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Donz R, Russia B, Barbaret C, Braybrook D, Perceau-Chambard E, Reverdy T, Economos G. What contributes to promote sexual health in cancer palliative care? A realist review. Sex Med Rev 2024; 12:334-345. [PMID: 38508856 DOI: 10.1093/sxmrev/qeae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Sexuality is an important determinant of the overall health of a population and remains so at the end of life and in patients with advanced cancers. Despite the abundant literature on sexuality and intimacy, these topics have been rarely discussed in the context of cancer palliative care, and very few interventions to promote sexual health in patients undergoing cancer palliative care have been explored. OBJECTIVES In this study we sought to identify which factors and mechanisms contribute to promoting sexual health in cancer palliative care. METHODS A realist review was performed according to the guidelines of the realist and meta-narrative evidence synthesis method guidelines. Articles published between January 2010 and June 2021 were searched in 4 databases. Records were screened for their relevance regarding a predefined list of context-mechanism-outcome (CMO) configurations. Abstracts were independently screened by 2 authors before the data were extracted from the full-text articles selected for inclusion. With the use of abductive and retroductive reasoning techniques, each article was examined for evidence of its contribution to one of the CMO configurations, which could be refined when relevant. The data were summarized according to the final CMO configurations. RESULTS Of the 2056 articles identified, 38 articles were included in the review. The data reported in these articles contributed to 7 CMO hypotheses: (1) improving communication skills, (2) healthcare provider training, (3) reorganizing the patient environment in care settings or at home, (4) managing sexual symptoms and also general symptoms, (5 and 6) patient-centered counseling or couple counseling, and (7) lifting the taboo. CONCLUSIONS The findings reported here highlight various ways to improve sexual health for patients in cancer palliative care but are limited to genital cancers. Further research should consider all types of cancer rather than being restricted to genital cancers.
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Affiliation(s)
- Roxane Donz
- Centre de soins palliatifs, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Benite 69495, France
- Centre pour l'Innovation en cancérologie de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon Sud, EA 3738, 69921 Oullins
| | - Bruno Russia
- Hospitalisation à domicile, Centre Léon Bérard, Lyon 69008, France
| | - Cécile Barbaret
- Service de soins palliatifs, CHU de Grenoble, La Tronche 38700, France
| | - Debbie Braybrook
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London SE5 9PJ, United-Kingdom
| | - Elise Perceau-Chambard
- Centre de soins palliatifs, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Benite 69495, France
| | - Thibaut Reverdy
- Centre pour l'Innovation en cancérologie de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon Sud, EA 3738, 69921 Oullins
- Oncology Department, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Benite 69495, France
| | - Guillaume Economos
- Centre de soins palliatifs, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Benite 69495, France
- Centre pour l'Innovation en cancérologie de Lyon, Université Claude Bernard Lyon 1, Faculté de médecine Lyon Sud, EA 3738, 69921 Oullins
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Reiss AB, Gulkarov S, Pinkhasov A, Sheehan KM, Srivastava A, De Leon J, Katz AE. Androgen Deprivation Therapy for Prostate Cancer: Focus on Cognitive Function and Mood. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:77. [PMID: 38256338 PMCID: PMC10819522 DOI: 10.3390/medicina60010077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/26/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024]
Abstract
Prostate cancer is the second leading cause of cancer death in men in the United States. Androgen deprivation therapy (ADT) is currently the primary treatment for metastatic prostate cancer, and some studies have shown that the use of anti-androgen drugs is related to a reduction in cognitive function, mood changes, diminished quality of life, dementia, and possibly Alzheimer's disease. ADT has potential physiological effects such as a reduction in white matter integrity and a negative impact on hypothalamic functions due to the lowering of testosterone levels or the blockade of downstream androgen receptor signaling by first- and second-generation anti-androgen drugs. A comparative analysis of prostate cancer patients undergoing ADT and Alzheimer patients identified over 30 shared genes, illustrating common ground for the mechanistic underpinning of the symptomatology. The purpose of this review was to investigate the effects of ADT on cognitive function, mood, and quality of life, as well as to analyze the relationship between ADT and Alzheimer's disease. The evaluation of prostate cancer patient cognitive ability via neurocognitive testing is described. Future studies should further explore the connection among cognitive deficits, mood disturbances, and the physiological changes that occur when hormonal balance is altered.
