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Vedovo F, Lonati C, Suardi N, Mariani L, Capogrosso P, Ficarra V, Salonia A, Trombetta C. Sexual outcomes in men who have sex with men who underwent radical prostatectomy. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00861-9. [PMID: 38918583 DOI: 10.1038/s41391-024-00861-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 05/31/2024] [Accepted: 06/13/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Sexual difficulties are a recognized consequence of prostate cancer (PCa) treatments. An estimated one in three men who have sex with men (MSM) receive PCa a diagnosis during their lifetime. MSM may experience all types of sexual dysfunction as reported in men who have sex with women (MSW), along with a number of more specific bothersome problems. This systematic literature review aims to evaluate sexual outcomes in MSM who have undergone radical prostatectomy (RP). METHODS A systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The searches were made using relevant keywords in the PubMed, Scopus, and Web of Science databases, thus including the whole literature from January 2000 to November 2023. Studies which did not allow to retrieve data on sexual outcomes on MSM treated with RP for PCa were excluded. Data on sexual outcomes and health-related quality of life (HRQoL) were retrieved, mostly including changes in libido, erectile function, ejaculatory disorders, orgasm, climacturia, changes in role-in-sex identity, changes in sexual partnerships, and the presence of painful receptive anal intercourses (AI). PROSPERO ID CRD42024502592. RESULTS Six articles met the inclusion criteria. In total, data of 260 patients were analyzed. Three main themes emerged: (a) MSM may experience specific sexual dysfunctions due to the different dynamics of their intimacy; (b) the lack of tool validated on gay and bisexual population to assess sexual outcomes (c) the need for a tailored approach that also takes into account sexual orientation throughout the oncological journey. CONCLUSIONS MSM undergoing RP may experience similar sexual problems as MSW. Painful AI should be considered a potential post-operative adverse outcome in MSM. Future studies should prioritize validating a questionnaire that explores AI. Healthcare providers should adopt a tailored approach that takes into account sexual orientation throughout the cancer journey.
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Affiliation(s)
- F Vedovo
- Department of Medicine, Urological Clinic, Surgery and Health Sciences, University of Trieste, Trieste, Italy.
| | - C Lonati
- Department of Medical and Surgical Specialties, Urology Unit, ASST Spedali Civili di Brescia, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - N Suardi
- Department of Medical and Surgical Specialties, Urology Unit, ASST Spedali Civili di Brescia, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - L Mariani
- AST 3, Civitanova Marche, Italy
- AST 4, Fermo, Italy
| | - P Capogrosso
- Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy
| | - V Ficarra
- Gaetano Barresi Department of Human and Paediatric Pathology, Urologic Section, University of Messina, Messina, Italy
| | - A Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele, University, Milan, Italy
| | - C Trombetta
- Department of Medicine, Urological Clinic, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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2
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Dickstein DR, Edwards CR, Lehrer EJ, Tarras ES, Gallitto M, Sfakianos J, Galsky MD, Stock R, Safer JD, Rosser BRS, Marshall DC. Sexual health and treatment-related sexual dysfunction in sexual and gender minorities with prostate cancer. Nat Rev Urol 2023; 20:332-355. [PMID: 37217695 PMCID: PMC10389287 DOI: 10.1038/s41585-023-00778-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 05/24/2023]
Abstract
Prostate cancer treatment has substantial effects on sexual health and function. Sexual function is a vital aspect of human health and a critical component of cancer survivorship, and understanding the potential effects of different treatment modalities on sexual health is crucial. Existing research has extensively described the effects of treatment on male erectile tissues necessary for heterosexual intercourse; however, evidence regarding their effects on sexual health and function in sexual and gender minority populations is minimal. These groups include sexual minority - gay and bisexual - men, and transgender women or trans feminine people in general. Such unique effects in these groups might include altered sexual function in relation to receptive anal and neovaginal intercourse and changes to patients' role-in-sex. Sexual dysfunctions following prostate cancer treatment affecting quality of life in sexual minority men include climacturia, anejaculation, decreased penile length, erectile dysfunction, and problematic receptive anal intercourse, including anodyspareunia and altered pleasurable sensation. Notably, clinical trials investigating sexual outcomes after prostate cancer treatment do not collect sexual orientation and gender identity demographic data or outcomes specific to members of these populations, which perpetuates the uncertainty regarding optimal management. Providing clinicians with a solid evidence base is essential to communicate recommendations and tailor interventions for sexual and gender minority patients with prostate cancer.
