Sexual Expression in Long-Term Care Institutions: Are We Ready for the Baby Boomer Generation?

Baby boomers were at the forefront of profound social changes in sexual attitudes and many have expressed a desire to remain sexually active throughout their life course. The purpose of this survey study was to assess the perceived preparedness of Ontario's long-term care (LTC) homes to meet the changing sexuality needs and expectations of LTC residents. We examined sexuality-related attitudes, including in the context of dementia, among 150 LTC administrators. Participants also completed a questionnaire assessing their experiences and perceptions regarding existing and anticipated supports, barriers, and priorities. Most participants demonstrated positive sexual attitudes; however, multiple challenges to meeting residents' sexuality needs were noted, including assessing capacity to consent, limited privacy, staff training, conflicting attitudes, and a lack of adequate policy and guidelines. Challenges are broad and significant and considerable attention is required to meet the expectations of the next generation of LTC residents, including gender and sexual minority elders.

Power Dynamics in Discussions of Contemporary Jungian Theory and Practice.

Groups of Jungian analysts, which included the present authors, met to discuss four key theoretical concepts, each of which was felt to have problematic aspects if used unquestioningly in contemporary practice. The concepts were: The Primitive, Inner and Outer Worlds, Contrasexuality and Participation Mystique. The discussions were informed by clinical material and specific papers chosen for their critical evaluation of the topic. Four recorded transcripts were made, with permission, for further consideration of the relationship between contemporary Jungian theory and practice using the research method of thematic analysis. Three main themes were identified: Work of Analysis, Frames of Reference and Power Dynamics. The authors discuss the themes in relation to the overarching theme of power, understood as operating at conscious and unconscious levels. The artwork "Cold Dark Matter: An Exploded View" by Cornelia Parker is used as a metaphor in discussing the dynamic of challenging foundational concepts. The authors suggest that power dynamics are intrinsic in both the difficulty and the benefits of critically evaluating key concepts, binding together the theoretical (what informs us) with the clinical (what we do in the consulting room) as well as blowing apart pre-conceived notions of what underpins the analyst's work.

Les auteurs de cet article ont fait partie de groupes d'analystes jungiens qui se sont rencontrés pour débattre de quatre concepts théoriques fondamentaux, chacun de ces concepts étant perçu comme problématique si on l'utilise dans la pratique contemporaine sans se poser de questions. Ces concepts sont : primitif, mondes intérieur et extérieur, contra­sexualité et participation mystique. Les discussions ont été nourries par du matériel clinique et par des articles spécialement choisis pour leur évaluation critique du sujet traité. Quatre transcriptions enregistrées furent faites, avec l'accord des personnes concernées, pour une étude plus approfondie de la relation entre la théorie et la pratique jungienne contemporaine, en s'appuyant sur la méthode de recherche de l'analyse thématique. Trois thèmes furent identifiés : le travail d'analyse, les cadres de référence, et les dynamiques de pouvoir. Les auteurs débattent de ces thèmes en les reliant avec le thème fondamental du pouvoir, perçu comme fonctionnant aux niveaux conscient et inconscient. L'œuvre de l'artiste Cornelia Parker « Cold Dark Matter: An Exploded View ¼ est utilisée comme métaphore lorsqu'il est question de la dynamique de questionner des concepts fondamentaux. Les auteurs suggèrent que les dynamiques de pouvoir sont propres à la difficulté mais aussi aux bénéfices de cette remise en question, en reliant le théorique (ce qui nous informe) avec la clinique (ce que l'on fait dans la salle de consultation) et en faisant sauter les notions qui n'ont pas été questionnées, en ce qui concerne ce qui étaye le travail analytique.

