Implementation of individually tailored treatment plans in a group-based intervention for women with mixed vulvo-vaginal and sexual health concerns following cancer treatment: A feasibility study.

PURPOSE: This study evaluated a professionally-led, group-based vulvo-vaginal and sexual health (VSH) workshop for women diagnosed with cancer. The study goals were to: (1) implement and assess a novel group intervention for diverse VSH concerns; (2) explore post-workshop changes in symptom bother, motivation to use VSH treatments, and frequency of VSH treatment use; (3) examine post-workshop changes in sexual well-being. METHODS: A group-based educational workshop to address a variety of VSH concerns was developed and implemented. During the workshop, participants created an individualized treatment plan by selecting from various VSH treatment options presented. Treatment plan follow-ups were administered online at one-, two-, and three-months post-workshop. At baseline and three-month follow-up, participants completed online questionnaires to assess self-reported vulvo-vaginal symptoms, sexual function, sexual distress, and use of VSH strategies. RESULTS: 195 participants (age 20-81) attended workshops over a 2.5-year period. Individualized treatment plans were effectively completed by most participants (92%). Preliminary results show decreases in bother severity associated with VSH concerns post-workshop, stabilizing after 2 months. At three-month follow-up, participants reported increased use of VSH treatment strategies. Sexual satisfaction, sexual distress, and emotional impact of vulvovaginal symptoms also improved. CONCLUSIONS: Workshop attendance was associated with increased uptake of VSH treatment strategies and improvements in several parameters of sexual well-being. Findings indicate that individualized treatment plans can be implemented effectively in a group setting and that a one-time, group-based educational workshop can meaningfully impact VSH-related behavior change, reduce vulvo-vaginal symptom bother and promote sexual well-being in patients with diverse VSH concerns.

Periurethral and Anterior Vaginal Wall Masses: Etiology, Presentation, and Treatment Outcomes.

OBJECTIVE: To describe the etiology and presenting symptoms of periurethral and anterior vaginal wall masses in a large series of patients in an academic institution. METHODS: A retrospective chart review of 126 patients presenting and undergoing treatment for periurethral and anterior vaginal wall masses between November 2001 and July 2021 was completed. Clinicopathologic data were extracted. Ethics approval was obtained. The primary objective of this study was to determine the etiology of these masses; secondary objectives included determining the rates of presenting symptoms, complications, resolution of stress urinary incontinence (SUI), and de novo SUI. RESULTS: The median age of patients was 42 years. The most common etiology was urethral diverticula (39.7%), followed by Skene gland cysts or abscesses (30.2%). The rate of malignancy was 1.6%, and the rate of infection was 21.4%. The most common presenting symptoms were sensation of mass (78.6%), dyspareunia (52.4%), and discharge (46.0%). The rate of surgical complications was 9.5%. Three patients had recurrence on follow-up, but there were no recurrent urethral diverticula after excision. The rate of de novo SUI was 5.6%. The rate of resolution of SUI was 67.6%, and all patients who had slings reported resolution of SUI. CONCLUSION: Urethral diverticula and Skene gland cysts or abscesses accounted for 70% of periurethral and anterior vaginal wall masses in this series. Treatment by complete excision is usually successful.

Structural Violence Education: A Critical Moment for Psychiatric Training.

The mental health ramifications of structural violence are borne disproportionately by marginalized patient populations in North America, which includes Black, Indigenous, and 2SLGBTQIA+ communities and people who use drugs. Structural violence can comprise, for example, police or state violence, colonialism, and medical violence. We chronicle the history of psychiatric discourse around structural violence over the past 50 years and highlight the critical need for new formalized competencies to become incorporated into the training of medical students across Canada, specifically addressing the impacts of structural violence for the aforementioned populations. Finally, we offer a framework of learning objectives for designing educational sessions discussing structural violence and mental health for integration into pre-clerkship psychiatry curricula at medical schools across Canada.

Delivering Breast Reconstruction Information to Patients-Part 2: Women Report on Preferred Information Content.

PURPOSE: To determine the type of information women want to be provided in order to make an informed decision as to whether, when, and using what technique to proceed with breast reconstruction. METHOD: Using purposeful sampling, 19 patients who had recently undergone various breast reconstruction procedures were recruited to each participate in a 30- to 45-minute semi-structured interview. Participants shared their insights and beliefs regarding the type of breast reconstruction information they most valued prior to undergoing breast reconstruction surgery. Participants were also queried as to perceived information gaps. In some cases, the participants' partners or support persons were also interviewed. Grounded theory and thematic analysis assisted in interview transcript analysis. RESULTS: Eight topics were identified relating to women's informational needs around breast reconstruction. Examples include how to weigh the pros and cons of various breast reconstruction options to decide between flap or implant reconstruction, whether there are safety concerns with immediate breast reconstruction or nipple-sparing reconstruction, and expectations and advice on how to manage possibly unexpected intimacy issues after breast reconstruction. CONCLUSIONS: Using mixed methods research methodology, 19 women reported on preoperative informational gaps relating to their recent breast reconstruction experiences. Patients report that adequate breast reconstruction information prior to breast reconstruction surgery helps them to manage their expectations, prepare for surgery and recovery, and improve postoperative satisfaction.

