Sexual health in cancer: the results of a survey exploring practices, attitudes, knowledge, communication, and professional interactions in oncology healthcare providers.

PURPOSE: To assess, focusing on population of healthcare professionals providing oncosexology care to men with cancer, clinical practice, attitudes, knowledge, communication, and professional interaction. METHODS: We performed a descriptive cross-sectional study with an online self-administered e-questionnaire addressed to all medical, paramedical, or administrative professionals attending the 4th "Cancer, Sexuality and Fertility" Meeting in Toulouse, France. Their participation was voluntary and totally anonymous. RESULTS: The 165 respondents comprised 44% of physicians, 47% of paramedics, and 9% of other health professionals in oncology, from all French regions. Paramedics were significantly younger than physicians (p = .006). One third of respondents were degreed in sexology, but 75.8% were in demand of oncosexology-specific trainings, particularly paramedics (p = .029). Regarding the oncosexology network, respondents declared being linked to organ specialists (56.8%), psychologists (49.5%), oncologists (47.4%), nurses (31.5%), radiation therapists (27.4%), and general practitioners (25.3%). Compared to paramedics, physicians were more likely to be engaged in oncosexology care (p = .039) and couple counseling (p = .005), but the proportions of counseled patients or couple were identical (p = .430 and p = .252, respectively). Overall, 90% of respondents reported discussing sexuality issues with patients. Regarding the time for discussion, physicians reported communicating more at cancer announcement (p = .004) or after treatments (p = .015), while more paramedics reported discussing at another time (p = .005). Regarding the place for discussion, paramedics more frequently reported talking about sexuality in the hospital room (p = .001) or during a specific consult (p = .007). CONCLUSIONS: Results emphasize various levels for improving existing oncosexology care, such as developing oncosexology-specific educational and practical training programs, particularly for paramedics; consolidating information, counseling, and therapeutic education with formal procedures like implementing medical and paramedical "oncosexology moments," or strengthening the community-hospital networks, from diagnosis to survivorship.

Sexual health and needs for sexology care in digestive cancer patients undergoing chemotherapy: a 4-month cross-sectional study in a French University Hospital.

PURPOSE: To assess sexual health and needs for sexology care of cancer patients during chemotherapy. METHODS: We performed a 4-month cross-sectional study in cancer patients treated by chemotherapy in the digestive cancer department of a regional university hospital. Patients were asked to fill out a self-administered questionnaire about their sexual health, Sexual Quality of Life Questionnaire for Male (SQoL-M) or Female (SQoL-F), and their needs for sexology care. RESULTS: The study sample was composed of 47 men and 31 women. Tumor locations were 36 colorectal (46%), 23 pancreatic (30%), and 19 other digestive cancers (24%). SQoL scores were lower in women (p < .001), in pancreatic and colorectal tumors (p = .041 and p = .033, respectively) compared to other digestive cancers, and in less-educated patients (p = .023). During chemotherapy, 40% of sexually active patients had less frequent sexual intercourse than before diagnosis, and 33% had completely stopped sexual activity. Sexuality care was desired by 44% of respondents. Among them, 83% favored a consultation with a medical sexologist and 63% with a psycho-sexologist, 54% wanted couple therapy, and 31% considered support groups. Patients with colorectal cancer had more frequent sexual intercourse without penetration at the time of survey (p = .036) and more often wanted couple therapy than patients with pancreatic cancer (p = .048). CONCLUSIONS: This study is the first determination of sexual health and sexual quality of life in digestive cancers. Targets for interventions during chemotherapy for digestive cancers include populations with lower sexual quality of life: women, pancreatic sites, patients with sexual troubles during chemotherapy, and less-educated patients.

Sexual Quality of Life and Needs for Sexology Care of Cancer Patients Admitted for Radiotherapy: A 3-Month Cross-Sectional Study in a Regional Comprehensive Reference Cancer Center.