Grupos de analistas Junguianos, los cuales incluyen a las presentes autoras, se reunieron para discutir cuatro conceptos teóricos fundamentales, cada uno de los cuales se consideraba que tenía aspectos problemáticos si se utilizaba sin cuestionamientos en la práctica contemporánea. Los conceptos eran: Primitivo, Mundos Interior y Exterior, Contrasexualidad y Participation Mystique. Los debates se basaron en material clínico y en artículos específicos elegidos para una evaluación crítica del tema. Se transcribieron con permiso cuatro grabaciones para un examen más detenido de la relación entre la teoría y la práctica junguiana contemporánea utilizando el método de investigación del análisis temático. Se identificaron tres temas: Trabajo Analítico, Marcos de Referencia y Dinámicas de Poder. Las autoras analizaron los temas en relación con el tema más amplio del poder, entendido como algo que opera a nivel consciente e inconsciente. La obra de arte "Cold Dark Matter: An Exploded View", de Cornelia Parker, fue utilizada como metáfora para discutir acerca de la dinámica de cuestionar los conceptos fundamentales. Se sugiere que las dinámicas de poder son intrínsecas tanto a la dificultad como a los beneficios de hacer esta tarea, ligando lo teórico (lo que nos informa) con lo clínico (lo que hacemos en la consulta), así como a desarmar nociones incuestionadas de aquello que sustenta el trabajo analítico.

[Sexuality among the elderly: understanding the weight of stereotypes]. / Sexualité chez les personnes âgées : comprendre le poids des stéréotypes.

Sexuality is an integral part of health and accompanies human beings throughout their lives. It contributes to well-being and improves quality of life. The social representations conveyed by Western society modulate sexuality and can play a decisive role in the expression of seniors' sexuality.

[Sex therapy and support for women and couples]. / Sexothérapie et accompagnement de la femme et du couple.

Sexuality is shaped by experience and by what has been passed down. Body image and sex influence desire and pleasure. In the case of endometriosis, suffering and pain can lead to shame and guilt. Encouraging people to talk to each other helps to create a free eroticism that resembles the couple.

[Chemsex: Harm reduction and support for users]. / Chemsex : réduction des risques et accompagnement des usagers.

The phenomenon of chemsex, or the use of psychoactive substances in a sexual context, is increasing in communities of men who have sex with men (MSM), and carry along significant risks and consequences. No specific treatment approach has yet been established, but risk and harm reduction strategies are at the forefront. Multi-disciplinary treatment, care and support need to be based on a non-judgmental attitude, offered by trained professionals who take into account the cultural specificities of users.

[Detecting and preventing sexual violence against people with disabilities]. / Dépister et prévenir les violences sexuelles sur les personnes en situation de handicap.

People with disabilities are more often victims of sexual violence, especially women. Dependence due to disability encourages domination and control. Studies put forward significant figures, reflecting a growing awareness of the various forms of violence and a liberation of speech, though still insufficient. Professionals and associations, backed by the law, are trying to identify and support victims.

Sentidos sobre o adoecer por câncer no filme Aquarius / Meanings about cancer in the movie Aquarius / Significations du cancer dans le film Aquarius / Sentidos sobre el cáncer en la película Aquarius

A linguagem fílmica constitui um importante recurso para o ensino-aprendizagem no campo da saúde. Para trabalhar a temática do adoecimento por câncer, diversos filmes têm sido empregados como disparadores de reflexões necessárias à formação de profissionais de saúde capazes de uma atuação mais empática, sensível e humanizada. Para contribuir com esse cenário, o presente estudo teve por objetivo discutir os sentidos sobre o adoecimento pelo câncer a partir da análise do filme Aquarius. Os sentidos predominantes neste filme referem-se ao câncer como uma invasão do corpo sadio e como roubo de algo importante ao sujeito. As temáticas da sexualidade e do protagonismo feminino entrelaçam-se na costura de um filme que metaforiza o câncer em suas múltiplas representações sociais, abrindo espaço para o sentido de potência, rompendo com estereótipos negativos predominantes nas demais linguagens

