Psychosexual development in adolescents with chronic medical illnesses

Relationship and sexual experiences in women with early-onset oestrogen deficiency: Comparison between women with Turner syndrome and premature ovarian insufficiency

OBJECTIVE

Age at first date and sexual intercourse have been observed to be delayed in women with Turner syndrome (TS), with delayed puberty being the main factor. We sought to assess relationship and sexual experiences comparing women with TS and premature ovarian insufficiency (POI).

DESIGN

Cross-sectional observational study.

PATIENTS

302 women with TS and 53 women with karyotypically normal POI (median age 33.0 [15.0-78.4] and 26.3 [17.8-52.3], respectively).

MEASUREMENTS

A self-reporting questionnaire was used to collect data on relationship and sexual experiences.

RESULTS

Women with TS were older than women with POI (P = .002). Compared to women with POI, a smaller proportion of women with TS had ever had vaginal sexual intercourse (VSI) (40 [78.4%] vs 169 [58.1%], respectively, P = .006) and women with TS exhibited a delay in the median age at first relationship and VSI (POI 19.3 ± 0.4 vs TS 22.2 ± 1.1, P = <.001). Start of oestrogen replacement therapy at ≤ 14 years of age compared with > 14 years did not result in earlier relationship and sexual debut. After adjusting for age and diagnosis, induction of puberty, as opposed to spontaneous puberty, was associated with a delay in the median age at first relationship and VSI and a reduced probability of having VSI (Hazard ratio = 0.44 [95% confidence interval: 0.32-0.60], P = <.001).

CONCLUSIONS

Turner syndrome and induction of puberty are associated with a reduced likelihood and a delay in relationship and sexual experiences. Women needing puberty induction and women with TS more than POI have a delayed mean age at first VSI compared to the general population.

Psychosexual functioning among adult female survivors of childhood cancer: a report from the childhood cancer survivor study

PURPOSE

Childhood cancer survivors may be at risk for impaired psychosexual functioning as a direct result of their cancer or its treatments, psychosocial difficulties, and/or diminished quality of life.

PATIENTS AND METHODS

Two thousand one hundred seventy-eight female adult survivors of childhood cancer and 408 female siblings from the Childhood Cancer Survivor Study (CCSS) completed a self-report questionnaire about their psychosexual functioning and quality of life. On average, participants were age 29 years (range, 18 to 51 years) at the time of the survey, had been diagnosed with cancer at a median age of 8.5 years (range, 0 to 20) and were most commonly diagnosed with leukemia (33.2%) and Hodgkin lymphoma (15.4%).

RESULTS

Multivariable analyses suggested that after controlling for sociodemographic differences, survivors reported significantly lower sexual functioning (mean difference [MnD], -0.2; P = .01), lower sexual interest (MnD, -0.2; P < .01), lower sexual desire (MnD, -0.3; P < .01), lower sexual arousal (MnD, -0.3; P < .01), lower sexual satisfaction (MnD, -0.2; P = .01), and lower sexual activity (MnD, -0.1; P = .02) compared with siblings. Risk factors for poorer psychosexual functioning among survivors included older age at assessment, ovarian failure at a younger age, treatment with cranial radiation, and cancer diagnosis during adolescence.

CONCLUSION

Decreased sexual functioning among female survivors of childhood cancers seems to be unrelated to emotional factors and is likely to be an underaddressed issue. Several risk factors among survivors have been identified that assist in defining high-risk subgroups who may benefit from targeted screening and interventions.

Growth and development issues in adolescents with ostomies: a primer for the WOC nurses

Caring for the adolescent (13-18 years of age) with an ostomy presents multiple challenges. The purpose of this article is to provide strategies to assist the WOC nurse in minimizing the potential impact on growth and development for this age group with an ostomy. This is relevant to the WOC nurse since it is estimated that between 6% and 14% of all adolescents have symptoms of irritable bowel disease, and many will require an ostomy. Thus the WOC nurse will be called upon to provide care to this age group. This article discusses normal adolescent growth and development and provides strategies to support the normal growth and development.

A longitudinal assessment of early pubertal timing as a predictor of psychosocial changes in adolescent girls with and without spina bifida

OBJECTIVE

A longitudinal comparison of adolescent girls with and without spina bifida (SB), regarding the effects of early pubertal timing on girls' depressive symptoms, mother-daughter conflict, and emotional distancing.

METHODS

62 mother-daughter dyads (31 with SB and 31 without) reported on psychosocial outcomes at 5 time points (ages 8/9 to 16/17 years).

RESULTS

A pubertal timing × SB status interaction predicted emotional distancing (T2), conflict (T2, T5), and depressive symptoms (T4), such that early maturing girls without SB reported the greatest increase in each outcome. Main effects of pubertal timing predicted emotional distancing (T4), conflict (T4), and depressive symptoms (T2, T3, T5). Findings were not always consistent across reporters, assessments of pubertal timing, and time-points.

