Policies, Guidelines, and Practices Supporting Women's Menstruation, Menstrual Disorders and Menopause at Work: A Critical Global Scoping Review.

(1) Objectives: This paper presents a scoping review of global evidence relating to interventions (i.e., policies, practices, guidelines, and legislation) aimed at supporting women to manage menstruation, menstrual disorders, and menopause at work. (2) Methods: Databases including Medline (Ebsco), CINAHL (Ebsco), Scopus, Web of Science, APA PsychInfo (Ebsco), Humanities International Complete (Ebsco), Academic Search Premier (Ebsco), HeinOnline and OSH Update, and Google Scholar were searched in May 2022. (3) Results: Of 1181 unique articles screened, 66 articles are included. Less half of the articles (42%, 28/66) presented/reviewed an intervention related to women's workplace health. A total of 55 out of the 66 articles are set across 13 countries with the remaining 12 articles described as multi-country studies or reviews. Half of the articles presenting/reviewing an intervention were grey literature, with several undertaken in UK and EU member countries. Interventions focusing on supporting women with menopause at work were the most common (43%, 12/28), followed by menstruation (25%, 7/28) and menstrual disorders (7%, 2/28). Across the reviewed articles, recommendations were categorised as adjustments to the physical work environment, information and training needs, and policy and processes. Few articles explicitly presented or affirmed a design-process and/or evaluation tied to their intervention. In lieu of design-process, this review categorises the rationales driving the development of an intervention as: pronatalist, economic rationalism, gendered occupational health concern, cultural shift towards gender equity objectives, and efforts to reduced shame and stigma. (4) Conclusions: There is a growing body of evidence aimed at understanding women's experiences of managing their menstrual and reproductive health in the workplace and how this impacts their work/career trajectories. However, little research is explicitly concerned with exploring or understanding interventions, including their design or evaluation. Most articles report menopause guidelines and are typically confined to the UK and EU-member countries. Despite the prevalence of menstrual disorders (e.g., endometriosis and polycystic ovarian syndrome (PCOS)) there is limited literature focused on how women might be supported to manage symptoms associated with these conditions at work. Accordingly, future policies should consider how women can be better supported to manage menstruation and menstrual disorders at work and recognise the importance of co-design during policy development and post-intervention evaluation. Further research needs to be undertaken on the impact of workplace policies on both employers and employees.

Unmet Needs of Australians in Endometriosis Research: A Qualitative Study of Research Priorities, Drivers, and Barriers to Participation in People with Endometriosis.

Background and Objectives: Endometriosis causes significant personal and societal burden. Despite this, research funding lags behind other chronic conditions. Determining where to prioritise these limited funds is therefore vital. Research priorities may also differ between individuals with endometriosis and clinicians/researchers. The aim of this research project is to explore research priorities and factors shaping participation in endometriosis research from the perspective of people with endometriosis in Australia. Materials and Methods: Four focus groups involving 30 people with endometriosis were conducted and analysed using qualitative inductive content analysis. Results: Two categories were developed from the data: unmet research needs and motivators and barriers to participation in endometriosis research. Participants expressed interest in developing non-invasive diagnostic tools and a more multidisciplinary or holistic approach to treatment. Participants urgently desired research on treatment options for symptom management, with many prioritising non-hormonal treatments, including medicinal cannabis and complementary medicine. Others prioritised research on the causes of endometriosis over research on treatments to assist with prevention and eventual cure of the disease. The main drivers for participating in endometriosis research were hope for symptom improvement and a reduction in time to diagnosis. Research design features that were important in supporting participation included ease of access to testing centres (e.g., for blood tests) and sharing test results and automated data collection reminders, with simple stra-tegies to record data measurements. Research incentives for younger people with endometriosis and a broad dissemination of information about research projects was considered likely to increase participant numbers. Barriers included time commitments, a lack of flexibility around research appointments for data collection, travel or work commitments, concerns about the safety of some products, and trying to conceive a child. Conclusions: People with endometriosis were open to participating in research they felt aligned with their needs, with a significant focus on diagnostic tools and symptom relief. However, researchers must co-design approaches to ensure convenience and flexibility for research participation.

Suitability of vocabulary assessments: Comparing child scores and parent perspectives on communicative inventories for Aboriginal families in Western Sydney.