Film language is an important resource for health teaching-learning. Discussions on cancer and its illness process have used several movies to trigger reflections necessary for a more empathic, sensitive and humanized health care performance. Seeking to contribute to this scenario, this study investigates the meanings around cancer mobilized by the movie Aquarius. The narrative portrays cancer as an invasion against the healthy body and as theft of one's life. Sexuality and female empowerment are intertwined in this film that metaphorizes cancer in its multiple social representations, opening up space for a sense of power and breaking with negative stereotypes prevalent in other languages

Le langage cinématographique est une ressource importante pour l'enseignement et l'apprentissage dans le domaine de la santé. Les discussions sur le cancer et sont processus de maladie ont utilisés plusieurs films pour déclencher les réflexions nécessaires à une performance professionnelle plus empathique, sensible et humanisée. Cherchant à contribuer à ce scénario, cette étude examine les significations au tour du cancer mobilisées par le film Aquarius. Le récit dépeint le cancer comme une invasion du corps sain et comme le vol de la vie. La sexualité et le protagonisme féminin sont entrelacés dans ce film qui métaphorise le cancer dans ses multiples représentations sociales, ouvrant un espace pour un sentiment de pouvoir et rompant avec les stéréotypes négatifs prévalant dans d'autres langues

El lenguaje cinematográfico es un recurso importante para la enseñanza-aprendizaje en el campo de la salud. Para trabajar sobre el tema del cáncer, se han utilizado de películas como desencadenantes de reflexiones necesarias para la formación de profesionales de la salud capaces de un desempeño más sensible y humanizado. Para contribuir a este escenario, el presente estudio tuvo como objetivo discutir los significados sobre el cáncer con base en el análisis de la película Aquarius. Los significados predominantes en esta película se refieren al cáncer como una invasión del cuerpo y como el robo de algo importante para el sujeto. Los temas de la sexualidad y el protagonismo femenino se entrelazan en la creación de una película que metaforiza el cáncer en sus múltiples representaciones sociales, abriendo espacio para la sensación de poder, rompiendo con los estereotipos negativos que prevalecen en otros idiomas

[Sexuality in the cognitive-behavioral unit]. / La sexualité en unité cognitive et comportementale.

Sexuality in geriatrics poses ethical dilemmas, particularly for patients with cognitive disorders. What is the place of consent, presumption of competence and caregiver responsibility? A tool structuring these questions has facilitated collective decisions in the cognitive-behavioral unit to ensure respectful support for intimate relationships between patients. Ongoing reflection remains essential for optimal care.

Mythological Underpinnings of Feminine Development.

In the manner of Oedipus Rex, the myth of Myrrha-a story about a daughter's initiation of sex with her father-promises to divulge insights about feminine development. Given parallels between these two myths, the author asks why Jung identified Electra rather than Myrrha as the feminine counterpart to Oedipus, and revisits Freud's and Jung's differing interpretations of the incest theme in personality development. To break open the metaphor of Myrrha's incest, the author analyzes a similar account of incest in the Old Testament story of Lot and his wife and finds that they share a theme of female bitterness related to wounding of the mother and its arresting effect on the daughter's maturation. The article then considers the Demeter-Persephone myth, a tale not of incest but rape in Persephone's initiation into womanhood. In contrast to Myrrha, Persephone's development unfolds with strong maternal support tempered by the opposing claims on her by the masculine. The article draws these stories together to illuminate the archetypal forces that drive feminine development as well as the human affairs that resist and complicate them. The article concludes with a case study of a client whose developmental "stuckness" follows the contours of the Myrrha myth.