BACKGROUND: Providing early and better care in onco-sexuality and a better understanding of the sexual health care needs of patients before they start treatment is required. OBJECTIVE: To assess sexual quality of life and need for sexology care of patients when they are starting radiotherapy. DESIGN: We performed a cross-sectional study of adult patients with cancer admitted for radiotherapy treatment in a regional comprehensive cancer center. METHODS: We selected all consecutive adult patients scheduled to start radiotherapy within a 3-month period and excluded patients who could not complete the questionnaires. Patients were asked to complete the Sexual Quality of Life Questionnaire (SQoL) and a needs-assessment questionnaire. OUTCOMES: Total score on the SQoL and willingness (yes or no) to get help for a sexual problem. RESULTS: The study sample was composed of 77 men and 123 women. The average SQoL scores were 68.4 ± 20.9 and 47.1 ± 13.0 for men and women, respectively (P < .001). Of sexually active patients, 58% had decreased frequency of intercourse or had completely stopped sexual activity after their cancer diagnosis. Half the participants wanted care for their sexual concerns. The proportion desiring specific types of care varied from 28.5% (couple counseling) to 54.5% (sexual physician) with variation by sex or type of cancer. Furthermore, 11.5% of participants declared their willingness to join support groups. CLINICAL IMPLICATIONS: Early interventions before radiotherapy could improve sexual quality of life, particularly in women. STRENGTHS AND LIMITATIONS: Strengths are the SQoL validated in men and women, the original window for assessment, and the study location. Limitations are the monocentric design, the potential recall bias for data before cancer diagnosis, and the fact that some patients had treatments before radiotherapy. CONCLUSION: Our data suggest the need to examine the sexual health trajectory in a prospective fashion from diagnosis to survivorship. Almont T, Delannes M, Ducasson A, et al. Sexual Quality of Life and Needs for Sexology Care of Cancer Patients Admitted for Radiotherapy: A 3-Month Cross-Sectional Study in a Regional Comprehensive Reference Cancer Center. J Sex Med 2017;14:566-576.

[Oncologic supportive care for a personalized support of all patients]. / Les soins de support pour améliorer l'accompagnement personnalisé des patients.

Ever since the officialization of oncologic supportive care by the DHOS circular in February 22nd, 2005 and measure 42 of the 2003-2007 Cancer Plan, their content has been enriched for inpatients and outpatients. A guaranteed care package was determined in February 2017 following a study lead by AFSOS and INCa. It adds adapted physical activity and sexual health support to basic supportive care such as pain relief, nutrition, psychology, social support. Supportive cares in pediatric oncology were defined in March 2004. They always were part of holistic pediatric care. The offer in supportive care for children and AYA and the offer in adult supportive care can complete, inspire or improve each other.

Pauci-symptomatic disseminated tuberculosis revealed by an increase in the specific antigen of the prostate.

Tuberculosis remains a leading cause of morbidity and mortality in developing countries, including my country. It usually affects the lungs, but it can also affect other parts of the body. Its prostatic location is very rare, described for the first time by Jasmin in 1882. The diagnosis of certainty requires positive cultures, Ziehl - Nielsen staining, PCR and/or histological examination. Therapeutically, antituberculous chemotherapy has radically transformed the management of tuberculosis, and is currently the basis of treatment for this condition. We report an original observation of pauci-symptomatic disseminated tuberculosis revealed by an increase in the prostate specific antigen (PSA).

Priapism / Priapisme

Priapism. Priapism is a therapeutical emergency for 2 major reasons: the risk of cavernous acute ischemia specific to acute venous priapism by far the most frequent, and to avoid the erectile sequels by treating before the 24th hour. The physiopathological diagnosis and the etiological check-up are two mandatory steps for the treatment. In the majority of cases, the clinical step easily differentiates between the arterial or venous (acute or not) type. Major progress, the treatment must be always progressive and adapted to both (arterial and venous) mechanism and anoxic suffering explaining the cavernous blood gas role. In case of venous acute priapism, the medical treatment, always efficient before the 24th hour, has reduced the surgery only indicated for patients consulting too late. The prevention of erectile sequels that too often concern young people requires: a) to sensitize the at-risk populations (sickle cell disease or drug therapy for erectile dysfunction), 2) to homogenize the first line care treatment.