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Affiliation(s)
- Daniel R Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Collin R Edwards
- Department of Radiology, Vagelos College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Eric J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elizabeth S Tarras
- Department of Pulmonology, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Matthew Gallitto
- Department of Radiation Oncology, Vagelos College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - John Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew D Galsky
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Richard Stock
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua D Safer
- Center for Transgender Medicine and Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - B R Simon Rosser
- Division of Epidemiology and Community Health, School of Public Health at University of Minnesota, Minneapolis, MN, USA
| | - Deborah C Marshall
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Daniels J, Stephenson R, Langer S, Northouse L, Odouli R, Amarasekera C, Vandeneeden S, Langston M. "Ultimately, You Realize You're on Your Own": The Impact of Prostate Cancer on Gay and Bisexual Men Couples. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105756. [PMID: 37239485 DOI: 10.3390/ijerph20105756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/07/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023]
Abstract
An estimated one in three gay and bisexual (GB) male couples receive a prostate cancer (PCa) diagnosis over their life course with limited understanding of the impacts on their relationships. Psychological distress related to PCa diagnosis and treatment-related side effects have been shown to disrupt established GB partnership dynamics. Communication barriers often develop within GB relationships affected by PCa, further exacerbating couple tensions, isolating partners, and lowering quality of life for both patients and partners. In order to elaborate on these phenomena following a PCa diagnosis, we conducted focus group discussions with GB men in relationships. Men were recruited nationally through PCa support groups, and after completing consent procedures, they were invited to one of two focus group discussions conducted through video conference. Topics discussed included the diagnosis and medical decision making pertaining to PCa; healthcare provider experiences; the emotional, physical, and sexual impact of PCa diagnosis and treatment; sources of support and appraisal of resources; and partner involvement and communication. There were twelve GB men who participated in focus group discussions that were audio-recorded and transcribed, and analyzed using a thematic approach. GB couple experiences with PCa during and after treatment choice and recovery identified common patient-provider communication barriers. In particular, GB men reported difficulties in disclosing their sexuality and relationship to their providers, limiting conversations about treatment choice and partner engagement in care. Both patients and partners experienced times of being alone after treatment, either by choice or to give space to their partner. However, partners often did not explicitly discuss their preferences for being alone or together, which resulted in partners' disengagement in their relationship and the prostate cancer healthcare process. This disengagement could blunt the notable PCa survival benefits of partnership for GB men.
