Mapping the prevalence and use of questionnaires to detect the neglected sexual side effects after prostate cancer treatment: a scoping review

Background Early prostate cancer (PCa) treatment interventions may leave men with debilitating sexual side effects, especially when not diagnosed or present at initial follow-up treatment. Men are often embarrassed to disclose their sexual dysfunction. This may lead to sexual side effects related to PCa treatment remaining untreated, adding to their burden of disability. This study was conducted to map the evidence on the prevalence of neglected sexual side effects (NSSE) after radical prostatectomy (RP) surgery or radiation treatment (RT) for PCa treatment and the reported use of questionnaires to identify such side effects. Methods This systematic scoping review’s search strategy involved searching MEDLINE/PubMed, Science Direct and Google Scholar databases. Guided by eligibility criteria, two independent reviewers conducted title, abstract and full-text screening. Data from the included studies were extracted. The review team explored the implications of the findings in relation to the research question and aims of the study. The Mixed Method Appraisal Tool was used to appraise the quality of the included studies. This review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Results Searches of the databases identified 1369 articles, with 23 eventually included for review. The prevalence of NSSE ranged between 0 and 78% in studies reporting on early PCa treatment of RP and RT patients. Orgasmic dysfunction (5–78%), penile curvature changes (10–15.9%) and penile length shortening (0–55%) similarly showed a low to moderate prevalence. Climacturia had low prevalence (4–5.2%) after RT and moderate prevalence (21–38%) after RP, whilst anejaculation had low to high prevalence (11–72%) after RT. No validated questionnaire was used to detect any NSSE after early PCa treatment. Studies mainly modified other questionnaires, and two studies used non-validated questionnaires to identify some NSSE. Participants in the included studies reported being inadequately informed about the possible sexual side effects of their treatment. Conclusion This study showed a low to a high prevalence of NSSE in men after RP and RT for early PCa treatment. Questionnaires helped detect individual NSSEs after PCa treatment but there is currently no evidence of a valid, reliable and comprehensive questionnaire to detect the NSSE collectively. Scoping review registration N/A

Psychosexual Problem in Remitted Psychiatric Patients

Background: Many patients and health literature, in general, allege that psychotropic agents cause sexual side effects. Objective: We intended to investigate this issue in a Nepalese clinical setting by estimating the prevalence of psychosexual problems among remitted psychiatric outpatients (on psychotropic medication) and by comparing it with that of a nonpsychiatric patient group (on nonpsychotropic medication). Methodology: In this hospital-based cross-sectional comparison study with purposive sampling, we collected the responses to a self-response questionnaire called “Arizona Sexual Experience Scale” from a total of 400 subjects: 100 male and 100 female consecutive consenting remitted psychiatric and dermatological outpatients, each with sex and marital status matching. We recorded pertinent information in the proforma and screened psychosexual problems with the Arizona Sexual Experience Scale after informed written consent. The problems in psychiatric and dermatological groups were compared. Results: We have more subjects of reproductive ages in both the psychiatric and dermatological groups. Depression, anxiety, and bipolar affective disorder were the most common diagnoses in the psychiatric patients, whereas eczema, fungal, immunologic, and allergic skin lesions/diseases were common in the dermatological patients. Both groups had comparable sexual dysfunction rates, both by overall and the criteria of ≥3 items with scores ≥4, whereas dermatological patients had more problems with criteria of ≥1 item with a score ≥5. Conclusions: Psychosexual dysfunction was more or less similar in frequency among both the psychiatric patients on psychotropic medication and dermatological patients on topical agents.

INFERTILITY AND MENTAL HEALTH: CHALLENGES, MANAGEMENT AND FUTURE AHEAD

Infertility is known to distress humanity since time is known. It does not merely affect the female or her spouse rather impacts signicantly the family as a whole. Its suffering is very stressful and even leads to a morbid mental health issue of- depression, anxiety, aggression, phobia, sexual dysfunction, dissociation and sleep disturbances. The medical management of these issues further complicates the picture with drug-related sexual side effects. Also, there is a signicant psychological and social dysfunction associated with infertility. Thus, Infertility is a multifactorial disease that needs comprehensive multidisciplinary management and care.

Dosimetric Analysis of Patients Receiving Radiotherapy with VMAT Technique in Localized Prostate Cancer and Its Correlation with Side Effects

