van de Harry Wiel

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.

Psychosexual functioning after treatment for gynecological cancer: an integrative model, review of determinant factors and clinical guidelines

This review summarizes investigations dealing with the sexual functioning of women with gynecological cancer. A critical review of methods of investigation and results is presented and an outline for future research. The literature review is preceded by a short theoretical introduction on cancer and sexual behavior relevant to the conceptualization and assessment of sexual functioning under these circumstances. The review is concluded by some guidelines to help patients and partners cope with sexual problems after treatment of gynecological 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.

Sexuality, Intimacy, and Gynecological Cancer

On a psychological level, not all changes in sexual functioning following gynecological cancer treatment automatically lead to sexual problems or dysfunctions. Whether sexual dissatisfaction occurs will also depend on personal factors, social factors, and the context in which these negative changes occur.This article has been retracted.

What Importance Do Women Attribute to the Size of the Penis

OBJECTIVE A great deal of men consider that the size of the penis is directly proportional to its sexual power. Some men, who are worried that their penis is too small, wish to be considered for surgical lengthening or thickening procedures. The argumentation for this chiefly points in the direction of women. However, have women actually been asked about the extent to which they consider the size of the penis to be of importance from a sexual point of view? Or asked what they think about ideas surrounding the size of the penis in relation with actual sexual functioning? PATIENTS AND METHODS To address these questions, 375 sexually active women who had recently given birth at the University Hospital Groningen were asked a number of questions about sexual functioning and the importance they attach to the size of their partners penis. RESULTS A total of 170 questionnaires were returned (response rate 45%); 20% of the women found the length of the penis important and 1% very important; 55% and 22% of the women found the length of the penis unimportant and totally unimportant, respectively. Opinions about the girth of the penis followed the same trend. Length was less important than girth: 21% and 32%, respectively. The women who found the girth of the penis important had the same opinion about the length of the penis (correlation 0.71, p=-0.001). Median division into two subgroups (girth important/unimportant; t-test) did not reveal any significant differences in relation with demographic data. Correlation analysis did not reveal any significant correlation between sexual functioning (measured with the NSF) and opinions about the girth of the penis. CONCLUSION Although clearly in the minority, a nevertheless considerable percentage of the women respondents attached substantial importance to the size of the male sexual organ.

Objective and subjective effects of treatment for testicular cancer on sexual function

 To determine whether the treatment of patients with testicular cancer, using cisplatin combined with etoposide and bleomycin (BEP) after orchidectomy in those with disseminated disease, causes changes in sex hormones and penile vascularization, possibly related to sexual dysfunction.

Psychological assessment of patients with Meniere's disease

The objective of this study was to evaluate daily stressors, coping, personality, physical and mental health, and quality of life in Menière patients. 110 consecutive patients with definite Menières disease were assessed using the Dutch Daily Hassles List, Coping Inventory for Stressful Situations (CISS), Symptoms Checklist 90 (SCL-90), NEO Five Factor Inventory (NEO-FFI), General Health Questionnaire (GHQ-12), and the Short Form Health Survey 36 (SF-36). Duration and subjective severity of symptoms were scored using a self-report questionnaire. It was shown that Menière patients had more daily stressors, used certain coping strategies less often, and had more psychopathology (e.g. anxiety and depression), and a worse quality of life compared to healthy reference groups. No abnormalities in personality were found. Patients with more severe symptoms had more psychopathology and a worse quality of life than patients with mild symptoms. The psychological profile of Menière patients seems comparable to patients with other chronic diseases. The outcomes should be used to intensify psychological support in patients with this disabling disease. Sumario El objetivo de este estudio fue evaluar los factores de estrés cotidiano, la capacidad de manejo de problemas, personalidad, salud física y mental, y calidad de vida en pacientes con Menière. Se evaluaron 110 pacientes con enfermedad de Menière confirmada utilizando la Lista Holandesa de Problemas Diarios, el Inventario de Manejo de Situaciones Tensinógenas (CISS), el Listado 90 de Síntomas (SCL-90), el Inventario NEO de Cinco Factores (NEO-FFI), el Cuestionario General de Salud (GHQ-12) y la Encuesta de Salud de Fórmula Corta 36 (SF-36). Se anotó la duración y la severidad relativa de los síntomas usando un cuestionario de auto-reporte. Se mostró que los pacientes con Menière tenían más factores cotidianos de estrés, utilizaban menos a menudo ciertas estrategias para enfrentar dificultades, y tenían más psico-patología (p.e., ansiedad y depresión) y una peor calidad de vida que los grupos saludables de referencia. No se encontraron anormalidades de personalidad. Los pacientes con síntomas más severos tenían más psico-patología y peor calidad de vida que los pacientes con síntomas leves. El perfil psicológico de los pacientes con Menière parece comparable el de pacientes con otras enfermedades crónicas. Los resultados pueden utilizarse para intensificar el apoyo psicológico a los pacientes con esta enfermedad tan discapacitante.