À la manière d'Oedipe Roi, le mythe de Myrrha, une histoire sur l'initiation sexuelle d'une fille avec son père promet de divulguer des éclairages concernant le développement féminin. Compte tenu des parallèles entre ces deux mythes, l'auteur se demande pourquoi Jung a identifié Électre plutôt que Myrrha comme la contrepartie féminine d'Œdipe. Il revisite les interprétations différentes de Freud et Jung sur le thème de l'inceste dans le développement de la personnalité. Pour ouvrir la métaphore de l'inceste de Myrrha, l'auteur analyse un récit similaire d'inceste dans l'histoire de Lot et de sa femme dans l'Ancien Testament et constate qu'ils ont en commun le thème de l'amertume féminine lié à la blessure de la mère et à son effet saisissant sur la maturation de la fille. L'article examine ensuite le mythe de Déméter-Perséphone, qui est non pas une histoire d'inceste mais de viol dans l'initiation de Perséphone à la féminité. Contrairement à Myrrha, le développement de Perséphone se déroule avec un fort soutien maternel tempéré par les revendications que le masculin lui oppose. L'article rassemble ces histoires pour éclairer les forces archétypales qui animent le développement féminin ainsi que les affaires humaines qui y résistent et les compliquent. L'article se termine par l'étude d'un cas clinique dont le « blocage ¼ développemental suit les contours du mythe de Myrrha.

A la manera de Edipo Rey, el mito de Mirra, una historia sobre la iniciación sexual de una hija con su padre, promete divulgar conocimientos sobre el desarrollo de lo femenino. Dados los paralelismos entre estos dos mitos, la autora se pregunta por qué Jung identificó a Electra en lugar de Mirra como la contrapartida femenina de Edipo y revisa las diferentes interpretaciones de Freud y Jung sobre el tema del incesto en el desarrollo de la personalidad. Para desentrañar la metáfora del incesto de Mirra, la autora analiza un relato similar de incesto en la historia de Lot y su esposa en el Antiguo Testamento y descubre que comparten el tema de la amargura femenina relacionada con la herida de la madre y su efecto paralizante en la maduración de la hija. A continuación, el artículo examina el mito de Deméter-Perséfone, una historia, no de incesto sino de violación, en la iniciación de Perséfone a la femineidad. A diferencia de Mirra, el desarrollo de Perséfone se desarrolla con un fuerte apoyo materno atenuado por las pretensiones opuestas de lo masculino sobre ella. El artículo reúne estas historias para iluminar las fuerzas arquetípicas que impulsan el desarrollo de lo femenino, así como los asuntos humanos que se resisten a ellas y las complican. El artículo concluye con un estudio de caso de una clienta cuyo "estancamiento" en su desarrollo sigue los devenires del mito de Mirra.

[Genital gender affirming surgery in trans women: Vulvo-vaginoplasty review]. / Chirurgie génitale d'affirmation de genre pour les femmes trans : revue des vulvo-vaginoplasties.

INTRODUCTION: A trans woman is a woman who was assigned male at birth, and who has a female gender identity. The majority are requesting a gender affirming genital surgery by vulvo-vaginoplasty. The objective is to review this surgery based on its history, then by presenting the different surgical techniques and their success and complication rates. MATERIAL AND METHODS: A narrative review was performed, based on a bibliography search with keywords from 2000 to 2022 on Pubmed. RESULTS: Vulvo-vaginoplasty for trans women began in 1931, and the first case series date from 1969. The procedure includes excision of scrotal skin, orchiectomy, clitoroplasty, urethroplasty, labioplasty, recto-vesico-prostatic dissection and creation of a vaginal cavity (performed by penile skin inversion and graft, intestine, or peritoneum). Vulvo-vaginoplasty by penile skin inversion (VPPI) is today the reference surgical technique. It represents the vast majority of surgeries performed with the longest follow-up. The majority of trans women are satisfied with the procedure aesthetically (90%) and functionally (80%), with an active sexuality. Major complications are rare (< 5%), they correspond to fistulas or vaginal stenosis. CONCLUSION: VPPI is the gold standard technique with satisfactory overall results, but long-term follow-up is requested.

[Adolescence and identity peregrinations]. / Adolescence et pérégrinations identitaires.

When we work with children and teenagers, we are always open to their singular questions about their subjective foundations and their future. Questions of identity are increasingly present at the heart of our fast-paced modern world. Two clinical extracts from psychotherapies show that this quest for identity is dealt with on a case-by-case basis, while respecting each individual's temporality.

[Photobiomodulation and vulvovaginal disorders after anticancer treatments]. / Photobiomodulation et troubles vulvovaginaux après traitements anticancéreux.

