G. Jonker-Pool

Sexual functioning after treatment for testicular cancer - Review and meta-analysis of 36 empirical studies between 1975-2000

Literature concerning sexual functioning after treatment for testicular cancer from 1975–2000 is reviewed. After a literature search in Medline and Psylit was conducted, as well as a search for cross-references made, a meta-analysis was performed. To describe sexual functioning, several aspects of the sexual response cycle were used: sexual desire, sexual arousal, erection, and orgasm; ejaculatory function, sexual activity, and sexual satisfaction were used as well. The number of patients included in the studies as well as treatment modalities were taken into account. A total of 36 relevant studies was screened (28 retrospective and 7 prospective studies), concerning 2,786 cases of testicular cancer. Meta-analysis revealed that ejaculatory dysfunction was reported most frequently and was related to surgery in the retroperitoneal area. Erectile dysfunction was related to irradiation, but was reported least frequently. Other sexual functions were not related to treatment modality. Meta-analysis revealed no deterioration of sexual functioning in the course of time, except a decrease in sexual desire and an increase in sexual satisfaction. Retrospective studies reported more sexual dysfunction than did prospective studies. Detailed analysis of separate studies, however, revealed a wide variation in reported sexual morbidity, as well as in assessment methods. Somatic consequences of disease and treatment may reduce ejaculation; however, other aspects of sexual functioning are not clearly related to disease- or treatment-related factors and may instead refer to a psychological vulnerability caused by ones confrontation with a life-threatening, genito-urinary disease, such as testicular cancer.

Sexual functioning after treatment for testicular cancer

This retrospective study evaluates changes in sexual functioning after treatment for testicular cancer and investigates whether there is a relationship with different treatment modalities.

Male sexuality after cancer treatment - needs for information and support : testicular cancer compared to malignant lymphoma

Testicular cancer (TC) as well as malignant lymphoma (ML), both have nowadays an excellent prognosis. However, both types of cancer may be diagnosed at young adulthood and patients may experience sexual concerns. In this article the need for information and support concerning sexuality will be explored, and the traumatic impact of cancer diagnosis with respect to this will be considered. A total of 264 patients with testicular cancer, median age 36 (S.D. 9.7) years, and 50 patients with malignant lymphoma, median age 42 (S.D. 11.7) years returned a questionnaire concerning sexual functioning; four items assessed the need for information or support concerning sexuality, at diagnosis and at follow-up. It appeared that more than half of the patients with testicular cancer reported a lack of information and support concerning sexuality during treatment; 67% of them still had a need for information at follow-up. These rates were significantly lower for patients with malignant lymphoma. Especially patients with testicular cancer who suffered sexual dysfunction reported extremely high needs for information and support. According to these findings it can be concluded that more attention should be paid to the doctor-patient communication with respect to sexual concerns in general, and especially where it concerns patients with testicular cancer.

Sexual dysfunction in nonseminoma testicular cancer patients is related to chemotherapy-induced angiopathy.

PURPOSE To establish the prevalence of sexual dysfunctions after different treatment modalities for nonseminomatous testicular germ cell tumor (NSTGCT) and to investigate whether treatment-induced angiopathy and neuropathy is related to sexual dysfunction. PATIENTS AND METHODS A questionnaire assessing sexual dysfunction was sent to 255 NSTGCT survivors. Polychemotherapy (PCT) regimens (cisplatin, vinblastine, and bleomycin [PVB], vinblastine substituted by etoposide [BEP], or cisplatin substituted by carboplatin [CEB], etoposide combined with cisplatin [EP], or with ifosfamide and cisplatin [VIP] were compared regarding treatment-induced angiopathy and neuropathy. Sexual dysfunctions were related to Raynauds phenomenon and acral paresthesia. RESULTS Among the 215 responders, 56 (26%) had been treated by orchidectomy and surveillance, 42 (19.6%) by PCT, and 117 (54.4%) by PCT and resection of residual retroperitoneal tumor mass (RRRTM). Overall, loss of libido was reported by 19.1%, decreased arousal by 11.2%, erectile dysfunction by 12.1%, decreased intensity of orgasm by 20%, and ejaculatory problems by 28%. Patients treated with PVB suffered more often from Raynauds phenomenon compared with those treated with other regimens (40.4% v 29%; P < .05) and from paresthesia (31.6% v 14.7%; P < .05). Patients with Raynauds phenomenon had more often erectile dysfunction (28.8%) compared with those without (8.4%) (P < .05). CONCLUSION Compared with orchidectomy alone, PCT, with or without RRRTM, induced more often posttreatment sexual dysfunction. Compared with other chemotherapeutic regimens, signs of angiopathy and neuropathy were most prevalent in those treated with PVB. Erectile dysfunction was related to the chemotherapy-induced Raynauds phenomenon but not to acral paresthesia.