Purpose: Standardised testing tools within an Aboriginal Australian context have been found to produce inaccurate results due to language and cultural differences. The primary aim of the study is to compare Aboriginal children's scores in urban NSW across two language assessment tools: the Early Language Inventory (ERLI) and the Australian English Communicative Development Inventory, short form (OZI-SF). These tools are vocabulary checklists for children aged approximately 12-30 months. OZI-SF is an Australian tool for mainstream use and ERLI has been developed with and for Aboriginal families, but not in urban contexts, so its suitability there is unknown, given the great cultural and linguistic diversity among Aboriginal people across Australia. The second aim is to identify which tool is more culturally appropriate for urban Aboriginal families through parent perspectives.Method: Overall, 30 parents (of 31 children) participated in the study to complete the ERLI, and 14 parents from this sample completed both the ERLI and OZI-SF and interviews to explore child scores and parent perspectives, in a mixed methods approach.Result: Aboriginal children (N = 14) scored higher on the ERLI than the OZI-SF. Gender and age were significant contributors to the scores as scores were higher for older children and higher for girls than boys. In answer to the second aim, four themes emerged to explain parental perspectives and their preference for the ERLI, which supported connection to culture and language.Conclusion: Findings have implications for paediatric language assessments with urban Aboriginal families in clinical, educational and research settings.

Viewpoint: Visibilising Care in the Academy: (Re)Performing Academic Mothering in the Transformative Moment of COVID-19.

The effects of COVID-19 have been profoundly felt across higher education as across broader society. In particular, the pandemic has revealed that many of our most stubbornly entrenched inequalities do not simply follow gendered fault lines, but rather care fault lines. In this article, we adopt a maternal epistemology and collaborative witnessing to outline the disruption that academic mothers have experienced during the pandemic. However, we argue that this disruption is not simply obstructive to academic mothers and other caregivers. Rather, COVID-19 has provided a potentially transformative moment for the visibility and normalisation of care in the academy. It has forced the complex negotiation of paid work and care work that academic mothers must constantly manage into the spotlight. The pandemic has provoked an opportunity for a different performance of mothering in the academy; one that does not require us to invisibilise our care to be valued. This (re)performance and revaluation has the potential to reform the cultural landscapes of the academy, towards spaces in which care is reimagined as not simply an encumberment but also an enrichment.

Perceived causes and consequences of sexual changes after cancer for women and men: a mixed method study.

BACKGROUND: Previous research on cancer and sexuality has focused on physical aspects of sexual dysfunction, neglecting the subjective meaning and consequences of sexual changes. This has led to calls for research on cancer and sexuality to adopt an "integrative" approach, and to examine the ways in which individuals interpret sexual changes, and the subjective consequences of sexual changes. METHOD: This study examined the nature and subjective experience and consequences of changes to sexual well-being after cancer, using a combination of quantitative and qualitative analysis. Six hundred and fifty seven people with cancer (535 women, 122 men), across a range of reproductive and non-reproductive cancer types completed a survey and 44 (23 women, 21 men) took part in an in-depth interview. RESULTS: Sexual frequency, sexual satisfaction and engagement in a range of penetrative and non-penetrative sexual activities were reported to have reduced after cancer, for both women and men, across reproductive and non-reproductive cancer types. Perceived causes of such changes were physical consequences of cancer treatment, psychological factors, body image concerns and relationship factors. Sex specific difficulties (vaginal dryness and erectile dysfunction) were the most commonly reported explanation for both women and men, followed by tiredness and feeling unattractive for women, and surgery and getting older for men. Psychological and relationship factors were also identified as consequence of changes to sexuality. This included disappointment at loss of sexual intimacy, frustration and anger, sadness, feelings of inadequacy and changes to sense of masculinity of femininity, as well as increased confidence and self-comfort; and relationship strain, relationship ending and difficulties forming a new relationship. Conversely, a number of participants reported increased confidence, re-prioritisation of sex, sexual re-negotiation, as well as a strengthened relationship, after cancer. CONCLUSION: The findings of this study confirm the importance of health professionals and support workers acknowledging sexual changes when providing health information and developing supportive interventions, across the whole spectrum of cancer care. Psychological interventions aimed at reducing distress and improving quality of life after cancer should include a component on sexual well-being, and sexual interventions should incorporate components on psychological and relational functioning.