Anticancer treatments induce vulvovaginal complications that alter the quality of life and sexuality of patients. New technologies, such as photobiomodulation, could address this problem, for which few effective therapeutic solutions exist. The objective of this study was to describe the characteristics of patients seeking treatment and to observe the effects of photobiomodulation. This is a prospective cohort of patients treated for cancer, in failure of first-line medical treatment, managed at the University Hospital of Nîmes. The history, symptoms and impact of the disorders on their quality of life were collected. At follow-up, improvement was assessed using the PGI-I and FSFI questionnaires. Twenty-eight patients were treated. They were all menopausal, half of them after anticancer treatments [chemotherapy (78%), radiotherapy (36%), hormone therapy (36%)]. The main symptom reported was vaginal dryness (72%). Seventy-one percent of patients (n=20) felt that their daily life was affected≥8/10. All patients had sexual dysfunction. Twenty-two patients received at least 6 sessions of photobiomodulation. Seventy-two percent (n=18) of patients felt better or much better after treatment (PGI-I≤2). The median improvement estimated by the patients was 65% (Q1=50%; Q3=72.5%). There was also a significant clinical improvement. No serious adverse events were reported. Due to the small number of patients in a heterogeneous population with no control group, we cannot extrapolate our results. However, the objective was to assess the status of these pathologies and the contribution of photobiomodulation in patients who have failed first-line treatment; and these results are encouraging.

[Contraceptive Counseling: The Medical Toolbox Must Include the Full Range of Reversible Contraceptive Methods Also for Adolescent Women]. / Kontrazeptionsberatung: Die ärztliche Toolbox muss auch für Adoleszentinnen das gesamte Spektrum der reversiblen Verhütungsmethoden beinhalten.

Contraceptive Counseling: The Medical Toolbox Must Include the Full Range of Reversible Contraceptive Methods Also for Adolescent Women Abstract. When counselling adolescents, empathy and age-appropriate information on medical confidentiality are important. Addressing individual needs and wishes enables the targeted use of the necessary information and resources and is the best guarantee for successful contraception over time. The goal is to make informed decisions and to have a positive experience of successfully protected sexual and reproductive health. The range of suitable contraceptive options is very broad. To make the most of this potential, all methods should be addressed with their advantages and disadvantages, including information on sexually transmitted infections and protection against them. Concerns and questions should be answered comprehensively and openly, and the experiences with sexuality described should be approached without prejudice. Often this is also an opportunity to talk about experienced situations of sexual assault.

[Why (and how) to think of care beyond the sexuation of bodies]. / Pourquoi (et comment) penser le soin au-delà de la sexuation des corps.

More and more young people identify as transgender or non-binary today. This can be attributed to the increased availability of vocabulary regarding gender as well as the diverse representations of trans and non-binary people in media and on social networking sites. However, medical or educational institutions are slow to change and many trans individuals still feel uncomfortable in the presence of health care providers, regardless of their specialty.

Corpo feminino e sexualidade: gordura, feiura e exclusão social / Female body and sexuality: fatness, ugliness and social exclusion / Corps féminin et sexualité: graisse, laideur et exclusion sociale

O presente artigo busca investigar o lugar do corpo na atualidade, uma vez que ele nunca é totalmente apreendido pelos dispositivos culturais que possibilitem sua submissão completa às expectativas sociais. Neste sentido, é legítimo afirmar haver certa dificuldade epistêmica, no que tange às disputas de narrativas em torno do corpo gordo. Culturalmente legitimado, observamos um discurso dominante que sugere a responsabilização do sujeito por sua condição corporal. De modo análogo, a criminalização da gordura aumenta quando a sobrepomos à questão de gênero, conforme ilustrarão algumas vinhetas; fruto de entrevistas realizadas anteriormente pela autora, na pesquisa que desenvolve sobre corpo feminino, imagem, sofrimento psíquico e regulação social. A "feiura" ou o "estranho", muitas vezes poderão ser tomados como uma mensagem, cuja força reside, justamente, na sua surpreendente apresentação. Neste sentido, as práticas corporais podem ser compreendidas em um cenário de indiferenciação, na estetização da vida cotidiana, de sujeição ao discurso do outro, mas também, como uma contestação, como problematização do estatuto do corpo na contemporaneidade.

