Quality of Life Following Prostatectomy as a Function of Surgery Type and Degree of Nerve Sparing.

OBJECTIVES: To compare robotic-assisted laparoscopic prostatectomy with conventional retropubic radical prostatectomy in maintaining pre-surgery levels of urinary and sexual functioning and to evaluate the efficacy of nerve sparing in prostatectomies in protecting urinary functioning. MATERIAL AND METHODS: Patients (n = 385) receiving both surgical procedures were surveyed prior to surgery. Multiple measures, including the Expanded Prostate Cancer Index Composite, the Sexual Health Inventory for Men, and the International Prostate Symptom Score, assessed sexual and urinary function at an average of 12 months post-surgery. RESULTS: Across multiple measures, while controlling for pre-surgical sexual functioning, robotic-assisted surgery did not offer an advantage in maintaining sexual or urinary function an average of a year following the prostatectomy. Bilateral nerve sparing offered a strong and reliable advantage in the maintenance of sexual function, but not so regarding urinary function. CONCLUSION: While robotic-assisted prostatectomies may offer a number of medical advantages over open procedures, we found no significant effect on important quality of life outcomes associated with the technique.

Sexual Behavior, Definitions of Sex, and the Role of Self-Partner Context Among Lesbian, Gay, and Bisexual Adults.

Prior research has examined how heterosexual individuals define sex; however, these studies have rarely focused on sexual minority individuals or included a full range of applicable sexual behaviors. Participants were recruited from a local Pride Festival across two years. Study 1 (N = 329) was primarily descriptive and examined which physically intimate behaviors lesbian, gay, and bisexual (LGB) participants included in their definitions of sex and the behaviors in which they had previously engaged. Study 2 (N = 393) utilized a between-subjects design to assess differences in definitions of sex when judging one's own behavior compared with that of a partner outside of the relationship. The behaviors in which participants were most likely to have engaged were manual-genital (82%) and oral-genital stimulation (79%). Regarding definitions of sex, a clear "gold standard" emerged for men, with 90% endorsing penile-anal intercourse as sex. No equally clear standard existed for women. Participants who were asked to consider their partner's behavior outside of their relationship were more likely to endorse the behavior as "having sex" than participants asked to consider their own behavior. This study addressed a major limitation of prior research by investigating definitions of sex among a community sample of LGB adults, with implications for provision of health care and sexual agreements between same-sex couples.

Marital quality, depressive symptoms, and the metabolic syndrome: a couples structural model.

The indirect association of marital quality with metabolic syndrome (MetS) through depressive symptoms was examined in 301 middle-aged and older couples. MetS components (i.e., waist circumference, blood pressure, blood draws to assess triglycerides, HDL cholesterol, and fasting glucose) were assessed following a 12-h fast, and were treated as a continuous latent variable for analyses. In structural equation modeling of this indirect effect, overall model fit was good, and husbands' and wives' marital quality was associated with MetS only through depressive symptoms. Joint tests of the parameters indicated that gender did not moderate this association. The best fitting, most parsimonious model, after nested model comparisons, was one in which husbands' and wives' indirect paths were equated. Overall, marital quality was related to MetS through its relationship to depressive symptoms for men and women. Associations of marital quality and depression with MetS may overlap, and couple-based approaches to psychosocial risk factors for cardiovascular disease may be useful in future research.

How do heterosexual undergraduate students define having sex? A new approach to an old question.

This study examined how people define having sex utilizing a new approach to this area of research. A total of 267 men and 327 women rated their degree of confidence that engaging in each of 21 physically intimate behaviors (e.g., penile-vaginal intercourse) counted as "having sex" and then qualitatively explained their reasoning. Separate ratings were made for each behavior when engaged in by the respondent and by his or her partner with someone else. Results showed that, as in previous studies, for both sexes, some behaviors (e.g., penile-vaginal intercourse) were far more confidently rated (i.e., "definitely sex") than were others (e.g., oral-genital stimulation). Further, both men and women were significantly more certain that a behavior counted as "having sex" when considering their partner's behavior outside the relationship than when they considered their own behavior. Finally, the order in which the two scenarios (i.e., self versus partner) was presented significantly affected participants' certainty. Qualitative results, paired with quantitative findings, suggest that individuals consider a variety of contextual factors when making these definitional decisions. The methodological and sexual health implications of these results are discussed.

Addressing sexuality in youth with autism spectrum disorders: current pediatric practices and barriers.

OBJECTIVE: Research on adolescents and young adults with autism spectrum disorders (ASDs) has focused on promoting independence and optimizing quality of life, yet the areas of sexual development and sexuality has been largely neglected. The American Academy of Pediatrics encourages pediatricians to address sexuality issues in youth with disabilities to foster healthy development and minimize negative consequences. However, it is unclear to what extent pediatricians address sexuality issues in this population. METHODS: Two hundred three pediatricians who regularly care for youth with ASD completed an online survey about their experiences in providing sexuality-related care to families and youth with ASD. RESULTS: Respondents discussed an average of 10.9 of 26 sexuality topics with all families at least once during routine visits. Experience in caring for youth with ASD correlated positively with the number of sexuality-related topics discussed and with self-reported comfort discussing sexuality with parents of youth with ASD. The most common barriers to providing comprehensive sexuality-related care to youth with ASD included logistical barriers, pediatrician and parent discomfort, lack of training, and absence of information and materials to help pediatricians address sexuality in this population. CONCLUSIONS: Although most pediatricians acknowledged the importance of addressing sexuality-related issues with youth with ASD and their families, several important sexuality-related topics were rarely discussed due to a variety of perceived barriers. Implications and recommendations are discussed.