Sexual satisfaction in prostate cancer: a multi-group comparison study of treated patients, patients under active surveillance, patients with negative biopsy, and controls.

PURPOSE: Erectile function changes after prostate cancer (PCa) treatment are well documented, but less understood is the relative impact of prostate biopsy and active surveillance on sexual well-being. It is unknown whether potential negative impacts are exclusive to patients who have been treated for PCa, or whether the diagnosis itself or the experience of biopsy may also impact sexual well-being. Sexual satisfaction is an important yet understudied indicator of sexual well-being in this population. This study examines sexual satisfaction and its predictors across several comparison groups to explore relative impact. METHODS: At baseline and 12 months, questionnaire data was collected in four samples: (1) following PCa treatment, (2) active surveillance, (3) negative prostate biopsy result, and (4) controls receiving no biopsy or treatment. Predictors assessed included group, erectile function, communication style, and partner involvement. RESULTS: Sexual satisfaction declined in the active treatment group, no changes were observed in active surveillance or non-PCa control, and improvements were observed in the biopsy group. Predictors of sexual satisfaction over and above erectile function included restrictive communication (i.e. protective buffering) and perceived partner involvement. For higher levels of erectile function, a higher perceived degree of partner involvement was protective of sexual satisfaction. CONCLUSION: Sexual satisfaction is an important indicator of sexual well-being and is negatively impacted following PCa treatment, but not active surveillance or prostate biopsy. IMPLICATIONS FOR CANCER SURVIVORS: Communication and partner involvement are potentially modifiable factors to be considered for intervention and may promote sexual satisfaction following PCa treatment. Patients experiencing negative biopsy, who note lower sexual satisfaction may experience improved satisfaction with time, and those under active surveillance who worry about sexual satisfaction may find reassurance from these results.

Implementation of individually tailored treatment plans in a group-based intervention for women with mixed vulvo-vaginal and sexual health concerns following cancer treatment: A feasibility study.

PURPOSE: This study evaluated a professionally-led, group-based vulvo-vaginal and sexual health (VSH) workshop for women diagnosed with cancer. The study goals were to: (1) implement and assess a novel group intervention for diverse VSH concerns; (2) explore post-workshop changes in symptom bother, motivation to use VSH treatments, and frequency of VSH treatment use; (3) examine post-workshop changes in sexual well-being. METHODS: A group-based educational workshop to address a variety of VSH concerns was developed and implemented. During the workshop, participants created an individualized treatment plan by selecting from various VSH treatment options presented. Treatment plan follow-ups were administered online at one-, two-, and three-months post-workshop. At baseline and three-month follow-up, participants completed online questionnaires to assess self-reported vulvo-vaginal symptoms, sexual function, sexual distress, and use of VSH strategies. RESULTS: 195 participants (age 20-81) attended workshops over a 2.5-year period. Individualized treatment plans were effectively completed by most participants (92%). Preliminary results show decreases in bother severity associated with VSH concerns post-workshop, stabilizing after 2 months. At three-month follow-up, participants reported increased use of VSH treatment strategies. Sexual satisfaction, sexual distress, and emotional impact of vulvovaginal symptoms also improved. CONCLUSIONS: Workshop attendance was associated with increased uptake of VSH treatment strategies and improvements in several parameters of sexual well-being. Findings indicate that individualized treatment plans can be implemented effectively in a group setting and that a one-time, group-based educational workshop can meaningfully impact VSH-related behavior change, reduce vulvo-vaginal symptom bother and promote sexual well-being in patients with diverse VSH concerns.

Hard Times: Prostate Cancer Patients' Experiences with Erectile Aids.