This article seeks to investigate the place of the body nowadays, since it is never fully apprehended by cultural devices that allow its complete submission to social expectations. In this sense, it is legitimate to affirm that there is some epistemic difficulty, regarding the disputes of narratives around the fat body. Culturally legitimized, we observe a dominant discourse that suggests the responsibility of the subject for body condition. Similarly, the criminalization of fat increases when we overwrite it the issue of gender, as some vignettes will illustrate; the result of interviews previously conducted by the author, in the research she develops on the female body, image, psychic suffering and social regulation. The "ugliness" or the "strange" can often be taken as a message, whose strength lies precisely in its surprising presentation. In this sense, body practices can be understood in a scenario of indifferentiation, in the instantiation of everyday life, of subjection to the discourse of the other, but also, as a contestation, as a problematization of the body's status in contemporaneity.

Cet article cherche à étudier la place du corps de nos jours, car il n'est jamais complètement appréhendé par des dispositifs culturels qui permettent sa soumission complète aux attentes sociales. En ce sens, il est légitime d'affirmer qu'il existe une certaine difficulté épistémique, en ce qui concerne les disputes de récits autour du corps gras. Culturellement légitimé, nous observons un discours dominant qui suggère la responsabilité du sujet pour son état corporel. De même, la criminalisation des graisses augmente lorsque nous écrasons la question du genre, comme certaines vignettes l'illustreront; le résultat d'entretiens précédemment menés par l'auteure, dans la recherche qu'elle développe sur le corps féminin, l'image, la souffrance psychique et la régulation sociale. La «laideur¼ ou l'«étrange¼ peut souvent être prise comme un message, dont la force réside précisément dans sa présentation surprenante. En ce sens, les pratiques corporelles peuvent être comprises dans un scénario d'indifférenciation, dans l'estantiation de la vie quotidienne, de soumission au discours de l'autre, mais aussi, comme contestation, comme problématisation du statut du corps dans la contemporanéité.

[Disability, a factor of vulnerability to incest]. / Le handicap, un facteur de vulnérabilité face à l'inceste.

Disability, a factor of vulnerability to incestThere is a lack of visibility on the issue of sexual violence among people with disabilities. There is an omerta on this subject within the social and medico-social establishments that receive them. Intra-family sexual violence is kept silent, as it is everywhere else. The vulnerability of children with disabilities is a risk factor for rape and sexual assault, and communication problems hinder their disclosure. Interview with Marie Rabatel, President of the Francophone Association of Autistic Women, expert of the High Authority of Health on the issues of violence against women with disabilities, member of the Independent Commission on incest and sexual violence against children.

A metodologia topológica freudiana: elementos introdutórios / The freudian topological methodology: introductory elements / La méthodologie topologique freudienne: éléments préliminaires

Pretende-se evidenciar uma questão que tem sido pouco explorada: a existência de uma lógica dos lugares na obra freudiana, a que seria possível chamar de metodologia topológica freudiana. Espera-se contribuir com a exposição dos elementos introdutórios à compreensão das raízes, da constituição e dos desdobramentos do emprego de tal metodologia por Freud. Adota-se, para tanto, o seguinte encaminhamento: o discernimento da noção de invariante como categoria topológica e sua presença no percurso freudiano, o entrelaçamento dos invariantes com a metapsicologia freudiana, bem como a sua concepção psicopatológica, e, destas, com a sexualidade. Depreende-se que o discernimento de tais elementos é fundamental tanto para a compreensão do recurso singular à topologia por Lacan, como para o entrecruzamento entre a experiência psicanalítica, sua formalização teórica e sua transmissão

