Sexual Health Concerns Among Cancer Survivors: Testing a Novel Information-Need Measure Among Breast and Prostate Cancer Patients.

While it is recognized that cancer treatment can contribute to problems in sexual function, much less is currently known about the specific sexual health concerns and information needs of cancer survivors. This study tested a new instrument to measure cancer survivors' sexual health concerns and needs for sexual information after cancer treatment. The Information on Sexual Health: Your Needs after Cancer (InSYNC), developed by a multidisciplinary team of experts, is a novel 12-item questionnaire to measure sexual health concerns and information needs of cancer survivors. We tested the measure with a sample of breast and prostate cancer survivors. A convenience sample of 114 cancer survivors (58 breast, 56 prostate) was enrolled. Results of the InSYNC questionnaire showed high levels of sexual concern among cancer survivors. Areas of concern differed by cancer type. Prostate cancer survivors were most concerned about being able to satisfy their partners (57 %) while breast cancer survivors were most concerned with changes in how their bodies worked sexually (46 %). Approximately 35 % of all cancer survivors wanted more information about sexual health. Sexual health concerns and unmet information needs are common among breast and prostate cancer survivors, varying in some aspects by type of cancer. Routine screening for sexual health concerns should be included in comprehensive cancer survivorship care to appropriately address health care needs. The InSYNC questionnaire is one tool that may help clinicians identify concerns facing their patients.

PREVALENCE OF AND FACTORS ASSOCIATED WITH ORAL SEX AMONG RURAL AND URBAN MALAWIAN MEN.

Despite medical evidence that female-to-male oral sex (fellatio) carries a lower risk for HIV transmission than unprotected vaginal intercourse, little research exists on the practice of fellatio in Africa. We used two samples of men from Malawi-one rural and one urban-to examine the prevalence of oral sex. While 97% of the rural sample and 87% of the urban sample reported having had vaginal sex, just 2% and 12%, respectively, said they had ever received oral sex. Only half of the rural sample, and less than three quarters of the urban sample, reported having heard of oral sex. Education, exposure to newspapers and television, and condom use significantly predicted oral sex knowledge after controlling for other confounding factors, while exposure to radio did not. The large gap between sexual activity and oral sex prevalence suggests that fellatio should be taken into consideration as a potential component of an HIV prevention strategy, but further quantitative and qualitative research that includes women as well as men is needed to understand potential benefits and drawbacks.

A biopsychosocial approach to sexual recovery after prostate cancer surgery: the role of grief and mourning.

Erectile dysfunction is a common side-effect of prostate cancer surgery that causes men suffering and hinders their sexual recovery. There are studies that describe men's and partners' distress and couples' difficulties engaging in sexual recovery. A few studies show a short-term benefit of brief psycho-social interventions such as psychoeducation and counseling. However, there is no conceptual framework to guide psychosocial treatments. We propose a model of intervention in sexual recovery that incorporates grief and mourning as a gateway to new and satisfying sexuality after prostate cancer treatment.

A multidisciplinary approach to sexual dysfunction in medical education.

OBJECTIVE: Addressing sexual health concerns in medical practice has been an emerging concept for the past two decades. However, there have been very few educational opportunities in medical training that would prepare future physicians for such a responsibility. Since assessing and treating sexual problems requires knowledge that encompasses many disciplines and requires skills typically not within the purview of medical training, the authors propose a multidisciplinary model that includes collaboration with sex therapists. METHODS: The authors review the extant literature on sexual health education in medical training. RESULTS: The authors describe an existing and evolving model at the University of Michigan which is based on several collaborative initiatives between the medical school, the psychiatry residency program, and several medical departments. CONCLUSION: The authors propose a collaborative training model that would facilitate future physicians' comfort with the subject and the acquisition of skills necessary to provide optimal care for patients who present with sexual health concerns.

Sexual functioning in young adult survivors of childhood cancer.

BACKGROUND: Studies of sexuality or sexual behavior in childhood cancer survivors tend to examine relationships or achievement of developmental milestones but not physiological response to cancer or treatment. The purpose of this study is to (1) identify prevalence and risk factors for sexual dysfunction in childhood cancer survivors, and (2) examine the extent to which sexual dysfunction may be associated with health-related quality of life (HRQOL) and psychosocial outcomes. METHODS: Five hundred ninety-nine survivors age 18-39 years completed standardized measures of sexual functioning, HRQOL, psychological distress and life satisfaction. Descriptive statistics assessed prevalence of sexual symptoms. Bivariate analyses identified correlates of sexual symptoms and examined associations between symptoms and HRQOL/psychosocial outcomes. RESULTS: Most survivors appear to be doing well, although 52% of female survivors and 32% of male survivors reported at least 'a little of a problem' in one or more areas of sexual functioning. Mean symptom score for females was more than twice that of males. Sexual symptoms were associated with reporting health problems. Significant associations between sexual functioning and HRQOL outcomes were observed, with gender differences in strengths of association suggesting that males find sexual symptoms more distressing than do females. CONCLUSIONS: While most survivors appear to be doing well in this important life domain, some young adult survivors report sexual concerns. While female survivors may report more sexual symptoms than male survivors, males may experience more distress associated with sexual difficulties. Better-specified measures of sexual function, behavior and outcomes are needed for this young adult population.