BACKGROUND: Prostate cancer (PCa) treatments commonly lead to erectile difficulties. While the mainstay treatment is erectile aids (EAs) to promote erectile recovery, some men never use these treatments and those whose do use EAs often abandon them in the long-term. AIM: The goal of this study was to examine PCa patients' experiences with EAs, to elucidate relationships between experiences with EAs on psychological and sexual well-being, and to explore benefits and drawbacks to EA use. METHODS: A self-report survey including validated questionnaires was administered to examine PCa patients' use and perceptions of helpfulness of EAs, and to characterize associations between use, perceived helpfulness, and psychological and sexual well-being. The survey was followed by an open-ended prompt to explore participants' experiences with EAs. OUTCOMES: We surveyed 260 North American men, up to 25 years after receiving treatment for PCa. Three groups of patients were observed, including those who used EAs and perceived them to be helpful, those who used EAs and perceived them to be unhelpful, as well as a smaller group of patients who never used EAs. RESULTS: Around 80% of the sample were using or had used EAs. Despite the high frequency of use, not all men found EAs helpful. Men who used EAs and found them unhelpful reported poorer psychological and sexual well-being compared to men who didn't use aids or who used EAs but found them helpful. Results indicated both benefits and drawbacks to the use of EAs. Benefits related largely to the efficacy of the aid in promoting erections. A wide range of drawbacks were also reported. CLINICAL IMPLICATIONS: Given the negative sexual and psychological impacts associated with using EAs and finding them unhelpful, we suggest that researchers and health care providers should take care to proactively address potential challenges that are common with EA use, and also to consider the risks of failed attempts with EAs. STRENGTHS & LIMITATIONS: By using both scaled and open-ended questions, a more nuanced picture of the relative benefits and limitations of EA use within the PCa population is presented. As responses were not mandatory, a subset of participants provided comments about the use of EAs. Additionally, the sample was quite homogenous, with mostly white, American and well-educated participants, so it therefore lacks generalizability to other populations. CONCLUSION: This paper illustrates several challenges to EA use, while providing insight into reasons for abandonment of use of EAs. Walker LM, Sears CS, Santos-Iglesias P, et al. Hard Times: Prostate Cancer Patients' Experiences with Erectile Aids. J Sex Med 2021;18:1775-1787.

Impact of Vulvovaginal Symptoms in Women Diagnosed with Cancer: A Psychometric Evaluation of the Day-to-Day Impact of Vaginal Aging Questionnaire.

Background: Vulvovaginal symptoms (VVS), such as dyspareunia, dryness, and itching, are common following cancer treatment and can negatively impact sexual well-being, daily activities, mood, self-concept, and overall quality of life. Information about the impact of VVS after cancer treatment is scarce, mainly because of a dearth of validated measures. This study aimed to validate the Day-to-Day Impact of Vaginal Aging (DIVA) questionnaire, which assesses impact of VVS on women's lives, in a sample of women with cancer. Methods: Women diagnosed with cancer (n = 202) completed a questionnaire package, including the DIVA and measures of VVS, sexual function, and sexual distress. Data were collected as part of study evaluating an educational workshop. Confirmatory factor analysis (CFA) was used to examine whether the factor structure of the DIVA in this population reflected that of the original validation study. Results: CFA showed that the DIVA assesses VVS impact on four domains: activities of daily living, sexual functioning, emotional well-being, and self-concept and body image. All subscales showed excellent internal consistency reliability; however, item analyses indicated that items in the activities of daily living subscale showed very low means. Correlations with sexual function and distress provided evidence that the DIVA assesses impact of VVS. Conclusions: This is the first study aimed at validating the DIVA in women treated for cancer. Results provide evidence of the DIVA's utility in assessing the impact of VVS on four relevant domains. Although issues with certain scale items need to be resolved in future research, the DIVA provides opportunity to understand the impact of VVS after cancer treatment, to address unmet needs of cancer survivors.

Effects of a light therapy intervention on diurnal salivary cortisol in fatigued cancer survivors: A secondary analysis of a randomized controlled trial.

OBJECTIVE: Altered diurnal cortisol rhythms are a potential mechanism through which symptoms of fatigue are maintained in post-treatment cancer survivors. Exposure to early morning bright light may target this underlying dysregulation, resulting in improved diurnal cortisol patterns, subsequently improving symptoms of fatigue. This research investigates the effects of a 4-week light therapy intervention on the diurnal cortisol slopes and output in fatigued cancer survivors. METHODS: Post-treatment adult cancer survivors who met diagnostic criteria for cancer-related fatigue were randomly assigned to receive either a bright white light (BWL) or dim red light (DRL) device, used daily for 30 min over four consecutive weeks. Assessments of fatigue and salivary cortisol were collected at baseline and post-intervention. Cortisol was sampled four times per day (waking, noon, 5 pm, bedtime) for three days at each timepoint. Diurnal cortisol slopes and total cortisol output were calculated at baseline and post-intervention. Linear mixed models were used to analyze the data. RESULTS: Seventy-seven participants were included in this analysis (BWL n = 40; DRL n = 37). Participants in both groups displayed increased steepness in cortisol slope (B = -0.02, p = .01, Cohen's d = 0.57) and increased total cortisol output (B = 9.58, p = .03, Cohen's d = 0.49) from baseline to post-intervention, indicating only a moderate effect of time. Neither diurnal cortisol slopes nor total cortisol output mediated the relationship between the light therapy intervention and fatigue levels. CONCLUSION: Though the results of this trial are promising for light therapy as an effective intervention to reduce fatigue in cancer survivors, this does not appear to be achieved through alterations in neuroendocrine function. ClinicalTrials.gov registration #: NCT01780623.