CONCLUSIONS

Although early maturing girls in both groups may experience greater psychosocial difficulties, early maturing girls without SB may be most at-risk. The somewhat reduced impact of early pubertal timing in girls with SB is discussed.

Healthcare transitions for adolescents with chronic life-threatening conditions using a Delphi method to identify research priorities for clinicians and academics in Canada

PURPOSE

Research has only begun to examine the complexity of transition to adulthood under illness conditions. A Delphi method may be utilized to identify pertinent research priorities for academics and clinicians in adolescent healthcare transitions and prioritize a framework for an ongoing programme of research.

METHODS

Through a comprehensive recruitment strategy throughout Canada, 114 clinicians and academics were invited to participate in this national study. Three phases were conducted until consensus could be achieved for the five most pressing research priorities.

RESULTS

Thirty-eight respondents completed at least one of the three phases of the process. All responses were analysed, and five questions in phase 3 achieving a level of consensus ranging 64-80% were identified as the top five research priorities. These questions included: skills and knowledge adolescents require for the transition process, how to measure success, the factors that influence a successful transition and whether good transitions improve health outcomes.

CONCLUSIONS

The results of this study can inform and prioritize a framework for an ongoing programme of research in Canada. The inclusion of clinicians and academics ensures that the research agenda incorporates perspectives from the front-line work of individuals providing care to this population as well as individuals from the academic community with important knowledge and skills related to research approaches and methods.

Sexual function in adolescent and young adult survivors of lower extremity bone tumors

BACKGROUND

Improving survival rates and new surgical options have led to increased interest regarding late effects and quality of life in adolescent and young adult survivors of bone cancers, including their sexual functioning. This study investigated sexual functioning in adolescent and young adult survivors of lower limb bone tumors, in relation to surgical treatments, gender differences, depressive symptoms, global self worth, and physical disability.

PROCEDURE

Twenty-eight participants (age range 18-32 years) completed measures of gender specific sexual function, depressive symptoms, global self worth, and physical disability. For analysis, surgical intervention was grouped into limb sparing surgeries (LS; allograft fusion and endoprosthesis) and amputation or Van Nes rotationplasty (AMP).

RESULTS

Male survivors reported significantly higher scores than females on total sexual function scores (P = 0.050), sexual drive (P = 0.002), and frequency of sexual thoughts, fantasies or erotic dreams (P = 0.021). Men also reported significantly better physical functioning scores than women (P = 0.012). LS scored significantly lower on frequency of sexual thoughts, fantasies and erotic dreams (P = 0.048) and frequency of sexual experiences (P = 0.016) compared with AMP. In addition, LS reported significantly more depressive symptoms scores (P = 0.004) and lower self worth scores (P = 0.037), than AMP.

CONCLUSIONS

These results suggest that male survivors of lower extremity bone tumors experience better sexual functioning than women. Survivors of limb sparing surgeries struggle with sexual function, depressive symptoms, and poor self-perception compared to Van Nes rotationplasty and amputation survivors.

Using the new board game SeCZ TaLK to stimulate the communication on sexual health for adolescents with chronic conditions

OBJECTIVE

This study evaluated the feasibility and appreciation of a new educational board game (SeCZ TaLK) that stimulates communication on sexuality and intimate relationships in youth with chronic conditions.

METHODS

85 adolescents with chronic conditions or disabilities piloted the board game in three rehabilitation centers/schools for the disabled, one outpatient clinic and a patient organization. They assessed their experiences through a brief questionnaire, as did 12 health care professionals and teachers who acted as facilitators.

RESULTS

Eighty-five percent of the adolescents found it is (very) important to discuss sexuality and intimate relationships; 81% felt that SeCZ TaLK enabled this. Girls were more positive about the game than boys (p<.05) and younger participants were more positive than older ones (p<.01). Youth in an outpatient clinic appreciated the game most (p<.05) compared to other settings. Professionals asserted that discussing these issues is important for their work and would recommend the game to colleagues.

CONCLUSION

SeCZ TaLK is a promising tool for improving communication on sexuality with youth with special health care needs.

PRACTICE IMPLICATIONS

Health care providers and teachers are recommended to use interventions such as SeCZ TaLK to stimulate communication about sexual health with adolescents with chronic conditions.