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Affiliation(s)
- Joseph Daniels
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA
| | - Rob Stephenson
- University of Michigan School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA
| | - Shelby Langer
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA
| | - Laurel Northouse
- University of Michigan School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA
| | - Roxana Odouli
- Division of Research, Kaiser Permanente of Northern California, Oakland, CA 94612, USA
| | - Channa Amarasekera
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Stephen Vandeneeden
- Division of Research, Kaiser Permanente of Northern California, Oakland, CA 94612, USA
| | - Marvin Langston
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, CA 94305, USA
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4
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Conyers H, Wu D, Kpokiri E, Zhang Q, Hinchliff S, Shakespeare T, Tucker J. Barriers and facilitators to accessing sexual health services for older LGBTQIA+ adults: a global scoping review and qualitative evidence synthesis. Sex Health 2023; 20:9-19. [PMID: 36653021 DOI: 10.1071/sh22144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 12/15/2022] [Indexed: 01/20/2023]
Abstract
The number of older adults identifying as lesbian, gay, bisexual, transgender and other sexual and gender diverse identities (LGBTQIA+) is growing as populations age and social environments become more accepting. This study uses a global evidence synthesis to understand perceived barriers and facilitators to access to sexual healthcare globally for older LGBTQIA+ adults. We used a scoping review and qualitative evidence synthesis. Embase, PubMed and PsycInfo were searched with terms related to LGBTQIA+ populations, adults aged 45years, and sexual health care. We used the Cochrane Handbook and the review protocol was registered. Primary and secondary textual data were coded and grouped into themes using PRISMA-SCR and the Minority Stress Model. The certainty of review findings was assessed using the GRADE-CERQual approach. We identified 19 studies and 15 were included in the qualitative evidence synthesis. All studies were from high-income countries. Heterocentricity and male-centricity of sexual healthcare services contributed to feelings of exclusion for older LGBTQIA+ adults. Both anticipated and enacted stigma from healthcare providers resulted in older LGBTQIA+ adults, especially those with chronic conditions, avoiding health services (seven studies each, low certainty). Older LGBTQIA+ adults have unique sexual health needs and may feel their age empowers them to access appropriate care (four studies, low certainty). This review highlights the need for additional research and interventions to improve sexual health services for older LGBTQIA+ adults. Practical strategies to make sexual health less heterocentric (e.g. gender neutral signage) may increase uptake of essential sexual health services.
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Affiliation(s)
- Hayley Conyers
- London School of Hygiene and Tropical Medicine, London, UK
| | - Dan Wu
- Department of Clinical Research at the London School of Hygiene and Tropical Medicine, London, UK
| | - Eneyi Kpokiri
- London School of Hygiene and Tropical Medicine, London, UK
| | - Qihang Zhang
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Tom Shakespeare
- Disability Research, International Centre for Evidence in Disability at the London School of Hygiene and Tropical Medicine, London, UK
| | - Joseph Tucker
- London School of Hygiene and Tropical Medicine, London, UK; and University of North Carolina, Chapel Hill, NC, USA
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Body talk and resilience: Aging men's experiences with mastectomy and prostatectomy. J Aging Stud 2022; 61:101010. [DOI: 10.1016/j.jaging.2022.101010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/23/2022]
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Mitchell E, Ziegler E. Sexual Dysfunction in Gay and Bisexual Prostate Cancer Survivors: A Concept Analysis. JOURNAL OF HOMOSEXUALITY 2022; 69:1119-1139. [PMID: 33818298 DOI: 10.1080/00918369.2021.1905384] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Sexual dysfunction is a common side effect of prostate cancer (PCa) treatment, yet it remains poorly defined in the literature. Current definitions are based on heteronormative assumptions which do not consider the unique experiences of gay and bisexual (GBM) PCa survivors. The purpose of this paper is to use Walker and Avant's method to conduct a concept analysis of sexual dysfunction among GBM in the context of PCa survivorship. The review included 46 articles published between 2002-2019. The following attributes were identified: (1) erectile dysfunction, (2) ejaculatory change (anhedonia/anejaculation), (3) urinary incontinence/climacturia, and (4) anodyspareunia. For GBM PCa survivors, sexual dysfunction involves reduced or abnormal functioning of four core elements of a sexual encounter, which inhibit GBM from engaging in and being satisfied with sexual activity.