Preliminary validation of the Sexual Distress Scale-Short Form: Applications to Women, Men, and Prostate Cancer Survivors.

The Sexual Distress Scale (SDS) can be used to assess sexual distress in women, men, and prostate cancer (PCa) survivors. Despite its strong psychometric properties, researchers and clinicians could benefit from a short form of the scale. Two studies were conducted to develop (Study 1) and validate (Study 2) a short form of the SDS (SDS-SF) using samples of women, men, and PCa survivors from previous studies. Results of Study 1 suggested a 5-item SDS-SF. Study 2 showed that the SDS-SF items clustered in one factor with good fit across the three samples and excellent reliability. Sexual distress was associated with higher sexual bother, and poorer sexual satisfaction, sexual function, and relationship quality. The SDS-SF discriminated participants with and without distressing sexual problems. The SDS-SF facilitates the assessment of sexual distress in clinical settings by providing a quick way of screening patients with high levels of sexual distress.

On the Relationship Between Erectile Function and Sexual Distress in Men with Prostate Cancer.

Erectile difficulties are common after prostate cancer (PCa) treatment and are associated with sexual distress. However, the relationship between erectile function and sexual distress has yet to be carefully examined. This study had three goals: (1) examine the relationship between erectile function and sexual distress; (2) determine groups of men based on erectile function and sexual distress; and (3) examine the psychosexual characteristics of these groups. A cross section of 233 sexually active men after PCa treatment (age M = 64.90 years, SD = 7.50) completed an online survey containing demographic, health, and sexuality and relationship questionnaires. The relationship between erectile function and sexual distress was curvilinear. Four groups of men were found: good erectile function and low sexual distress, poor erectile function and high sexual distress, but also good erectile function yet high sexual distress, and poor erectile function and low sexual distress. Regardless of erectile function, men with greater sexual distress were more depressed, reported additional sexual concerns, placed less value on sex, were less sexually satisfied, and used protective buffering communication more frequently. They were also less likely to be satisfied with their adaptation to sexual changes and less likely to have found a solution to those changes. The relationship between erectile function and sexual distress is complex, characterized by a wide array of responses to erectile function (high and low distress) and multiple correlates of sexual distress. These results broaden the concept of sexual recovery after PCa treatment, which may assist clinicians and researchers to better address sexual problems after PCa treatment.

An Educational Program to Help Patients Manage Androgen Deprivation Therapy Side Effects: Feasibility, Acceptability, and Preliminary Outcomes.

Androgen deprivation therapy (ADT), a common treatment for prostate cancer, is associated with physical, psychological, and sexual side effects that reduce patients' quality of life. The authors designed an educational program to prepare patients for managing these side effects. This paper describes an implementation model for national dissemination of the program, testing its feasibility and acceptability at the institutional and patient level. Postprogram changes in patients' self-efficacy to manage side effects and side effect bother are also explored. Patients on or anticipating ADT enrolled in the educational program. Pre and post intervention questionnaires measured patient satisfaction with the program, side effect bother, and self-efficacy to manage ADT side effects. The ADT Educational Program was deemed feasible and acceptable. Five of six targeted sites successfully launched the program with sufficient patient enrolment. Patient attendees were highly satisfied. Self-efficacy, bother, and use of management strategies were interrelated. Lower bother was associated with increased self-efficacy and more use of management strategies, and increased bother was associated with lower self-efficacy and less use of management strategies. Based on pre-post scores, improvements in patients' self-efficacy to manage ADT side effects were also observed. Results demonstrate that this brief educational program is feasible and acceptable to patients and cancer care institutions. The program appears to promote self-efficacy and the uptake of ADT management strategies for ADT side effects. The results of this study support the program implementation and suggest that improvements in self-efficacy after program participation may help patients adapt to ADT side effects.

A Systematic Review of Sexual Satisfaction in Prostate Cancer Patients.