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Affiliation(s)
- Allison B. Reiss
- Department of Medicine and Biomedical Research Institute, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA; (S.G.); (K.M.S.); (A.S.); (J.D.L.)
| | - Shelly Gulkarov
- Department of Medicine and Biomedical Research Institute, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA; (S.G.); (K.M.S.); (A.S.); (J.D.L.)
| | - Aaron Pinkhasov
- Department of Psychiatry, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA;
| | - Katie M. Sheehan
- Department of Medicine and Biomedical Research Institute, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA; (S.G.); (K.M.S.); (A.S.); (J.D.L.)
| | - Ankita Srivastava
- Department of Medicine and Biomedical Research Institute, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA; (S.G.); (K.M.S.); (A.S.); (J.D.L.)
| | - Joshua De Leon
- Department of Medicine and Biomedical Research Institute, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA; (S.G.); (K.M.S.); (A.S.); (J.D.L.)
| | - Aaron E. Katz
- Department of Urology, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA;
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Castro RF, Araújo S, Marques A, Ferreira D, Rocha H, Aguiar S, Pieramico S, Quinta-Gomes A, Tavares IM, Nobre PJ, Carvalho J. Mapping the contributions of dyadic approaches to couples' psychosocial adaptation to prostate cancer: a scoping review. Sex Med Rev 2023; 12:35-47. [PMID: 37930753 DOI: 10.1093/sxmrev/qead044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Prostate cancer is the second-most prevalent cancer diagnosis worldwide among males. Although prostate cancer affects the physical, sexual, and mental health of patients, the impact of prostate cancer on partners has also been increasingly recognized. Hence, taking a dyadic approach is of relevance. Moreover, there is evidence of the utility of dyadic approaches to the study of relational stress that chronic diseases such as prostate cancer can bring to couples, even though knowledge is sparse about prostate cancer. OBJECTIVES This scoping review aimed to map existing dyadic studies on the psychosocial adaptation of couples to prostate cancer. METHODS A systematic search of studies published from 2005 to November 2022 was conducted on electronic databases (PubMed, Cochrane Library, EBSCOHost, Scopus, and Web of Science) following PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-analyses-Extension for Scoping Reviews). RESULTS The review included 25 eligible studies from the initial 2514 articles retrieved. Overall, the results emphasized the interdependency between couple members and suggested how partners' adaptation influences patients' adaptation to prostate cancer and vice versa, regarding several psychosocial dimensions (eg, intimacy, quality of life). CONCLUSIONS This work can bring awareness to health care professionals to adopt a couples approach when managing prostate cancer whenever there is a partner, due to these interdependent influences. For researchers and future studies, this work can strengthen the relevance of dyadic approaches on how couples adapt to prostate cancer and explore which other dimensions influence these complex dynamics.