'Not that I want to be thought of as a hero': narrative analysis of performative masculinities and the experience of informal cancer caring.

Providing care to a partner with cancer can have a significant impact on a carer's well-being and experience of subjectivity. However, there is little research examining how men experience the role of cancer carer, and in particular, how they negotiate constructions of gender in this role. This paper draws on a single case study of a heterosexual man caring for his partner, and conducts a narrative analysis of the construction and performance of masculine subjectivity. It was found that rather than inhabiting a stable masculinity, this carer engaged in a complex negotiation of masculinities, enacting a caring role associated with victimisation, rejection, distress and powerlessness, as well as strength and heroic resilience. We highlight the importance of the relationship context to the experience of caring, and suggest that research into the gendered experience of cancer care needs to acknowledge the active negotiation of masculinities and caring. We also discuss the utility of case study research in analyses of masculinity and cancer care, and in health psychology more broadly.

Feeling well and talking about sex: psycho-social predictors of sexual functioning after cancer.

BACKGROUND: Changes to sexual wellbeing are acknowledged to be a long-term negative consequence of cancer and cancer treatment. These changes can have a negative effect on psychological well-being, quality of life and couple relationships. Whilst previous conclusions are based on univariate analysis, multivariate research can facilitate examination of the complex interaction between sexual function and psycho-social variables such as psychological wellbeing, quality of life, and relationship satisfaction and communication in the context of cancer, the aim of the present study. METHOD: Six hundred and fifty seven people with cancer (535 women, 122 men) and 148 partners (87 women, 61 men), across a range of sexual and non-sexual cancers, completed a survey consisting of standardized measures of sexual functioning, depression and anxiety, quality of life, relationship satisfaction, dyadic sexual communication, and self-silencing, as well as ratings of the importance of sex to life and relationships. RESULTS: Men and women participants, reported reductions in sexual functioning after cancer across cancer type, for both people with cancer and partners. Multiple regression analysis examined psycho-social predictors of sexual functioning. Physical quality of life was a predictor for men and women with cancer, and for male partners. Dyadic sexual communication was a predictor for women with cancer, and for men and women partners. Mental quality of life and depression were also predictors for women with cancer, and the lower self-sacrifice subscale of self-silencing a predictor for men with cancer. CONCLUSION: These results suggest that information and supportive interventions developed to alleviate sexual difficulties and facilitate sexual renegotiation should be offered to men and women with both sexual and non-sexual cancers, rather than primarily focused on individuals with sexual and reproductive cancers, as is the case currently. It is also important to include partners in supportive interventions. Interventions aimed at improving sexual functioning should include elements aimed at improving physical quality of life and sexual communication, with a focus on psychological wellbeing also being important for women with cancer.

Constructions of sex and intimacy after cancer: Q methodology study of people with cancer, their partners, and health professionals.

BACKGROUND: The increasing number of individuals living with cancer has led to a focus on the quality of life of survivors, and their families. Sexual wellbeing is a central component of quality of life, with a growing body of research demonstrating the association between cancer and changes to sexuality and intimacy. However, little is known about patient and professional understanding of cancer and sexuality post-cancer. This study was designed to explore the complex perspectives that people with personal and professional experience with cancer hold about sexuality in the context of cancer. METHODS: An interview study using Q methodology was conducted with 44 people with cancer, 35 partners of a person with cancer and 37 health professionals working in oncology. Participants were asked to rank-order 56 statements about sexuality and intimacy after cancer and asked to comment on their rankings in a subsequent semi-structured interview. A by-person factor analysis was performed with factors extracted according to the centroid method with a varimax rotation. RESULTS: A three-factor solution provided the best conceptual fit for the perspectives regarding intimacy and sexuality post-cancer. Factor 1, entitled "communication - dispelling myths about sex and intimacy" positions communication as central to the acceptance of a range of satisfying sexual and intimate practices post-cancer. Factor 2, "valuing sexuality across the cancer journey," centres on the theme of normalizing the experience of sex after cancer through the renegotiation of sex and intimacy: the development of alternative sexual practices. Factor 3, "intimacy beyond sex," presents the view that even though sex may not be wanted, desired, or even possible following cancer, quality of life and relationship satisfaction are achieved through communication and non-genital intimacy. CONCLUSIONS: This study has demonstrated the complexity of perspectives about sexuality and intimacy post cancer, which has practical implications for those working in cancer care and survivorship. Therapists and other health professionals can play an important role in ameliorating concerns surrounding sexual wellbeing after cancer, by opening and facilitating discussion of sexuality and intimacy amongst couples affected by cancer, as well as providing information that normalizes a range of sexual and intimate practices.

