Princess Margaret Cancer Centre has collaborated with existing supportive care services in addition to supplying its own unique services to meet the comprehensive needs of AYAs in the domains of: symptom management (sexuality and fatigue), behavior modification (return to work and exercise), and health services (advanced cancer and survivorship). These collaborations are augmented by patient education interventions and timely referrals. The objective of this article was to assist other centers in expanding existing services to address the needs of AYA patients with cancer.

Quality of life and sexuality comparison between sexually active ovarian cancer survivors and healthy women

Objective

compare quality of life (QoL) and sexual functioning between sexually active ovarian cancer survivors and healthy women.

Methods

A cross-sectional study was performed in 103 successfully treated ovarian cancer survivors and 220 healthy women. All women had engaged in sexual activity within the previous 3 months, and ovarian cancer survivors were under surveillance after primary treatment without evidence of disease. QoL and sexual functioning were assessed using three questionnaires; the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), Ovarian Cancer Module (EORTC QLQ-OV28), and the Female Sexual Function Index (FSFI). Propensity score matching was used to adjust covariates between the ovarian cancer survivor and healthy women groups. In total, 73 ovarian cancer survivors and 73 healthy women were compared.

Results

Poorer social functioning (mean, 82.4 vs. 90.9; p=0.010) and more financial difficulties (mean, 16.4 vs. 7.8; p=0.019) were observed among ovarian cancer survivors than among healthy women. Sexuality, both in terms of desire, arousal, lubrication, orgasm, satisfaction, and pain and in terms of interest in sex, sexual activity, and enjoyment of sex (EORTC QLQ-OV28) were similar between the groups. However, vaginal dryness was more problematic in ovarian cancer survivors, with borderline statistical significance (p=0.081).

Conclusion

Sexuality was not impaired in ovarian cancer survivors who were without evidence of disease after primary treatment and having sexual activities, compared with healthy women, whereas social functioning and financial status did deteriorate. Prospective cohort studies are needed.

Factors affecting sexual function: A comparison between women with gynecological or rectal cancer and healthy controls

This study had two purposes: (i) to explore differences in sexual function between women with gynecological or rectal cancer after related pelvic-area treatments and women without cancer; and (ii) to investigate the relationships among body image, anxiety and depression, sexual relationship power, sexual self-schema, and female sexual function. The participants (n = 139) were recruited through Internet cancer support groups and women's health organizations in the USA. Six structured questionnaires were mailed, and the data were analyzed using descriptive and inferential statistics. The results showed that women with gynecological or rectal cancer had significantly worse sexual function than women without cancer. Having gynecological/rectal cancer and a negative sexual self-schema were significantly related to poor sexual function. Furthermore, sexual self-schema moderated the relationship between sexual relationship power and female sexual function. Healthcare providers could give more attention to sexual issues in women who have undergone treatment for gynecological or rectal cancer, especially for those with a negative sexual self-schema and high sexual relationship power, which might improve these women's quality of life.

What couples say about their recovery of sexual intimacy after prostatectomy: toward the development of a conceptual model of couples' sexual recovery after surgery for prostate cancer

INTRODUCTION

Interventions designed to help couples recover sexual intimacy after prostatectomy have not been guided by a comprehensive conceptual model.

AIM

We examined a proposed biopsychosocial conceptual model of couples' sexual recovery that included functional, psychological, and relational aspects of sexuality, surgery-related sexual losses, and grief and mourning as recovery process.

METHODS

We interviewed 20 couples preoperatively and 3 months postoperatively. between 2010 and 2012. Interviews were analyzed with Analytic Induction qualitative methodology, using NVivo software. Paired t-tests described functional assessment data. Study findings led to a revised conceptual model.

MAIN OUTCOME MEASURES

Couples' experiences were assessed through semi-structured interviews; male participants' sexual function was assessed with the Expanded Prostate Cancer Index Composite and female participants' sexual function with the Female Sexual Function Index.

RESULTS

Preoperatively, 30% of men had erectile dysfunction (ED) and 84% of partners were postmenopausal. All valued sexual recovery, but worried about cancer spread and surgery side effects. Faith in themselves and their surgeons led 90% of couples to overestimate erectile recovery. Postoperatively, most men had ED and lost confidence. Couples' sexual activity decreased. Couples reported feeling loss and grief: cancer diagnosis was the first loss, followed by surgery-related sexual losses. Couples' engagement in intentional sex, patients' acceptance of erectile aids, and partners' interest in sex aided the recovery of couples' sexual intimacy recovery. Unselfconscious sex, not returning to erectile function baseline, was seen as the end point. Survey findings documented participants' sexual function losses, confirming qualitative findings.

CONCLUSIONS

Couples' sexual recovery requires addressing sexual function, feelings about losses, and relationship simultaneously. Perioperative education should emphasize the roles of nerve damage in ED and grief and mourning in sexual recovery.