SEXUAL CONTACT IN THE DOCTOR-PATIENT-RELATIONSHIP IN THE NETHERLANDS

OBJECTIVE--To obtain data on sexual contact between doctors and their patients. DESIGN--Anonymous questionnaire with 17 items sent to all working gynaecologists (n = 595) and all ear, nose, and throat specialists (n = 380) in the Netherlands. RESULTS--Response rate was 74%; a total 64 doctors gave a reason for not completing the questionnaire. 201 (59%) male gynaecologists and 128 (56%) male ear nose, and throat specialists indicated that sexual feelings are acceptable in the doctor-patient relationship; 286 (85%) and 186 (81%), respectively, had felt sexually attracted to a patient at some time, as had 14 (27%) female gynaecologists. More than half (59%) of the doctors who indicated that sexual feelings are unacceptable in the doctor-patient relationship had experienced these feelings, and 91% of this group had a negative attitude towards these feelings. 4% of respondents in each group had had actual sexual contact with patients. Most gynaecologists were in favour of having more attention paid to sexual problems during training; having their professional society take an official viewpoint; subsequent public support of this viewpoint; and taking on an impartial counsellor for the patients as well as the doctors. CONCLUSION--Sexuality exists in the doctor-patient relationship. Gynaecologists have a higher risk of having sexual contact with their patients than do ear, nose, and throat specialists but compensate for this greater risk by a higher state of recognition and acknowledgement.

Treatment of vaginismus: A review of concepts and treatment modalities

In this study, the literature on the concept of vaginismus is reviewed as well as existing ideas about etiology and treatment. The review reveals that consensus only exists on the physiological aspects of vaginismus, whereas a great variety of ideas and opinions are used with regard to the etiology and treatment of this sexual problem. The most recent approaches are the psychoanalytical view, the behavioristic view, the interactional view and the sociocultural view. The study also comprises a review of the Anglo-Saxon literature on the outcome of treatment of vaginismus. Over the last three decades, 37 studies have been published: 17 case studies and 20 survey studies. The review makes it clear that vaginismus is usually treated successfully and that the kind of treatment does not seem to play an important role in this. All treatment modalities report a success rate of about 80%. Differences, however, do exist regarding the therapeutic goals and cost-benefit ratios. Before drawing any firm conclusions, it...

Sexual rehabilitation of radical vulvectomy patients

Ten women, who had undergone radical vulvectomy for cancer of the vulva, and their partners were interviewed on average nearly 2 years after the operation. In spite of many problems 8 out of 10 couples accomplished complete or partial sexual rehabilitation. For two couples only there seemed to be no return to sexual activity. The authors conclude that sexual rehabilitation after radical vulvectomy may be expected. But, sufficient information, sufficient coping, and sufficient communication does not guarantee complete sexual rehabilitation. It is suggested that motivation for sexual expression and mutual affection might be more important for sexual rehabilitation than any physical restrictions imposed by the surgery.