Talking about sex after cancer: a discourse analytic study of health care professional accounts of sexual communication with patients.

There is consistent evidence that health care professionals (hcps) are not addressing the sexual information and support needs of people with cancer. Thirty-eight Australian hcps across a range of professions working in cancer care were interviewed, to examine constructions of sexuality post-cancer, the subject positions adopted in relation to sexual communication, and the ways in which discourses and subject positions shape information provision and communication about sexuality. Participants constructed sexual changes post-cancer in physical, psychological and relational terms, and positioned such changes as having the potential to significantly impact on patient and partner well-being. This was associated with widespread adoption of a discourse of psychosocial support, which legitimated discussion of sexual changes within a clinical consultation, to alleviate distress, dispel myths and facilitate renegotiation of sexual practices. However, this did not necessarily translate into patient-centred practice outcomes, with the majority of participants positioning personal, patient-centred and situational factors as barriers to the discussion of sex within many clinical consultations. This included: absence of knowledge, confidence and comfort; positioning sex as irrelevant or inappropriate for some people; and limitations of the clinical context. In contrast, those who did routinely discuss sexuality adopted a subject position of agency, responsibility and confidence.

Men's experiences of sexuality after cancer: a material discursive intra-psychic approach.

Men can experience significant changes to their sexuality following the onset of cancer. However, research on men's sexuality post-cancer has focused almost exclusively on those with prostate and testicular cancer, despite evidence that the diagnosis and treatment for most cancers can impact on men's sexuality. This Australian qualitative study explores the experiences of changes to sexuality for 21 men across a range of cancer types and stages, sexual orientations and relationship contexts. Semi-structured interviews were analysed with theoretical thematic analysis guided by a material discursive intra-psychic approach, recognising the materiality of sexual changes, men's intrapsychic experience of such changes within a relational context and the influence of the discursive construction of masculine sexuality. Material changes included erectile difficulty, decreased desire, and difficulty with orgasm. The use of medical aids to minimise the impact of erectile difficulties was shaped by discursive constructions of 'normal' masculine sexuality. The majority of men reported accepting the changes to their sexuality post-cancer and normalised them as part of the natural ageing process. Men's relationship status and context played a key role managing the changes to their sexuality. We conclude by discussing the implications for clinical practice.

Information needs associated with changes to sexual well-being after breast cancer.

AIMS: This article is the report of a study of sexual information needs, experiences of obtaining such information, and patient communication about sexuality with health professionals, after breast cancer. BACKGROUND: Changes to sexuality after breast cancer can significantly affect quality of life. However, information needs associated with such changes are little understood, resulting in the absence of a knowledge base to guide information provision aimed at preventing or ameliorating distress. DESIGN: This study employs a mixed method analysis, integrating qualitative and quantitative responses to an online survey. METHOD: Participants were 1965 individuals with breast cancer (98·8% female) drawn from the membership of a national Australian breast cancer organization. The data were collected over 2 weeks in December 2010. RESULTS: Eighty-five per cent of participants reported changes to sexual well-being after breast cancer, with 68% wanting information on such changes, primarily in a written form. Information on physical changes, sexual response, relationship issues, psychological consequences, and body image or identity, were rated as very important by a substantial proportion of participants. Only 41% had obtained such information; however, 65% had spoken about sexual changes, to partner (76%), G.P. (49%), friend/relative (47%), oncologist (39%), or breast-care nurse (21%). Ratings of satisfaction with the discussion were highest for breast-care nurses (60%) and lowest for oncologists (34%). CONCLUSION: These findings provide clinicians and cancer organizations with specific suggestions about sexual information needs after breast cancer and the modalities which are preferred, to prevent and ameliorate distress.

Embodying sexual subjectivity after cancer: a qualitative study of people with cancer and intimate partners.