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Affiliation(s)
- Rita F Castro
- Center for Psychology at the University of Porto, Faculty of Psychology and Educational Sciences at University of Porto, Porto, 4200-135, Portugal
| | - Silvana Araújo
- School of Psychology, University of Minho, Braga, 4710-057, Portugal
| | - Ana Marques
- Center for Psychology at the University of Porto, Faculty of Psychology and Educational Sciences at University of Porto, Porto, 4200-135, Portugal
| | - Diana Ferreira
- Center for Psychology at the University of Porto, Faculty of Psychology and Educational Sciences at University of Porto, Porto, 4200-135, Portugal
| | - Hélia Rocha
- Center for Psychology at the University of Porto, Faculty of Psychology and Educational Sciences at University of Porto, Porto, 4200-135, Portugal
| | - Sandra Aguiar
- Center for Psychology at the University of Porto, Faculty of Psychology and Educational Sciences at University of Porto, Porto, 4200-135, Portugal
| | - Sonia Pieramico
- Center for Psychology at the University of Porto, Faculty of Psychology and Educational Sciences at University of Porto, Porto, 4200-135, Portugal
| | - Ana Quinta-Gomes
- Center for Psychology at the University of Porto, Faculty of Psychology and Educational Sciences at University of Porto, Porto, 4200-135, Portugal
| | - Inês M Tavares
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, B3H 4R2, Canada
| | - Pedro J Nobre
- Center for Psychology at the University of Porto, Faculty of Psychology and Educational Sciences at University of Porto, Porto, 4200-135, Portugal
| | - Joana Carvalho
- William James Center for Research, Department of Education and Psychology, University of Aveiro, Aveiro, 3810-193, Portugal
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Rio CJ, Goto T, Hsiao CP, Ross ALR, Saligan LN. Family Wellbeing and Sexual Health of Patients Receiving Treatment for Prostate Cancer. Cancer Manag Res 2023; 15:1197-1206. [PMID: 37929256 PMCID: PMC10625326 DOI: 10.2147/cmar.s421951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/09/2023] [Indexed: 11/07/2023] Open
Abstract
Purpose Prostate cancer and its treatment may affect patients' sexual function and social wellbeing. This study investigated the relationship between social/family wellbeing and sexual health in patients with prostate cancer. Additionally, the moderating effect of clinical characteristics on this relationship was also explored. Patients and Methods This is a descriptive correlational study using baseline data of a longitudinal study enrolling 137 patients with prostate cancer. Sexual Function (SF) and Sexual Function Distress (SFD) data were collected using the Symptom Index questionnaire. Demographic data were obtained during study intake and clinical data were obtained from chart review. Bivariate correlation determined the correlations among continuous demographic/clinical data, social/family wellbeing, and sexual health. Moderated regression analysis determined the moderating effects of clinical characteristics on the relationship of social/family wellbeing and sexual health. Results Moderate positive correlation was found between social/family wellbeing and SF, whereas a weak negative correlation was noted between social/family wellbeing and SFD. Depression was significantly correlated with social/family wellbeing and SFD. Both sexual health domains were significantly correlated with Gleason score. A significant difference was noted in the social/family wellbeing and both SF and SFD in participants receiving androgen deprivation therapy (ADT) compared to those not receiving ADT. Concomitant ADT use was the only clinical characteristic found to be a significant moderator of the relationship between social/family wellbeing and SFD, but none of the clinical characteristics was found to have a moderating effect on the relationship of social/family wellbeing and SF. Among patients who were not receiving ADT, high social/family wellbeing was associated with low SFD. Patients who were receiving ADT reported slightly higher SFD despite having higher social/family wellbeing. Conclusion Ensuring sexual health in patients with prostate cancer requires a comprehensive approach to address factors contributing to sexual health such as side effects of treatment and family wellbeing.
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Affiliation(s)
- Carielle Joy Rio
- National Institute of Nursing Research, Division of Intramural Research, National Institutes of Health, Bethesda, MD, USA
| | - Taichi Goto
- National Institute of Nursing Research, Division of Intramural Research, National Institutes of Health, Bethesda, MD, USA
| | - Chao-Pin Hsiao
- Case Western Reserve University School of Nursing, Cleveland, OH, USA
| | - Alexander L R Ross
- National Institute of Nursing Research, Division of Intramural Research, National Institutes of Health, Bethesda, MD, USA
| | - Leorey N Saligan
- Case Western Reserve University School of Nursing, Cleveland, OH, USA
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Winter N, Jongebloed H, Green A, Ugalde A, Livingston PM. Supportive interventions for carers of men with prostate cancer: systematic review and narrative synthesis. BMJ Support Palliat Care 2023:spcare-2022-004034. [PMID: 37263759 DOI: 10.1136/spcare-2022-004034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/27/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE The objective of this study was to summarise the literature on current interventions available for carers of men with prostate cancer and analyse the outcomes of these interventions in supporting carers' needs. METHODS A systematic review was conducted, searching databases MEDLINE, PsycINFO, CINAHL, Scopus and Cochrane, using terms related to prostate cancer, carers and interventions. Randomised controlled trials and non-randomised controlled trials of interventions for informal carers with or without patients were included. Data were analysed using descriptive and frequency statistics; interventions and their impact on carers' outcomes were reported on narratively. The SwiM guidelines were applied to guide data synthesis. RESULTS Overall, 24 articles were included in the review. On average, participants were spouses (92%) and women (97%). Interventions largely rwere delivered face-to-face (42%) or used a combination of face to face and online modalities (38%). Two-thirds (63%) showed a significant improvement in carer's outcomes including psychological, sexual, physical and relationship/marital. The majority of studies (79%) tailored contents to carers' circumstances, most within a couples counselling format. Over one-third (42%) of studies focused on a range of supportive care needs, most commonly were psychological (58%), sexual (42%) and informational (25%). CONCLUSIONS Interventions for carers of men with prostate cancer were largely face to face, patient-spouse focused and two-thirds had some measurable impact on carer's outcomes. Research continues to underserve other patient-carer roles, including non-spousal carers. Interventions delivered solely for carers are required to meet gaps in care, and determine the impact on carer outcomes. Further research and more targeted interventions are needed. PROSPERO REGISTRATION NUMBER CRD42021249870.