Sexuality of Young Adults with Cerebral Palsy: Experienced Limitations and Needs

Objective of this study is to describe the problems young adults with Cerebral Palsy (CP) experience in the various stages of the sexual response cycle, and the physical and emotional obstacles they experience with sexuality. In this prospective cohort study 74 young adults (46 men; 28 women) with CP and average intelligence participated, aged 20–24 years. Twenty percent of these young adults with CP experienced anorgasmia, 80% reported physical problems with sex related to CP and 45% emotional inhibition to initiate sexual contact. In 90% of the participants, sexuality had not been discussed during the rehabilitation treatment. Many adolescents reported wanting information about the impact of CP on sexuality and reproduction (35%), about interventions (26%), tools and medicines (16%) and about problems with their partner (14%). Young adults with CP can experience various problems or challenges with sexuality. For preventing sexual difficulties and treating sexual problems, health care professionals need to proactively take the initiative to inform young people with CP about sexuality.

Adolescents living with cancer: the role of computer-mediated support groups

The present study sought to explore the types of social support being provided to adolescents with cancer accessing a computer-mediated support group. Three hundred and ninety-three messages posted to a computer-mediated support group aimed at adolescents with cancer were coded for instances of informational and emotional support and then subjected to thematic analysis. Analysis revealed frequent instances of both informational and emotional support provision and sub-themes included 'treatment concerns', 'losing friends' and 'struggling with school'. Adolescents were also found to be frequently accessing the group to make requests for social support. It is concluded that health professionals need to tailor the services they provide to adolescent patients more appropriately.

Psychological profile of adolescents with a kidney transplant

To describe the psychological profile of renal transplant adolescents compared to healthy peers and to adolescents with CKD, three groups of adolescents aged 12-18 yr were selected: TX, CX, and adolescents with CKD. Psychiatric symptoms and disorders were evaluated through direct interviews (K-SADS-PL) and self-report questionnaires (YSR and CBCL). Forty TX (14 LRD and 26 DD transplant recipients), 40 CX and 20 CKD were included. Twelve of 40 (30%) TX, three of 20 (15%) CKD, and three of 40 (7.5%) CX had a history of learning difficulties (p = 0.03). Compared to CX, TX had lower total YSR competencies score (p = 0.028) and lower total CBCL competencies score (p = 0.003). Twenty-six of 40 (65%) TX, 12 of 20 (60%) CKD and 15 of 40 (37.5%) CX (p = 0.038) met DSM-IV diagnostic criteria for lifetime psychiatric disorder, with rates of depressive disorder of 35% among TX and CKD compared to 15.2% among CX (p = 0.043). Eight of 40 (20%) TX had a history of simple phobia. Nine of 40 (22.5%) TX met diagnostic criteria for ADHD as compared to one of 20 (5%) CKD and three of 40 (7.5%) CX. In the TX group, we found no significant differences in educational and psychiatric variables between LRD and DD. In conclusion, we found a high prevalence of psychiatric morbidity (depression, phobia, ADHD), educational impairment and social competence problems in the TX group. CKD scored in between TX and CX on most measures.

Anxiety and depression in adolescents with polycystic ovary syndrome and Mayer-Rokitansky-Küster-Hauser syndrome

PURPOSE

The purpose of this study was to assess self-reported depressive and anxiety symptoms in adolescents with polycystic ovary syndrome (PCOS) and those with the rare Mayer-Rokitansky-Kuster-Hauser Syndrome (MRKHS), compared with healthy adolescents.

MATERIAL AND METHODS

The participants were 49 adolescent girls, of whom 27 were patients with confirmed menstrual disorder, 22 with PCOS and 5 with MRKHS; and 22 were healthy eumenorrheic adolescents (control group) matched by age and school grade. The Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI-Gr) were used to measure depression and anxiety, respectively.

RESULTS

The results showed that it was 1.08 times more likely for the PCOS group (p = 0.043) and 1.12 times more likely for the MRKHS group (p = 0.039) to have higher scores than healthy adolescents on the anxiety scale. The MRKHS group was 1.40 times more likely to have a higher number of depressive symptoms (p = 0.040) than the control group.

CONCLUSIONS

These findings, although based on a small sample, suggest a relationship between PCOS and MRKHS and the presence of psychological problems, such as anxiety and depressive symptoms in adolescents. This study is among the first to examine psychological difficulties in adolescents with such a rare menstrual syndrome as MRKHS.

Psychosexual functioning of childhood cancer survivors

PURPOSE

The objective of the study is to explore psychosexual functioning and its relationship with quality of life in survivors of cancer in childhood.

METHODS

Sixty childhood cancer survivors completed two questionnaires: psychosexual and social functioning questionnaire and MOS-SF-36.