Research has increasingly recognised the profound impact that cancer can have upon embodied subjectivity. However, there has been little acknowledgement of the centrality of sexuality to subjectivity, and marginalisation of the experiences of intimate partners of people with cancer. This Australian qualitative study explores the post-cancer experiences of embodied sexual subjectivity for 44 people with cancer (23 women and 21 men) and 35 partners of people with cancer (18 women and 17 men) across a range of cancer types and stages. Semi-structured interviews were analysed with theoretical thematic analysis, guided by a post-structuralist approach to sexual subjectivity as a dynamic process of becoming that can change over time, and by Williams' [(1996). The vicissitudes of embodiment across the chronic illness trajectory. Body and Society, 2, 23-47] framework on post-illness embodiment. Participants took up the following post-cancer subject positions: 'dys-embodied sexual subjectivity' - characterised by bodily betrayal, sexual loss, lack of acceptance, depression, and anxiety; 're-embodied sexual subjectivity'--characterised by greater sexual confidence, acceptance, the exploration of non-coital sexual practices and increased relational closeness; and 'oscillating sexual subjectivity'--involving a shift between states of sexual dys-embodiment and sexual re-embodiment. The findings point to the importance of focusing on the sexual health of people with cancer and partners across the cancer trajectory.

Renegotiating sex and intimacy after cancer: resisting the coital imperative.

BACKGROUND: Previous research on sex and intimacy in the context of cancer has focused on documenting sexual changes and difficulties, primarily focusing on heterosexual individuals who have sexual or reproductive cancers. Analyses of sexual renegotiation and the social construction of sex are largely absent from the research agenda. OBJECTIVE: The objective of this study was to explore renegotiation of sex in individuals with cancer, and in partners, across a broad range of cancer types and relational contexts. METHODS: Semistructured interviews were conducted with 44 people with cancer (23 women, 21 men) and 35 partners (18 women, 17 men), 86% of whom identified as heterosexual. The data were analyzed with theoretical thematic analysis, from a material-discursive-intrapsychic perspective. RESULTS: Renegotiation of sex or intimacy was reported by 70% of participants, reflected in 3 themes: "resisting the coital imperative: redefining 'sex,'" "resisting the coital imperative: embracing intimacy," and "adopting the coital imperative: refiguring the body through techno-medicine." The importance of relational context was reflected in the theme "the inter-subjective nature of sexual re-negotiation: relationship context and communication." CONCLUSIONS: Whereas previous research has focused on embodied changes associated with sexuality after cancer, or their psychological consequences, the findings of the present study suggest that hegemonic constructions of "sex," in particular the coital imperative, are central to the experience and negotiation of sex and intimacy after cancer. IMPLICATIONS FOR PRACTICE: Resistance of the coital imperative should be a fundamental aspect of information and support provided by health professionals who seek to reduce distress associated with sexual changes after cancer.

Changes to sexual well-being and intimacy after breast cancer.

BACKGROUND: Changes to sexual well-being can be one of the most problematic aspects of life after breast cancer, with the impact lasting for many years after treatment, associated with serious physical and emotional adverse effects. However, the primary focus on corporeal changes negates the influence of social and relational constructions of sexuality and illness and the ways in which the meaning of sex is negotiated by individuals and within relationships. OBJECTIVE: The aim of this study was to examine changes to sexuality and intimate relationships in individuals who have experienced breast cancer, from a material-discursive-intrapsychic perspective, using mixed-method analysis. METHODS: An online survey containing 47 quantitative and qualitative items was completed by 1965 Australian individuals with breast cancer. Participants were 98% women, with a mean age of 54 years. RESULTS: Decreases in sexual frequency, response, and satisfaction were attributed to a range of factors, including tiredness and pain, psychological distress and body image, and medically induced menopausal changes such as vaginal dryness, hot flushes, and weight gain. Predominant concerns identified in the qualitative analysis were emotional consequences, physical changes, feeling unattractive or lacking femininity, reconciliation of self to changes, and impact on partner or relationship. CONCLUSIONS: These findings support and extend previous research that reports significant changes in sexual well-being after diagnosis and treatment for breast cancer. IMPLICATIONS FOR PRACTICE: The findings are of significance to clinicians because sexual well-being is central to psychological well-being and quality of life, and sexual intimacy has been found to make the experience of cancer more manageable and to assist in the recovery process.