INTRODUCTION: Prostate cancer (PCa) treatment has a significant negative impact on sexual function. Because research to this date has mostly focused on the impact of PCa on erectile function, very little is known about the impact of PCa on other relevant sexual outcomes, such as sexual satisfaction. AIM: To conduct a literature review of studies that have examined sexual satisfaction in men diagnosed with and treated for PCa. METHODS: A systematic review was conducted using Scopus and PubMed databases to identify studies that had assessed sexual satisfaction in men with PCa. The main characteristics of each study and results regarding the impact of PCa on sexual satisfaction were extracted and examined. MAIN OUTCOME MEASURE: The main outcome measure was studies that assessed general sexual satisfaction in men with PCa. RESULTS: Thirty-eight articles were found regarding sexual satisfaction in PCa. Most studies did not focus on sexual satisfaction specifically, and methodologic limitations produced very mixed results. Overall, PCa treatments had a low to moderate impact on sexual satisfaction, and psychosocial interventions were more successful at improving sexual satisfaction than medical interventions. Sexual satisfaction was correlated to a large number of sexual, relational, psychological, and medical variables. CONCLUSION: This literature review shows very mixed results about the sexual satisfaction in men with PCa. Differences in research designs, methodologic limitations, and studies conducted atheoretically limit our understanding of the mechanisms that impact sexual satisfaction in men with PCa. We propose an alternative way of conducting research on sexual satisfaction by using solid theoretical models of sexual satisfaction. Santos-Iglesias P, Rana M, Walker L. A Systematic Review of Sexual Satisfaction in Prostate Cancer Patients. Sex Med Rev 2020;8:450-465.

Psychometric Validation of the Sexual Distress Scale in Men with Prostate Cancer.

BACKGROUND: Different scales exist for the assessment of sexual distress in men with prostate cancer (PCa); however, these measures narrowly focus on distress associated with sexual function. AIM: To validate and examine the psychometric properties of the Sexual Distress Scale (SDS) and Sexual Distress Scale-Revised (SDS-R), which were recently validated for use within men, in samples of sexually functional and sexually dysfunctional men with PCa. METHODS: A sample of 538 men (with and without PCa and with and without sexual dysfunction) were used to examine the psychometric properties of the SDS. Confirmatory factor analysis followed by tests of measurement bias, calculations of reliability, and estimation of receiver operating characteristic (ROC) curves were used to examine the psychometric properties of the SDS and SDS-R. A subsample of 321 men completed the survey again 1 month later, and their responses were used to examine test-retest reliability. OUTCOMES: Participants completed the SDS and SDS-R, as well as measures of sexual bother and sexual concerns, sexual function, sexual attitudes, and mood states. RESULTS: The SDS and SDS-R assess 1 general domain of sexual distress; 1 violation of measurement invariance was found between men with and men without PCa, which limits the comparability of scores between these 2 groups. Internal consistency and test-retest reliabilities were above 0.93 and 0.82, respectively. Evidences of validity based on relations with other variables supported our predictions because sexual distress was associated with other measures of distress, sexual function, satisfaction, and mood and not correlated to sexual attitudes. Although the SDS and SDS-R discriminated between sexually functional and dysfunctional men, the accuracy of the cutoff scores was only moderate. CLINICAL TRANSLATION: This instrument can be used by researchers and clinicians to examine sexual distress and can be used to elucidate how sexual distress relates to sexual function, well-being, and quality of life. STRENGTHS AND LIMITATIONS: The SDS and SDS-R assess sexual distress independently of sexual function; however, with the current evidence, they should not be used to compare men with and men without PCa and to classify men with and men without sexual dysfunction. CONCLUSION: This study provides a validation of the SDS and SDS-R that can be used in samples of men with PCa and with and without sexual dysfunction for the assessment of distress. Santos-Iglesias P, Walker LM. Psychometric Validation of the Sexual Distress Scale in Men with Prostate Cancer. J Sex Med 2018;15:1010-1020.

Mood, sexuality, and relational intimacy after starting androgen deprivation therapy: implications for couples.

BACKGROUND: Patients on androgen deprivation therapy (ADT), a common treatment for prostate cancer, report significant declines in quality of life and detrimental impact on their intimate relationships. ADT depresses a man's testosterone to castrate levels, leading to declines in sexual function, and changes in mood. These changes can have profound impact on couples' intimate relationships. METHOD: Patients undergoing ADT, and their consenting partners, were followed on a variety of outcomes relating to mood, sexual changes, and relational intimacy. Participants were assessed at baseline, 3 months, and 6 months. Changes in these three domains are documented. A dyadic analysis was conducted on the primary outcome of relational intimacy in order to assess the role of changes in mood and various aspects of sexuality on couples' intimate relationships. RESULTS: Declines were observed in the first 6 months on ADT for sexual function, sexual frequency, and relational intimacy. Sexual bother increased within the first 3 months on ADT. No changes in mood were observed. Dyadic analysis revealed important effects on couples' reports of relational intimacy. (A) Patient and partner ratings of emotional intimacy were higher when partners better understood the patients' mood state. (B) Patient and partner ratings of sexual intimacy were higher when couples were more sexually active. CONCLUSIONS: The current study confirms that patients experience reduced sexuality and relational intimacy during the first 6 months on ADT. Specific facets of relational intimacy are improved with increased sexual activity and also when partners recognize the emotional changes that patients are experiencing.