OBJECTIF: Déterminer le type d'information que les femmes veulent recevoir pour décider de manière éclairée si elles veulent subir une reconstruction mammaire, le moment de la subir et la technique à privilégier. MÉTHODOLOGIE: À l'aide de l'échantillonnage raisonné, 19 patientes qui avaient récemment subi des reconstructions mammaires différentes ont été recrutées pour participer à des entrevues semi-structurées individuelles de 30 à 45 minutes. Elles ont donné leur point de vue et leur avis quant au type d'information sur la reconstruction qu'elles trouvaient le plus important avant l'opération. Elles ont également été invitées à confier leurs perceptions à l'égard du manque d'information. Dans certains cas, les chercheurs ont également interviewé les conjoints ou les proches aidants des participantes. La théorie ancrée et l'analyse thématique ont contribué à l'analyse des entrevues après leur transcription. RÉSULTATS: Huit sujets ont émergé quant aux besoins d'information des femmes sur la reconstruction mammaire. Les exemples incluaient la manière de soupeser le pour et le contre pour choisir entre la reconstruction par lambeau ou par implant, les enjeux de sécurité d'une reconstruction mammaire immédiate ou d'une reconstruction avec épargne mammaire, de même que les attentes et les conseils sur la gestion du risque de problèmes d'intimité inattendus après la reconstruction mammaire. CONCLUSIONS: À l'aide d'une méthodologie de recherche mixte, 19 femmes ont confié les insuffisances d'information dont elles avaient eu l'expérience avant leur récente expérience de reconstruction mammaire. Elles ont déclaré que la transmission d'information appropriée sur la reconstruction mammaire avant l'intervention contribue à gérer les attentes, à se préparer à l'opération et à la convalescence et à accroître la satisfaction après l'opération.

Patient interest in the Lowdown on Down There: attendance at a vulvovaginal and sexual health workshop post-cancer treatment.

PURPOSE: Sexual difficulties and vulvovaginal changes are common for women undergoing, and following, cancer treatments. These changes have significant impacts on quality of life and significant relationships. The current study aimed to (1) evaluate women's interest and attendance in a group-based educational workshop to address changes in vulvovaginal health and sexuality after cancer, and (2) describe participant characteristics and presenting concerns. METHODS: Two hundred eighteen women with a history of cancer expressed interest in receiving information about the workshop and completed phone screening. Interested women (n = 156) completed an online questionnaire package examining vulvovaginal health and sexual function prior to attending the workshop. RESULTS: Approximately 75% of the women who completed screening attended the workshop. Clinically significant sexual distress was reported by 91% of participants, and 97% of sexually active participants exceeded the threshold for sexual dysfunction (per FSFI). Women within 1-2 years of diagnosis tended to report less sexual distress, less severe vulvovaginal symptoms, and less impact from these symptoms compared to women farther out from diagnosis. While the majority of women reported vaginal dryness and pain during intercourse, only a minority reported engaging in health promotion strategies sufficient to expect symptom improvement. CONCLUSIONS: The current study suggests that group-based educational workshops for vulvovaginal and sexual concerns are utilized by patients and should be offered to women well into disease survivorship. Workshops targeting vulvovaginal symptoms and sexual concerns may be a cost-effective method of reducing sexual distress and improving patients' sexual function and quality of life.

The Making of Breasts: Navigating the Symbolism of Breasts in Women Facing Cancer.

In many cultures, the female breast is a potent symbol of beauty, motherhood, and vitality. When such breasts become diseased and a woman is faced with a mastectomy, multiple competing discourses converge to complicate the decision for or against breast reconstruction. This process can be fraught with tension and ambivalence. Women, along with surgeons working in the field of breast reconstruction, should be aware of the cultural history that shapes the understanding of breasts. When a woman considers her options, she is influenced by the personal and the evolving social and cultural discourse.

Dans bien des cultures, les seins féminins sont de puissants symboles de beauté, de maternité et de vitalité. Lorsqu'ils sont atteints par la maladie et que la femme subit une mastectomie, de multiples discours divergents compliquent la décision de subir ou non une reconstruction mammaire. Ce processus peut être teinté de tension et d'ambivalence. Les femmes, de même que les chirurgiens qui travaillent dans le domaine de la reconstruction mammaire, devraient connaître l'histoire culturelle qui façonne la compréhension des seins. Lorsqu'une femme évalue ses options, elle est influencée par son discours personnel et par l'évolution des discours sociaux et culturels.