Priapisme. Le priapisme est une urgence thérapeutique pour deux raisons majeures : le risque d'ischémie aiguë propre au priapisme veineux aigu, de loin le plus fréquent ; pour éviter les séquelles érectiles en traitant avant la 24e heure. Le diagnostic physiopathologique et le bilan étiologique sont deux étapes indispensables pour la conduite à tenir. Dans la majorité des cas, la clinique distingue sans difficultés le priapisme artériel du priapisme veineux (aigu ou non). Progrès majeur, le traitement doit être toujours progressif, adapté au mécanisme (artériel ou veineux) et à la souffrance anoxique (d'où le rôle de la gazométrie). En cas de priapisme veineux aigu, le traitement médical, très efficace avant la 24e heure, a réduit la chirurgie indiquée seulement pour les patients vus trop tard. La prévention des séquelles érectiles qui affectent encore trop de sujets souvent jeune, nécessite de sensibiliser les populations à risque (drépanocytose et traitements médicamenteux de l'insuffisance érectile), et d'homogénéiser la prise en charge en soins primaires.

Focal High Intensity Focused Ultrasound of Unilateral Localized Prostate Cancer: A Prospective Multicentric Hemiablation Study of 111 Patients.

BACKGROUND: Up to a third of patients with localized prostate cancer have unilateral disease that may be suitable for partial treatment with hemiablation. OBJECTIVE: To evaluate the ability of high intensity focused ultrasound (HIFU) to achieve local control of the tumor in patients with unilateral localized prostate cancer. DESIGN, SETTING, AND PARTICIPANTS: The French Urological Association initiated a prospective IDEAL multi-institutional study (2009-2015), to evaluate HIFU-hemiablation as a primary treatment. INTERVENTION: Multiparametric magnetic resonance imaging and biopsy were used for unilateral cancer diagnosis and control, and HIFU-hemiablation. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Primary: absence of clinically significant cancer (CSC) on control biopsy at 1 yr (CSC: Gleason score ≥ 7 or cancer core length>3mm regardless of grade or > 2 positive cores). Secondary: presence of any cancer on biopsy, biochemical response, radical treatment free survival, adverse events, continence (no pad), erectile function (International Index of Erectile Function-5 ≥ 16), and quality of life (European Organization for Research and Treatment of Cancer QLQ-C28) questionnaires. RESULTS AND LIMITATIONS: One hundred and eleven patients were treated (mean age: 64.8 yr [standard deviation 6.2]; mean prostate-specific antigen: 6.2 ng/ml [standard deviation 2.6]; 68% low risk, 32% intermediate risk). Of the 101 patients with control biopsy, 96 (95%) and 94 (93%) had no CSC in the treated and contralateral lobes, respectively. Mean prostate-specific antigen at 2 yr was 2.3 ng/ml (standard deviation 1.7). The radical treatment-free survival rate at 2 years was 89% (radical treatments: six radical prostatectomies, three radiotherapies, and two HIFU). Adverse events were Grade 3 in 13%. At 12 mo continence and erectile functions were preserved in 97% and 78%. No significant decrease in quality of life score was observed at 12 mo. One limitation is the number of low-risk patients included in this study. CONCLUSIONS: At 1 yr, HIFU-hemiablation was efficient with 95% absence of clinically significant cancer associated with low morbidity and preservation of quality of life. Radical treatment-free survival rate was 89% at 2 yr. PATIENT SUMMARY: This report shows that high intensity focused ultrasound half-gland treatment of unilateral prostate cancer provides promising results with high cancer control and low morbidity.

[Is intracavernosal corticosteroid infiltration really useless in Peyronie's disease?]. / L'infiltration intracaverneuse de corticoïdes est-elle réellement sans intérêt dans la maladie de Lapeyronie?