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Affiliation(s)
- Natalie Winter
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Hannah Jongebloed
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Anna Green
- Centre for Health Research, Faculty of Sciences, University of Southern Queensland, Springfield, Queensland, Australia
| | - Anna Ugalde
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
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Development of a Sexual Quality of Life Questionnaire for Men-Who-Have-Sex-With-Men With Prostate Cancer. Sex Med 2022; 10:100480. [PMID: 35149341 PMCID: PMC9023244 DOI: 10.1016/j.esxm.2021.100480] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 11/30/2021] [Accepted: 12/11/2021] [Indexed: 12/24/2022] Open
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Men's experiences of sex and intimacy after prostate cancer treatment in China: a qualitative study. Support Care Cancer 2021; 30:3085-3092. [PMID: 34853913 PMCID: PMC8635323 DOI: 10.1007/s00520-021-06720-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/22/2021] [Indexed: 11/25/2022]
Abstract
Purpose While the existing knowledge base on the impact of prostate cancer (PC) and its treatment on sexuality and intimacy has been generated from Western populations, there is a lack of such evidence in the Asian context. This study aimed to explore men’s experiences of sex and intimacy after PC treatment in China. Methods This study adopted an interpretive descriptive design. Using purposive sampling, 13 PC patients were selected from a urology outpatient unit of a hospital in South China and proceeded with individual semi-structured telephone interviews. Each interview was transcribed verbatim and analyzed using constant comparison analysis. Results Four themes emerged from the interview data, including (a) encountering altered sexuality, (b) communication and sexual adjustments, (c) maintenance of quality intimate relationship, and (d) lack of sexual health support. Conclusions The findings revealed that PC treatment significantly impaired patients’ sexual functions, and their sexual health needs were mainly unmet by healthcare providers. There is a great need to design culturally relevant interventions to improve sexual health among this population. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06720-w.
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Galvin KT, Garland SN, Wibowo E. The Association between Insomnia and Orgasmic Difficulty for Prostate Cancer Patients - Implication to Sex Therapy. JOURNAL OF SEX & MARITAL THERAPY 2020; 47:174-185. [PMID: 33225866 DOI: 10.1080/0092623x.2020.1848947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Sexual dysfunction and insomnia are common side effects of prostate cancer (PCa) treatment, but the link between these symptoms has not been explored. We explore here the association between various sexual parameters and insomnia symptoms in PCa patients. Data were collected via an online survey with recruitment through various PCa organizations. One hundred and forty two patients (age = 67.3 ± 8.9 years) completed the survey. The majority were in a relationship (84.6%), of Caucasian ethnicity (83.1%), and 33% had previously received androgen deprivation therapy (ADT). Control variables-age, number of comorbidities, past ADT use, body mass index, depression, anxiety, fatigue and daytime sleepiness-explained 58.2% of the variance for insomnia symptoms. Including orgasm difficulty in the models accounted for an additional 2.1% in the variance in insomnia symptoms. Conversely, the control variables listed above together with insomnia symptoms predicted 37.7% of the overall variance in orgasm difficulty in PCa patients. These data suggest that sexual rehabilitation programs for PCa patients should assess insomnia symptoms, and therapies to improve sexual function or sleep quality may be beneficial in both functions given the relationship between sleep and orgasm functions in this population.