It is intended to highlight an underexplored issue: the existence of a logic of locations in Freud's work, which could be called Freudian topological methodology. It is expected to contribute with the exposition of introductory elements to the understanding of the roots, constitution and consequences of the use of such methodology by Freud. For this purpose, the following procedure is adopted: the discernment of the notion of invariant as a topological category and its presence in the Freudian path, the interweaving of the invariants with Freudian metapsychology and its psychopathological conception, and, of these, with sexuality. It appears that the discernment of such elements is fundamental both for understanding Lacan's unique resource to topology, and for the intercrossing between the psychoanalytic experience, its theoretical formalization and its transmission

On cherche à mettre en évidence une question qui a été peu étudiée : l'existence d'une logique des lieux dans l'œuvre freudienne, que l'on pourrait appeler la méthodologie topologique freudienne. En exposant ces éléments préliminaires, on espère contribuer à une meilleure compréhension des racines de cette méthodologie, de ses implications et de la manière dont Freud l'a utilisée. À cet effet, on adopte le cheminement suivant : le discernement de la notion d'invariant comme catégorie topologique et sa présence dans le parcours freudien, l'entrelacement des invariants avec la métapsychologie freudienne et sa conception psychopathologique, et de ces premiers et ces dernières avec la sexualité. Il en ressort que le fait de discerner ces éléments est fondamental, aussi bien pour la compréhension de la manière singulière dont Lacan a eu recours à cette topologie, que pour l'entrecroisement de l'expérience psychanalytique, de sa formalisation théorique et de sa transmission

[The right of elderly people in old people's homes to have a fulfilling emotional and sexual life]. / Du droit des personnes âgées en Ehpad à avoir une vie affective et sexuelle épanouie.

The sexual life of elderly people living in residential institutions for the dependent elderly (Ehpad) is a sensitive subject that is rarely discussed. Particular difficulties sometimes arise when they have cognitive problems. Affectivity and sexuality in old people's homes must be approached with tact and maturity by the carers. Sexuality belongs to private life, but its excesses are difficult to reconcile with collective life. Some proposals can be made on ethical issues and on the relationship with residents and their families.

[Addressing the impact of cancer on reproductive and erotic sexuality]. / Aborder l'impact du cancer sur la sexualité reproductive et érotique.

The impact of oncological treatments on the sexual health of the individual is major. Reproductive and erotic sexuality may be altered. Prescriptions, of which the consequences are now well known, must be considered in the light of the patient's life plan. Multidisciplinary consultation meetings and individual or couple consultations are propticious places to discuss and make balanced decisions.

[Sexuality assessment of homozygous adult sickle cell patients with a history of priapism in Senegal]. / Évaluation de la sexualité des drépanocytaires adultes homozygotes ayant des antécédents de priapisme au Sénégal.

OBJECTIVES: The objective of this study was to evaluate the sexuality of SS sickle cell patients with a history of priapism. METHODS: This was a case-control study of adult SS sickle cell patients. The occurrence of priapism as well as the nature of the priapism had been investigated. The patients were subdivided into three groups: Group 1 (no priapism), Group 2 (intermittent priapism) and Group 3 (acute priapism). The patients' sexuality was studied using the IIEF-15 questionnaire. RESULTS: We interviewed 191 SS sickle cell patients. The mean age was 27.1±7.1 years. Priapism was observed in 43.5 %. Only 77 patients were eligible for the IIEF15 questionnaire. Groups 1 and 2 performed significantly better than group 3 on erectile function (EF) and orgasmic function (OF) scores. There was no significant difference in the EF and OF scores between groups 1 and 2. No significant difference was observed between the three groups for the scores of sexual desire (SD), intercourse satisfaction (IS), and overall satisfaction (OS). The impairment of erectile function in group 2 was related to the age of the first episode of priapism and the last episode. The impairment of erectile function in group 3 was related to the duration of evolution (P<0.05). CONCLUSION: This study shows that priapism is responsible for impaired erectile function in SS adult sickle cell patients. A program to prevent intermittent episodes of priapism should be put in place.