Sexuality after gynaecological cancer: a review of the material, intrapsychic, and discursive aspects of treatment on women's sexual-wellbeing.

Research in the area of gynaecological cancer has increasingly examined changes to women's sexuality, with the impact of treatment on sexual wellbeing considered particularly important. The objective of this paper is to review research on gynaecological cancer and sexuality from the years 1990 to 2011. Research has documented a range of post-treatment anatomical and physical changes to women's sexual wellbeing, including changes to sexual desire, pleasure, orgasm, vaginal lubrication, genital sensitivity, arousal, and frequency of sex. Women's intrapsychic experiences of changes to sexuality include anxiety, depression, distress, and negative perceptions of sexual identity and body image. Socially constructed discourses surrounding gender and sexuality also shape women's experiences of their sexual wellbeing post-gynaecological cancer and treatment, with many women feeling a loss of womanhood and femininity with the removal of, or changes to, their reproductive organs. Finally, women's relationship context, pattern of couple communication, and partner support are associated with women's ability to cope with changes to sexuality post-gynaecological cancer. Given that sexuality is an important part of quality of life, it is important that health professionals actively communicate information to women and their partner about the effects of treatment on sexual wellbeing, in order to legitimate and normalise sexuality in this context. It is concluded that research in the area of gynaecological cancer and sexuality needs to acknowledge not only the physical/anatomical/material effects of cancer treatments, but also women's intrapsychic experiences of changes to sexuality, her relationship context, and the role of gendered discourses in shaping women's experiences of sexuality post-gynaecological cancer and treatment.

Positive and negative interactions with health professionals: a qualitative investigation of the experiences of informal cancer carers.

BACKGROUND: Empathic and informative interactions with health professionals are important for the well-being of people with cancer. However, there is a dearth of research examining the construction and experience of interactions with health professionals from the perspective of informal cancer carers. OBJECTIVE: The aim of this study was to explore how cancer carers subjectively position their experiences of interactions with health professionals, in particular, their construction of experiences as positive or negative, and the perceived consequences of such interactions. Positioning theory is used to examine how the sociomedical construction of health professionals shapes carers' experiences of interactions with them. METHOD: Semistructured interviews were carried out with 53 informal cancer carers across a range of cancer types and stages, analyzed using thematic decomposition. RESULTS: Carers positioned positive interactions as those involving health professionals who were warm and genuine, accessible and approachable, and who made carers feel accepted and comfortable. In the case of allied health professionals, the provision of a space for carers' cathartic release was also constructed positively. Negative interactions were positioned as those involving poor communication and a lack of empathy, poor or absent information provision, and absence of guidance about additional support. CONCLUSIONS: Positive experiences with health professionals were positioned by carers as leading to feelings of empowerment, value, and recognition, and negative interactions as leading to distress, anger, frustration, and feelings of isolation. IMPLICATIONS FOR PRACTICE: It is important for health professionals to be supportive of carers' needs, to communicate in an empathic manner, to be approachable and accessible, and to recognize carers needs and concerns.

Sexuality after breast cancer: a review.

It is widely recognised that women's sexuality can be particularly complex after breast cancer, with sexual changes often becoming the most problematic aspect of a woman's life. The impact of such changes can last for many years after successful treatment, and can be associated with serious physical and emotional side-effects. The objective of this paper is to review research on breast cancer and sexuality from the years 1998 to 2010. Research has documented a range of physical changes to a woman's sexuality following breast cancer, including disturbances to sexual functioning, as well as disruptions to sexual arousal, lubrication, orgasm, sexual desire, and sexual pleasure, resulting from chemotherapy, chemically induced menopause, tamoxifen, and breast cancer surgery. Women's intrapsychic experience of changes to sexuality includes a fear of loss of fertility, negative body image, feelings of sexual unattractiveness, loss of femininity, depression and anxiety, as well as alterations to a sense of sexual self. The discursive construction of femininity and sexuality shapes the way women construct and experience their illness and their body - leading many women to try to appear 'normal' to others post-breast surgery. Finally, the quality of a woman's partnered relationship consistently predicts sexual health post-breast cancer - reinforcing the importance of recognising the intersubjective nature of issues surrounding breast cancer and sexuality. It is concluded that analyses of sexuality in the context of breast cancer cannot conceptualise the physical body separately from women's intrapsychic negotiation, her social and relational context, and the discursive constructions of sexuality and femininity: a material-discursive-intrapsychic interaction.