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Affiliation(s)
| | - Sheila N Garland
- Department of Psychology and Discipline of Oncology, Memorial University, St. John's, Canada
| | - Erik Wibowo
- Department of Anatomy, University of Otago, Dunedin, New Zealand
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Duthie CJ, Calich HJ, Rapsey CM, Wibowo E. Maintenance of sexual activity following androgen deprivation in males. Crit Rev Oncol Hematol 2020; 153:103064. [DOI: 10.1016/j.critrevonc.2020.103064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 05/12/2020] [Accepted: 07/12/2020] [Indexed: 01/14/2023] Open
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Ramirez-Fort MK, Suarez P, Carrion M, Weiner D, Postl C, Arribas R, Sayyah M, Forta DV, Niaz MJ, Feily A, Lange CS, Fort ZZ, Fort M. Prostatic irradiation-induced sexual dysfunction: A review and multidisciplinary guide to management in the radical radiotherapy era (Part III on Psychosexual Therapy and the Masculine Self-Esteem). Rep Pract Oncol Radiother 2020; 25:625-631. [PMID: 32536830 DOI: 10.1016/j.rpor.2020.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/20/2020] [Indexed: 01/16/2023] Open
Abstract
Psychological morbidity, sexuality, and health/system information have been identified as the highest areas of support needs in patients undergoing management of their prostate cancer (PCa). Management of a patient's sexual function prior to, during and after PCa radiotherapy requires multidisciplinary coordination of care between radiation oncologists, urologists, dermatologists, pharmacists, and psychiatrists. The finale of this three-part review provides a framework for clinicians to better understand the role of mental healthcare providers in the management of sexual toxicities associated with prostatic radiotherapy. The authors recommend that patients be referred for psychological evaluation and possibly to individual, couples or group general or cognitive behavioral sex therapy at the time of their PCa diagnosis, for a more specialized focus on management of sexual toxicities and sexual recovery. The importance and implications of the masculine self-esteem, sexual orientation, gender identification, cultural expectations, relationship status and patient education are reviewed. Well-informed patients tend to have a better quality of life outcomes compared to patients that take on a passive role in their cancer management.
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Affiliation(s)
- Marigdalia K Ramirez-Fort
- Life Sciences, BioFort Corp., Guaynabo, PR, USA
- Urology, Weill Cornell Medicine, New York, NY, USA
- Radiation Oncology, SUNY Downstate Health Sciences University, Brooklyn, New York, NY, USA
- Physiology and Pathology, San Juan Bautista School of Medicine, Caguas, PR, USA
| | - Paula Suarez
- Physiology and Pathology, San Juan Bautista School of Medicine, Caguas, PR, USA
| | - Margely Carrion
- Physiology and Pathology, San Juan Bautista School of Medicine, Caguas, PR, USA
| | - Daniel Weiner
- Psychiatry, VA New Jersey Healthcare System, Lyons, NJ, USA
- Psychiatry, Robert Wood Johnson UMDNJ Hospital, New Brunswick, NJ, USA
| | - Claire Postl
- Urology, Ohio State University, Columbus, OH, USA
| | - Ricardo Arribas
- Psychiatry, San Juan Bautista School of Medicine, Caguas, PR, USA
| | - Mehdi Sayyah
- Psychiatry, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Digna V Forta
- Life Sciences, BioFort Corp., Guaynabo, PR, USA
- Dermatology, Hospitales HIMA San Pablo, Bayamon, PR, USA
| | | | - Amir Feily
- Dermatology, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Christopher S Lange
- Life Sciences, BioFort Corp., Guaynabo, PR, USA
- Radiation Oncology, SUNY Downstate Health Sciences University, Brooklyn, New York, NY, USA
| | | | - Migdalia Fort
- Life Sciences, BioFort Corp., Guaynabo, PR, USA
- Psychiatry, VA New Jersey Healthcare System, Lyons, NJ, USA
- Psychiatry, Robert Wood Johnson UMDNJ Hospital, New Brunswick, NJ, USA
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Piccolo EEL, Johnson TW, Wassersug RJ. Sadomasochistic erotica and the sexual response cycle: Insights from the Eunuch Archives. THE CANADIAN JOURNAL OF HUMAN SEXUALITY 2019. [DOI: 10.3138/cjhs.2019-0016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Eunuch Archive (EA) is a website where registered members can post for others to read and rate sexual fantasies that involve genital mutilation and ablation. The EA includes over 8,000 stories. We have previously explored common features of 100 top-rated EA stories. We reasoned that understanding such fantasies may be a step toward recognizing who is at risk of irreversible injury should they act out their fantasies. Here we explore the top-rated EA stories in the context of well-established models for human sexual response. We argue the archetypal storyline from these fantasies, which are characterized by extreme sadomasochism (SM), can be interpreted and understood within the context of these established sexual response models, but we note several ways the fantasies diverge from such models. The stories closely fit the classic Masters and Johnson model, but with a protracted plateau phase resolved with pleasure and pain heightened. Even though the central character in all the stories is a male, the stories align well with the Basson intimacy-based model more characteristic of female motivations to be sexually active. In the fantasies, the central character is willing to sacrifice everything short of his life to develop or strengthen a dyadic relationship. In all the stories, castration is depicted with a sensory intensity equivalent to orgasm. The stories reveal what is both natural and pathological in extreme SM fantasies. They also reveal similarities between female sexual desire and the desire for genital ablation which has not, to the best of our knowledge, been previously elucidated.
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Affiliation(s)
| | - Thomas W. Johnson
- Department of Anthropology (Emeritus), California State University, Chico, Chico, CA
| | - Richard J. Wassersug
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, BC
- Australian Research Centre in Sex, Health and Society, LaTrobe University, Melbourne, Australia
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Wassersug RJ, Hamilton LD. Masculinity in Milliseconds: An Evolutionary & Neurophysiological Perspective on Expressions of Masculinity. ADAPTIVE HUMAN BEHAVIOR AND PHYSIOLOGY 2018. [DOI: 10.1007/s40750-017-0085-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Wassersug R, Wibowo E. Non-pharmacological and non-surgical strategies to promote sexual recovery for men with erectile dysfunction. Transl Androl Urol 2017; 6:S776-S794. [PMID: 29238658 PMCID: PMC5715194 DOI: 10.21037/tau.2017.04.09] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 03/30/2017] [Indexed: 12/22/2022] Open
Abstract
Erectile dysfunction (ED), the most commonly reported sexual problem for men, reduces the quality of life for both patients and their partners. Even when physiologically effective, long-term adherence to ED treatments is poor. We review here the implication of having patients' partners involved in ED treatment, starting with treatment selection. We suggest that having partners engaged from the outset may promote an erotic association of the treatment with the partner, i.e., conceptually linking the aid to the sexual pleasure that the partner provides. We hypothesize that this erotic association should enhance the sexual aid's effectiveness and might potentially help improve long-term adherence. The primary focus of this review, though, is non-pharmacological and non-surgical options for maintaining sexual activity for men with ED. Though not ED treatments per se, anecdotal data suggest that these options may be effective for some patients and their partners in regaining a satisfying sex life. The aids discussed include external penile prostheses, penile sleeves, and penile support devices. These devices can allow men to participate in penetrative sexual intercourse despite moderate to severe ED. External penile prostheses can be personalized so they match in size and shape a man's normal full erection. Penile sleeves can similarly be customized with a lumen that fits best a patient's penis for optimal tactile stimulation. We review how multi-sensory integration can enhance sexual arousal for men who use such devices, allowing them to achieve orgasm despite intractable ED. Patients are not always advised within ED clinics about these options nor why and how they can facilitate non-erection dependent sexual recovery. Clinicians need to be aware of these devices and their positive attributes, so they can objectively counsel and encourage couples to explore their use as an alternative to more invasive treatments. The most commonly promoted non-medical ED aid offered to patients is the vacuum erection device. We discuss how erections achieved with the vacuum erection device have a "hinge effect", that is an underappreciated barrier to the effectiveness of the erection. With a hinged erection, the penis points downward rather than upward. We show how the normal kinematics of the penis during coitus is not strictly linear (i.e., not uniaxial; not just in-and-out), and is impeded by hinging. Positional adjustment, such as the receptive partner being on top, may help overcome this problem for some couples. Lastly, we suggest that, in the case where ED can be anticipated from a pending medical treatment, such as a prostatectomy, pre-habilitative approaches may potentially improve adherence to sexual aid use in the long-term. In conclusion, non-pharmacological and non-surgical options for sexual recovery are available. Scientific studies on the effectiveness of these interventions in restoring satisfying sex are warranted.