UNLABELLED: The value of intracavernosal corticosteroid infiltration remains controversial or may even be contraindicated in Peyronie's disease, as it is considered to be ineffective and a source of morbidity. OBJECTIVE: To retrospectively analyse the efficacy and safety of intracavernosal corticosteroid infiltration in a selected population only presenting clinical criteria of the acute phase of Peyronie's disease (pain and/or recent onset < 6 months). MATERIAL AND METHOD: Intracavernosal corticosteroid infiltration (weekly or twice-weekly) was performed in or around the plaque. Evaluation was based on clinical criteria according to the course of pain, the nodule and curvature and the rates of improvement, resolution, stabilization and deterioration of these criteria were studied. RESULTS: In a series of 271 patients, 123 presented criteria of the acute phase of Peyronie's disease. Forty five of these patients were treated exclusively by intracavernosal corticosteroid infiltration. The mean age was 52 +/- 8 years. The number of intracavernosal infiltrations was usually less than 10 (n = 40) with less than 8 injections in the majority of patients (n = 36). Follow-up was 6 months. There were no cases of clinical deterioration. The best results were observed on pain, which decreased (13.6%) or totally resolved (61.4%). Curvature was decreased (20.5%), the plaque decreased (25%) or disappeared (9%). When intracavernosal corticosteroid infiltration is ineffective, it appears useless to administer more than 3 injections. No morbidity was observed. CONCLUSION: In our population, the reputation of inefficacy and morbidity of local corticosteroid therapy appears to be unjustified. There were no cases of deterioration, but, on the contrary, stabilization and especially very marked and rapid efficacy on pain, but a lesser efficacy on curvature and plaque. Local steroid therapy appears justified during the acute phase, as the injection allows corticosteroids to exert their anti-inflammatory action in situ in line with the pathophysiology of the disease. A standardized, multicentre, prospective, randomized, placebo-controlled study could confirm our impressions.

["Penis angina" or the current revolution in erectile dysfunction (ED)]. / L' "angor de verge" ou la révolution actuelle de la dysfonction erectile (DE).

Erectile dysfunction (ED) can no longer be neglected by the medical profession, as the presence of ED is never entirely benign, but is always a reliable marker of a sexual disorder but also (and sometimes especially) a non-sexual disorder (physical and/or mental). Its documented association with many chronic diseases and high-risk situations is in the process of extending the significance of ED beyond the purely sexual domain, as this symptom, easily detected by simple clinical interview, appears to be not only a barometer of health, but also a warning indicator of situations that can sometimes be dangerous for the patient's health. For example, in male populations with a high vascular risk, ED is as frequent as diabetes and metabolic syndrome, and must be considered, until proof to the contrary, to reflect angina of the penis, i.e. an exercise-induced vascular symptom, which has a double warning value: 1) marker of deterioration, 2) potential prodrome of acute vascular accidents. These close relations between ED and cardiovascular disease give a completely different dimension to ED, which now constitutes a potential candidate for a new clinical vascular marker and possibly, in some cases, a new marker of cardiovascular risk. These unexpected roles of revealing factor and clinical marker of multiple health states (cardiovascular or other) paradoxically contribute to "desexualization" of ED, as sexual health no longer appears to be the major risk involved. In particular, they open the realistic perspective of opportunistic and proactive detection of ED in well targeted populations for the purposes of primary prevention of cardiovascular disease, a public health priority. For all these reasons, the development of ED requires a minimal evaluation of the patient's state of health, regardless of the doctor's qualification, by clearly distinguishing quality of life and health objectives. This modern management of ED is part of an individual (humanistic) and social (civic and ethical) approach. This "revolution" complies with the requirements of a good quality scientific approach, which comprises the concepts of evidence-based medicine and a rational approach to the service rendered to the patient, as management of his sexual health (and not his sexuality) also comprises management of his general health.

[Preservation of erectile function and radical prostatectomy: what to expect in 2005?]. / Préservation de la fonction erectile et prostatectomie radicale: que faut-il penser en 2005?