RESULTS

Psychosexual problems were frequent. About 20% of the survivors felt a limitation in their sexual life due to their illness. Older survivors (> or =25 years) had significantly less experience with sexual intercourse than their age-matched peers in the Dutch population (p = 0.010). Survivors treated in adolescence had a delay in achieving psychosexual milestones compared with those treated in childhood: dating (p<0.025), touching under clothes (p<0.025), masturbation (female) (p<0.05) and sexual intercourse (p<0.025). No differences were found for sexual fantasies, kissing, masturbation (male) and oral sex. The total survivor group appraised their quality of life as less positive than their Dutch peers for the subscales of general and mental health (both p<0.001), physical and social functioning (p<0.01; p<0.001), bodily pain and vitality (both p<0.001). However, quality of life was not more affected adversely in survivors with psychosexual problems compared with survivors without these problems.

CONCLUSION

In this cohort of childhood cancer survivors, psychosexual problems were frequent. Treatment in adolescence is a risk factor for a delay in psychosexual development.

Sexuality and haemophilia: connections across the life-span

A broad overview of sexuality issues and needs as they relate to haemophilia are presented. Venturing well beyond 'safer sex', sexuality is defined here to encompass physical, emotional, social, interpersonal, moral, and cultural aspects. From this perspective, sexuality extends beyond behaviour and includes a person's thoughts, feelings, nature, and identity. As a means of experiencing intimacy, sexuality is a significant factor in achieving quality of life with chronic illness. Its impact in haemophilia is influenced by different stages of physical and psychosexual development, misconceptions about sexuality, and unique concerns for this group, including joint disability, human immunodeficiency virus, medication side-effects, and other complications. This paper explores the interconnections of sexuality with haemophilia, with a focus on the roles that haemophilia care providers can play in addressing these issues. A biopsychosocial model of aspects and interrelationships regarding sexuality and haemophilia is proposed for use in understanding individuals and planning care approaches. The PLISSIT model is offered to guide counselling about sexuality on different levels of complexity. Sample strategies for initiating discussion, communicating about sex, and developing goals and interventions are presented.

Childbearing, curve progression, and sexual function in women 22 years after treatment for adolescent idiopathic scoliosis: a case-control study

STUDY DESIGN

A consecutive series of female patients with adolescent idiopathic scoliosis treated between 1968 and 1977, either with distraction and fusion using Harrington rods (n = 145) or with a brace (n = 122), were followed for at least 20 years after completion of the treatment.

OBJECTIVES

To determine the long-term outcomes of childbearing and sexual life in women treated for adolescent idiopathic scoliosis, as compared with matched control subjects who did not have scoliosis.

SUMMARY OF BACKGROUND DATA

The effect of pregnancy on curve progression is not established, and results are contradictory. Few reports exist on the social life (marriage, childbearing, and sexual function) of formerly treated individuals with scoliosis.

METHODS

In this study, 136 surgically treated women (94%) and 111 brace-treated women (91%) completed the Scoliosis Research Society (SRS)/MODEM's questionnaire concerning childbearing and sexual life as a part of an unbiased personal follow-up examination. Of these, 129 surgically treated and 105 brace-treated women also underwent a radiographic examination. The Cobb method was used to measure curve size in present and earlier examinations. An age-matched control group of 90 women was randomly selected and subjected to the same examinations.

RESULTS

The mean age for all the groups was 40 years. Of the surgically treated and brace-treated women, 85% were or had been married, as compared with 82% of the control women. In the total cohort, 628 pregnancies had occurred. No significant mean difference existed between the groups in the number of children born (1.8 for the surgically treated, 1.9 for the brace-treated, and 2 for the control women) (P = 0.25). The patients in the brace-treated group had a significantly higher mean age at first pregnancy (28 years) than the control subjects (25.9 years) (P = 0.011), whereas the age for the surgically treated women (26.6 years) did not differ significantly from that for the brace-treated women. There were no significant differences between the groups in rates for low back pain (35% for the surgically treated, 43% for the brace-treated, and 28% for the control group) or for cesarean section (19% for the surgically treated, 14% for the brace-treated, and 18% for the control group) during the first pregnancy. The rate of vacuum extractions was higher in the surgically treated group (16%) than in the control group (5%) (P = 0.036) or the brace-treated group(8%). Limitation of sexual function from the back was admitted by 33% of the surgically treated, 28% of the brace-treated, and 15% of the control women: surgically treated vs control subjects (P = 0.0042), brace-treated vs control subjects (P = 0.026), and brace-treated vs surgically treated subjects (P = 0.57, a nonsignificant difference). These limitations were largely because of difficulties participating physically in activities or self-consciousness about appearance. Pain was a minor reason for limitation. There was no correlation between progression of the major or lumbar curve and number of pregnancies, or between curve progression and age at first pregnancy.

CONCLUSIONS

Patients treated for adolescent idiopathic scoliosis appeared to function well with regard to marital status and number of children. The scoliotic curve did not seem to increase as a result of childbearing. Minor problems occurred during pregnancy and delivery. Some patients, however, experienced a slight negative effect in their sexual life.