Propiedades psicométricas del index of spouse abuse en una muestra de varones españoles / Psychometric properties of the index of spouse abuse in a spanish male sample

El objetivo del presente estudio fue analizar algunas propiedades psicométricas de la versión española del index of spouse abuse en una muestra de varones españoles, ya que no existen instrumentos validados en España en esta población. Participaron 598 varones con edades comprendidas entre 18 y 77 años (M = 40.20; DT = 13.71) seleccionados de la población general mediante muestreo incidental. Los resultados mostraron una estructura de 30 ítems agrupados en tres subescalas: abuso no físico, control de conductas y abuso físico. Los valores de fiabilidad oscilaron entre .60 y .81. Mostró buena validez convergente con las puntuaciones de la sexual assertiveness scale. Se encontró que las conductas de abuso más frecuentes son de abuso no físico y control de conductas, siendo el abuso físico menos frecuente. Se discuten los resultados obtenidos y sus implicaciones para la evaluación de la violencia de pareja en varones.

The aim of the present study was to analyze some psychometric properties of the index of spouse abuse in a spanish male sample, because there are no adapted instruments in Spain for this population. Participants were 598 males with ages ranging from 18 to 77 years old (M = 40.20; SD = 13.71), and they were selected from general population through a convenience sampling procedure. Results showed a structure made up of 30 items clustered into three subscales: nonphysical abuse, behavior controlling, and physical abuse. Reliability values ranged from .60 to .81. It showed good convergent validity with scores on the sexual assertiveness scale. Further, it was found that nonphysical abuse and behavior controlling were the most frequent form of abuse, while physical abuse was less frequent. Results and their implications for the assessment of partner abuse are discussed.

Culpabilidad sexual en jóvenes: influencia de las actitudes y la experiencia sexual / Sexual guilt in youngsters: the influence of attitudes and sexual experience

La culpabilidad sexual es un factor determinante de la conducta sexual. El objetivo del presente estudio fue analizar la culpabilidad sexual en una muestra de 594 jóvenes salvadoreños con edades comprendidas entre 14 y 18 años, seleccionados mediante un procedimiento no aleatorio, con el propósito de determinar la influencia que sobre la misma tienen una serie de variables sociodemográficas y de actitudes hacia la sexualidad. Los participantes contestaron el Inventario de Culpabilidad Sexual Revisado de Mosher, la Escala de Opinión Sexual, la Escala Hurlbert de Fantasías Sexuales y el Inventario de Actitudes Negativas hacia la Masturbación. Los resultados del análisis de regresión múltiple mostraron que la culpabilidad sexual está determinada, entre otros factores, por las actitudes hacia las fantasías sexuales, la erotofilia, las actitudes negativas hacia la masturbación y por la experiencia sexual en este orden, siendo más importantes las variables actitudinales que las sociodemográficas. Los resultados de estudios como éste sirven para analizar el papel de la culpabilidad sexual en la sexualidad humana y desarrollar futuros programas de educación sexual para adolescentes.

Sex guilt is a determinant of sexual behavior. The goal of the present study was to analyze sex guilt in a Salvadorian sample of 594 young with ages ranging from 14 to 18 years, selected through a non-random process, in order to assess the influence of socio-demographic and sexual attitudinal variables on it. Participants filled in the Revised Mosher Guilt Inventory, the Sexual Opinion Survey, the Hurlbert Index of Sexual Fantasy, and the Negative Attitudes toward Masturbation Inventory. Results of multiple regression analysis suggested that sex guilt is determined, among other things, by attitudes towards sexual fantasy, erotophilia, negative attitudes toward masturbation, and sexual experience, in this order, being the attitudinal variables more important than the socio-demographic variables. Results of studies like this are useful to analyze the role of sex guilt in human sexuality and to develop sexual education programs for adolescents.

Análisis transnacional del sistema de evaluación y selección del profesorado universitario / Transnational analysis of the evaluation and selection of university professors

Se analizó el sistema de evaluación y selección del profesorado universitario de los países que ocupan los diez primeros puestos del ranking académico mundial elaborado por el Institute of Higher Education, y si el tipo de sistema (centralizado vs no centralizado) de cada país determina el número de universidades que posee en ese ranking. Los resultados indicaron que, aunque no existe una asociación entre el tipo de sistema y el número de universidades/100000 habitantes que cada país tiene dentro del ranking, este número es mayor en los países con sistema no centralizado, lo que sugiere la importancia del sistema de selección en la determinación de la productividad de las universidades.