The sexual sequelae of testicular cancer.

Malignant tumours of the thestis are mainly found in the third and fourth decade of life, a period in wich most men are highly sexually active. Although post-treatment sexual funtioning is a very relevant aspect of the quality of life, only a very small amount of information is available about the sexual sequelae of the current therapies for testicular cancer. In this thesis, the impact of the different treatment modalities on organ systems important for normal sexual functioning was studied. ... Zie: Summary

Sexual functioning after multimodality treatment for disseminated nonseminomatous testicular germ cell tumor

PURPOSE We determined sexual functioning after chemotherapy for disseminated nonseminomatous testicular germ cell tumor, and evaluated the impact of resection of post-chemotherapy residual retroperitoneal tumor. MATERIALS AND METHODS A total of 155 consecutive patients treated with chemotherapy for disseminated nonseminomatous testicular germ cell tumor (between 1980 and 1994) was questioned about their sexual functioning. The patients were divided in 2 subgroups: patients treated with or without resection of post-chemotherapy residual retroperitoneal tumor. Volume and location (divided into left para-aortal or right paracaval/interaortacaval) of the resected tumor were related to absence of ejaculation as well as decreased semen amount. In addition, libido, arousal, erection and orgasm were related to ejaculatory dysfunction. RESULTS A total of 43 patients (27.7%) was treated with chemotherapy only and 112 (72.3%) had additional resection of post-chemotherapy residual retroperitoneal tumor mass. Overall, 22.4% reported loss of libido, 14.1% decreased arousal, 16% erectile dysfunction, 23.1% decreased orgasmic intensity, 17.4% decreased semen amount and 18.7% complete absence of antegrade ejaculation. With exception of absence of ejaculation, sexual dysfunctions were reported in similar frequencies in both treatment subgroups. In the resection of post-chemotherapy residual retroperitoneal tumor subgroup, 25.9% of the patients had complete absence of ejaculation. The other sexual dysfunctions were related neither to decreased semen amount nor to complete absence of ejaculation. The mean volume of resected tumor was higher (95 cm.3) in patients with absence of ejaculation than in those without (40 cm.3), and patients with right paracaval/interaortacaval tumor (20 of 58, 34.5%) reported more often absence of ejaculation than those with left para-aortal tumor (9 of 54, 16.7%). CONCLUSIONS In patients treated for disseminated nonseminomatous testicular germ cell tumor, post-chemotherapy sexual morbidity cannot be neglected. Except for loss of antegrade ejaculation, sexual dysfunctions are not related to resection of post-chemotherapy residual retroperitoneal mass. A high volume of tumor and a right paracaval/interaortacaval location predispose to loss of antegrade ejaculation.

Uitgespeeld. Een casus over testiskanker : seksuele gevolgen en emotionele verwerking

Dit artikel beschrijft hoe de confrontatie met kanker een verstoring van verschillende levensgebieden kan betekenen. Kanker is een veel voorkomende ziekte: 30% van de vrouwen en 40% van de mannen worden er in de loop van hun leven door getroffen. Aan de hand van een gevalsbeschrijving worden psychotherapeutische interventies geïllustreerd. De patiënt heeft testiskanker gehad, een vorm van kanker die mannen meestal in de kracht van hun leven treft: tussen de 20 en 40 jaar. Hoewel de prognose gunstig is (90% geneest), is de medische behandeling ingrijpend en kan deze leiden tot verminking en fysieke beperkingen, zoals vermoeidheid en geringe neurologische problemen. Verder blijkt uit onderzoek in Nederland dat 30 tot 40% van de patiënten seksuele problemen ervaart. In de gevalsbeschrijving zijn seksuele problemen de aanleiding om hulp te zoeken, maar andere levensgebieden komen eveneens aan bod in het psycho-oncologische therapeutische proces: aanpassing aan de storende fysieke en seksuele beperkingen, de psychotraumatische effecten van de diagnose kanker en de behandeling ervan, de rol van eerdere levensgebeurtenissen, verstoring van de ‘normale’ volwassen ontwikkelingsfase, het evenwicht in de partnerrelatie en existentiële vragen. Tot slot worden het belang van integratieve psychotherapie en de rol van de houding van de therapeut aangaande ziekte, leven en dood besproken.AbstractWhatever view we hold, it must be shownWhy every lover has a wish to makeSome other kind of otherness his own:Perhaps, in fact, we never are alone.(W.H. Auden, 1967)