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Affiliation(s)
- Evan Mitchell
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Erin Ziegler
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
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Wulff-Burchfield E. Supportive and Palliative Care for Genitourinary Malignancies. Urol Oncol 2022. [DOI: 10.1007/978-3-030-89891-5_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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The Politics of LGBT+ Health Inequality: Conclusions from a UK Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020826. [PMID: 33478019 PMCID: PMC7835774 DOI: 10.3390/ijerph18020826] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 11/16/2022]
Abstract
This scoping review of UK evidence aimed to describe what is known about Lesbian, Gay, Bisexual, and Trans (LGBT+) health inequalities in relation to cancer, mental health, and palliative care to inform research, policy and public health interventions. Using a scoping review methodology, we identified studies from database searches, citation tracking, and expert consultation. The in/exclusion criteria was based on the PICOS framework. The data were charted and then summarised to map the theoretical approaches and the main types of evidence and identify knowledge gaps. In total, 279 articles were screened and 83 were included in the final review. We found that there is limited UK research examining LGBT+ health inequality in cancer, mental health and palliative care. We would argue that this thin evidence base is partly due to national policy discussions of LGBT+ health inequality that are framed within a depoliticised ‘it’s getting better’ narrative, and an unwillingness to adequately acknowledge the unjust social and economic relations that produce LGBT+ health inequality. In addition, LGBT+ health inequality is depoliticised by existing public health explanatory theories, models and frameworks that exclude sexual orientation and gender diversity as dimensions of power that interlock with those of socio-economic, race and ethnicity. This is a barrier to developing public health interventions that can successfully tackle LGBT+ health inequality
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Papadopoulou C, Schubach K. Promoting Sexual Well-being for Men and Their Partners Affected by Prostate Cancer. Semin Oncol Nurs 2020; 36:151053. [PMID: 32674972 DOI: 10.1016/j.soncn.2020.151053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To present an overview of the issues related to the sexual well-being of people affected by prostate cancer and their partners, and propose ways to manage and address these by oncology nurses and the wider multi-disciplinary team. DATA SOURCES Electronic databases such as PubMed and Cinahl were used to retrieve relevant literature published between 2010 and 2020. CONCLUSION Sexual well-being in patients with prostate cancer and their partners is multifaceted, comprising physical, emotional, social, and cultural aspects. IMPLICATIONS FOR NURSING PRACTICE A combination of pharmacologic and non-pharmacologic interventions, together with enhanced communication, can be successful in providing culturally competent, person-centered care by oncology nurses and the wider multi-disciplinary team.
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Affiliation(s)
- Constantina Papadopoulou
- University of the West of Scotland, School of Health and Life Sciences, Hamilton International Technology Park, South Lanarkshire, United Kingdom.
| | - Kath Schubach
- Urology Nurse Practitioner, Men's Health Melbourne, Victoria, Australia
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10
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Alexis O, Adeleye AO, Worsley AJ. Men's experiences of surviving testicular cancer: an integrated literature review. J Cancer Surviv 2019; 14:284-293. [PMID: 31823122 DOI: 10.1007/s11764-019-00841-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/25/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To synthesise literature in order to elucidate the experiences of men who have survived testicular cancer and determine their quality of life following treatment. METHODS An integrated review sought appropriate literature by utilising a keyword search across seven databases. Retrieved studies were appraised for quality, with 2 qualitative, 12 quantitative and 2 mixed method studies deemed appropriate for this review. The data were extracted and aggregated into categories by way of a thematic analysis. The themes were personal challenges and impact on health, psychological and emotive challenges, perception of reproduction and sexual changes and outlook and support. RESULTS Men experienced physical, emotional and sexual difficulties. Some men believed they were infertile, despite evidence that fertility is not compromised in the long term. Psychological conditions can be exacerbated by cultural pressures to conceive and cultural expressions about male identity. Men who had undergone orchidectomy reported minimal impact on their mental health than the men who had chemotherapy or radiotherapy as part of their treatment modality. Sexual dysfunction caused by chemotherapy-associated side effects was detrimental to men's quality of life. In addition, men who had a partner, who were employed, and who had children were able to adjust better after treatment than those who did not. Provision of clear and honest information post-treatment helped testicular cancer survivors return to their normal lives. CONCLUSIONS The evidence from the review suggests that the burden of disease for testicular cancer survivors is overall low. Men who had surgical intervention and were treated for testicular cancer experienced minimal impact on their mental health status than the men who had chemotherapy or radiotherapy as part of their treatment modality. IMPLICATIONS FOR CANCER SURVIVORS There is a need to provide appropriate referrals to the relevant services, including psychosocial support, and the development of more adequate communication resources for men following treatment for testicular cancer.
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Affiliation(s)
- Obrey Alexis
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Adeniyi O Adeleye
- School of Nursing, Midwifery and Social Sciences, CQUniversity, Rockhampton, Australia
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