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Affiliation(s)
- Richard Wassersug
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - Erik Wibowo
- British Columbia Cancer Agency, Vancouver, Canada
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Cheung AS, de Rooy C, Hoermann R, Lim Joon D, Zajac JD, Grossmann M. Quality of life decrements in men with prostate cancer undergoing androgen deprivation therapy. Clin Endocrinol (Oxf) 2017; 86:388-394. [PMID: 27696495 DOI: 10.1111/cen.13249] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/02/2016] [Accepted: 09/28/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE While androgen deprivation therapy (ADT) has been associated with decreased quality of life (QoL), controlled prospective studies are lacking. We aimed to assess QoL during ADT using two validated questionnaires and determine contributing factors. DESIGN Prospective controlled study. PATIENTS Sixty-three men with nonmetastatic prostate cancer newly commencing ADT (n = 34) and age- and radiotherapy-matched prostate cancer controls (n = 29). MEASUREMENTS QoL was measured by Short-Form 12 version 2 survey (SF-12) and Aging Males' Symptoms (AMS) score at 0, 6 and 12 months. Generalized linear models determined the mean adjusted difference (MAD) (95% confidence interval) between groups during follow-up. RESULTS Compared to controls over 12 months, men receiving ADT had decreased SF-12 physical component score [MAD -3·61 (-6·94, -0·29), P = 0·013] reflecting worsening QoL but no change in the mental component (P = 0·74). Total AMS score increased [MAD 9·35 (5·65, 13·07), P < 0·001], reflecting worse QoL. Both SF-12 and AMS changes were greater than reported minimum clinically important differences. AMS sub-domains showed increased somatic [MAD 3·96 (1·94, 5·99), P < 0·001] and sexual [MAD 3·80 (2·16, 5·44), P < 0·001] components but not psychological (P = 0·19). Decrements were related to an increase in hot flushes (P = 0·016) but not haemoglobin decrease (P = 0·46). CONCLUSIONS Within 12 months, ADT is associated with clinically significant decreased QoL, particularly physical and sexual aspects, independent of the confounding effects of a cancer diagnosis or radiotherapy. As QoL is a crucial aspect of prostate cancer treatment, addressing hot flushes, sexual dysfunction and exercise may potentially improve outcomes for men undergoing ADT.
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Affiliation(s)
- Ada S Cheung
- Department of Medicine, The University of Melbourne, Heidelberg, Vic., Australia
- Department of Endocrinology, Austin Health, Heidelberg, Vic., Australia
| | - Casey de Rooy
- Department of Medicine, The University of Melbourne, Heidelberg, Vic., Australia
| | - Rudolf Hoermann
- Department of Endocrinology, Austin Health, Heidelberg, Vic., Australia
| | - Daryl Lim Joon
- Department of Radiation Oncology, Austin Health, Heidelberg, Vic., Australia
| | - Jeffrey D Zajac
- Department of Medicine, The University of Melbourne, Heidelberg, Vic., Australia
- Department of Endocrinology, Austin Health, Heidelberg, Vic., Australia
| | - Mathis Grossmann
- Department of Medicine, The University of Melbourne, Heidelberg, Vic., Australia
- Department of Endocrinology, Austin Health, Heidelberg, Vic., Australia
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