The preservation of erectile function in patients undertaking radical prostatectomy was discussed in multiple studies. In this review article we will discuss the factors which influence the recovery of erections as well as the therapeutic modalities. In fact, four possibilities of prevention and treatment are currently available: (1) nerve sparing surgery, (2) nerve grafting, (3) nerve stimulation and (4) pharmacotherapy after surgery.

[Sexual health management in oncology]. / L'intervention sexologique en oncologie.

The cancer and its treatments have consequences on the intimacy and the sexuality of the patients and their partners. Supporting them with valid information, by spotting risk factors, warning complications, and by bringing answers to the often commonplace concerns of the patients, is an ethical duty. This intervention concerning the sexual health is collectively realized by all the healthcare professionals, in an organization of gradual answer, and benefits ideally from the clinical and educational expertise of sex therapists associated to the supporting care offer.

[The personalized health care process in oncosexology: a new health care offer in the service of both patients and health carers]. / Le parcours personnalisé de soins en oncosexologie : une nouvelle offre de soins au service des soignés et des soignants.

The sexual problematic linked to both cancers and their treatments remains underestimated by health carers especially since patients dare not speak about it. The oncosexology is a new offer of health care responding to an epidemiological reality, a strong demand, a care quality process and a societal demand of ethical, technical and humanist medicine. It aims at conciliating the oncological and quality of life objectives because sexual health belongs to oncological care and quality of life belongs to well-being for a majority of people/couple. By comparison to the pain situation of 20 years ago, a proactive politics is necessary to change the individual level to a collective one by modifying the attitudes of patients and… health carers, that is, by breaking the silence, by legitimating the demand and by allowing all the actors to be open about it. The optimal strategy for actualizing the "software" of physicians, who are the main factor of resistance, consists in simplifying and professionalizing the oncosexology by responding to the needs for information and offer visibility for all, and training for the most sensitized or involved carers. The term oncosexology should not shock. This new competence in supportive care corrects a real inequality of access to health care and fits in with a medical humanism by promoting a more personalized approach as much initially as in follow-up: a) to inform about sexual risks and sequels is an ethical and legal duty, b) the therapeutic strategy may be influenced by the iatrogenic sexual risk, which is frequently treatment-dependant, c) the impact and demand evolve throughout the health care process, d) multidisciplinary solutions exist according to the demand and its simple or complex nature, e) the impact is often positive for the patient/couple.

Ethical aspects of sexual medicine.

INTRODUCTION: Ethics describe the ways in which moral life is understood. Morality comprises norms for human conduct, and addresses what is right and what is wrong. AIM: To provide a consensus-based summary of the ethical aspects of sexual medicine. METHODS: Over 200 multidisciplinary specialists from 60 countries were divided into 17 consultation committees as part of a process organized by an international consultation on sexual medicine held in Paris, June 28-July 1, 2003 in close alliance with several sexual medicine organizations. Embarking on a study on ethics in sexual medicine, 10 experts from eight countries assembled over a two-year period to develop this consensus-based summary. MAIN OUTCOME MEASURE: Although ethics are recognized as subjective, expert opinion was based on grading of evidence-based medical literature, in addition to cultural and ethical considerations. The process also involved extensive internal committee discussion, public presentation, and debate. RESULTS: Contemporary medical practitioners provide health care for patients from many different cultures from all around the world. Thus, it is recommended that all health professionals working in sexual medicine should above all be able to demonstrate respect, understanding, and tolerance toward the differing moral worldviews of their patients and colleagues, and the societies they represent. In sexual medicine, health professionals have an obligation to respect the autonomy of any individual that they treat, regardless of that individual's religious or socio-cultural tradition, race, gender, or sexual orientation. Sexual rights are a necessary condition for sexual health. Sexual health requires a positive and respectful approach to sexuality and sexual relationships as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected, and fulfilled. CONCLUSIONS: Additional discussion and research on ethics in sexual medicine is needed.