Aim: It is aimed whether there is a relationship between dosimetric data of localized prostate cancer patients who have been treated with curative radiotherapy and gastrointestinal (GIS), genitourinary (GUS), anal and sexual side effects and whether there is a difference between dosimetric data and clinical findings between risk groups. Method : Eighty-seven patients who received curative radiotherapy for localized prostate cancer between 2014 - 2019 were included in the study. Dosimetrically; whether there was a relationship between V30, V40, V50, V60, V65, V70, V75 for rectum and bladder; D90 for the penile bulb, V72, V74, V76 for the bulbomembranous urethra, V30, V45, V53, Dmax for the anus and V45 (cc) for the intestine data and the side effects was analyzed. It was evaluated whether there was a relationship between testosterone values and sexual side effects. The Kolmogorov-Smirnov test, One Way ANOVA (F-test), and paired-sample T-test were used as statistical methods. For statistical significance, p <0.05 was accepted. Results : The mean age of the patients was 69 (50-86), the mean PSA (ng/dl) before RT was 25.1 (0.9-339), the median RT dose was 76 Gy (74-78 Gy), and the mean follow-up period was 38.2 months. PTVmax, PTVmean, PTVmin, bladder V40, bladder V50, rectum V30, rectum V40, rectum V50 and intestinal V45 (cc) were determined as dosimetric data showing differences between risk groups. A statistically significant relationship was found between rectum V30 (p = 0.017), V60 (p = 0.019), V65 (p = 0.008), V70 (p = 0.007) and V75 (p = 0.034) and chronic GIS side effects. G2 GIS side effects were observed in 4 patients (4.6%) in the entire patient group in the acute period. A statistically significant relationship was found between the patients receiving hormonotherapy (p = 0.021) and testosterone values ​​at the last control (p = <0.001) and chronic sexual side effects. Conclusion: Attention should be paid to the rectum V30, V60, V65, V70, and V75 values to minimize the long-term GIS side effects of patients who have undergone RT. Testosterone level and HT status affect chronic sexual toxicity.

Couples Coping with Prostate Cancer: Women and Men (Re)Negotiating Discourse of Gender, Sexuality and Intimate Relationships

This dissertation project investigates the ways in which men and their female partners navigate discourses of sex, gender, and relationships as they cope with recovery from prostate cancer and engage in penile/sexual rehabilitation. Study I involves a discourse analysis of online patient information sources for prostate cancer-related penile/sexual rehabilitation with a focus on how sex, erections, gender, patients, and relationships are depicted. Study II involves discourse analysis of in-depth interviews with prostate cancer survivors, female partners of men with prostate cancer, and couples, to explore the social norms and collective meanings they adopt when speaking about sex, their identity as a man/woman, recovery, and relationships. Analyses also explore discursive points of connection and discordance between the two studies. Penile rehabilitation is positioned in both studies as a medical imperative through close alignment with scientific empiricism. Sexual side effects (e.g., changes in erections) are framed in biomedical and mechanical terms, and penile rehabilitation is presented as a scientific and effective solution. Both Study I and Study II convey that one’s health and recovery are largely individual responsibilities. Ideal patients are framed as entrepreneurial, responsible, and informed in Study I, and Study II participants largely adopt these discourses. Online information sources situate sexuality within the realm of health and medicine so that changes in erections are positioned as medical issues best resolved using the expertise of medical specialists. The findings from Study II, however, challenge a purely biomedical or health-focused approach to erections. Many patients emphasize the relational and psychological aspects of sex and the inability of pro-erectile interventions to adequately address the injuries caused by prostate cancer treatment. Online materials from Study I reinforce narrowly defined views of masculinity/femininity and (hetero)sexuality. Masculinity and femininity are framed as complementary and distinct opposites, and intercourse is positioned as an essential sexual practice. Many participants frame prostate cancer as a major disruption to successful gender performance and to the sexual status quo. A number of participants resist medicalized/healthisized discourses of sex, and hegemonic masculine subjectivities. They espouse alternative definitions of what it means to be a lover and man/woman. Implications and recommendations are discussed.

Couples Coping with Prostate Cancer: Women and Men (Re)Negotiating Discourse of Gender, Sexuality and Intimate Relationships

This dissertation project investigates the ways in which men and their female partners navigate discourses of sex, gender, and relationships as they cope with recovery from prostate cancer and engage in penile/sexual rehabilitation. Study I involves a discourse analysis of online patient information sources for prostate cancer-related penile/sexual rehabilitation with a focus on how sex, erections, gender, patients, and relationships are depicted. Study II involves discourse analysis of in-depth interviews with prostate cancer survivors, female partners of men with prostate cancer, and couples, to explore the social norms and collective meanings they adopt when speaking about sex, their identity as a man/woman, recovery, and relationships. Analyses also explore discursive points of connection and discordance between the two studies. Penile rehabilitation is positioned in both studies as a medical imperative through close alignment with scientific empiricism. Sexual side effects (e.g., changes in erections) are framed in biomedical and mechanical terms, and penile rehabilitation is presented as a scientific and effective solution. Both Study I and Study II convey that one’s health and recovery are largely individual responsibilities. Ideal patients are framed as entrepreneurial, responsible, and informed in Study I, and Study II participants largely adopt these discourses. Online information sources situate sexuality within the realm of health and medicine so that changes in erections are positioned as medical issues best resolved using the expertise of medical specialists. The findings from Study II, however, challenge a purely biomedical or health-focused approach to erections. Many patients emphasize the relational and psychological aspects of sex and the inability of pro-erectile interventions to adequately address the injuries caused by prostate cancer treatment. Online materials from Study I reinforce narrowly defined views of masculinity/femininity and (hetero)sexuality. Masculinity and femininity are framed as complementary and distinct opposites, and intercourse is positioned as an essential sexual practice. Many participants frame prostate cancer as a major disruption to successful gender performance and to the sexual status quo. A number of participants resist medicalized/healthisized discourses of sex, and hegemonic masculine subjectivities. They espouse alternative definitions of what it means to be a lover and man/woman. Implications and recommendations are discussed.