Renegotiating sexuality and intimacy in the context of cancer: the experiences of carers.

There is a growing body of evidence to show that cancer can result in dramatic changes in sexuality, sexual functioning, and intimate couple relationships, with significant implications for both quality of life and psychological well-being. However, the experiences of intimate partners are often neglected in research on sexuality and intimacy in the context of cancer. This study used a material-discursive framework and a qualitative methodology to investigate the ways in which intimacy and sexuality are renegotiated in the context of cancer, and what factors are associated with successful or unsuccessful renegotiation, from the perspective of partners caring for a person with cancer. Twenty participants were interviewed, across a range of cancer types, stages, and age groups. Eleven participants reported that they were unable to negotiate other ways of being sexually intimate when penetrative sexual intercourse was no longer physiologically possible or desirable. Nine were able to renegotiate sexual intimacy in the context of cancer to include practices previously positioned as secondary to "real sex," such as mutual masturbation, self masturbation, manual stimulation, oral sex, massage, the use of vibrators, kissing, and hugging. Grounded theory analysis identified two themes associated with renegotiation: "Alternative" sexual practices-redefining sexual intimacy, and couple communication and relationship context. Difficulties in renegotiation were associated with adherence to the coital imperative, sexual relationship or communication problems which existed prior to cancer, and the positioning of the person with cancer as a child or an asexual sick patient rather than a sexual partner. The implications for health professional intervention to ameliorate changes to sexuality in the context of cancer are discussed.

Socio-cultural perceptions of sudden infant death syndrome among migrant Indian mothers.

AIM: To explore socio-cultural influences on migrant mother decisions and beliefs regarding co-sleeping as a risk factor for sudden infant death syndrome (SIDS). METHODS: Semi-structured interviews with five Indian-born women in a socio-economically disadvantaged suburb in the south-west of Sydney were conducted between September and December 2007. Transcripts were analysed using principles of discourse analysis. RESULTS: Discourse analysis revealed that SIDS-related decisions and beliefs about co-sleeping as a risk factor for SIDS are constructed amid competing discourses of motherhood and child health. Mothers are either actively or unconsciously deciding how they negotiate or resist dominant Western discourses of motherhood and child health to make 'the best' health-related decisions for their children. Participants resisted acknowledging child sleep practices recommended by health practitioners, particularly recommendations to put to sleep the baby in its own cot. This resistance was expressed by constructing messages as 'inapplicable' and 'inappropriate'. Co-sleeping was constructed as a highly valued practice for its physical and social benefits to the child, mother and family by facilitating child security, breastfeeding, bonding and family connectedness. CONCLUSION: This study illustrates how decisions and behaviour are shaped by socio-cultural influences embedded in discourses and context. It also shows that in-depth investigation through a social constructivist lens is particularly useful for investigating influences on knowledge acquisition, interpretation and implementation among migrant groups. A greater appreciation of the social meanings and ideologies attached to behaviours can help to ensure that the correct messages reach the correct populations, and that child health outcomes can be achieved and maintained both for overseas and Australian-born populations.

Accounts of disruptions to sexuality following cancer: the perspective of informal carers who are partners of a person with cancer.

There is a growing body of research showing that cancer impacts upon the sexuality of informal carers in a couple relationship with a person with cancer. However, this research is primarily focused on partners of a person with gynaecological or breast cancer, within a framework where the physiological effects of cancer on sexual performance are the focus. We conducted semi-structured interviews with 20 informal carers in a couple relationship with a person with cancer, across a range of cancer types. The aim was to explore accounts of changes to sexuality and intimacy post-cancer, in the context of discursive constructions of sexuality and the caring role. Our findings show that partners' sexual experiences were shaped by absence of desire in the person with cancer; the stress and exhaustion associated with caring tasks; the repositioning of the person with cancer as childlike or as an asexual 'sick patient'; and the belief that there were expectations about 'acceptable' sexual conduct in the context of cancer caring. Carers accepted the diminishment of their sexual relationship, but expressed feelings of disappointment, anger and sadness about this loss. It is concluded that it is vital that support services are developed, so that couples may develop new sexual strategies, and cope more effectively with potential disruptions to their sexual and intimate relationship.