Choosing Castration: A Thematic Analysis of the Perceived Pros and Cons of Genital Injuries and Ablation by Men Who Voluntarily Sought Castration.

Some men elect castration voluntarily without any clear medical reason. Here we aim to document their perception of genital ablation and injuries to better understand their motivations for castration. Participants completed an online survey with open-ended questions related to their perspectives on castration, genital ablation, and genital injuries. Thematic analyses were performed on the responses to these questions. Responses were obtained from 208 male castrated individuals (51.9 ± 16.0 years old). Among these, 154 were physically castrated, 36 chemically castrated, and 18 nullified (had testicles and penis removed). The majority learned about castration from media (55.8%) or animal castration (23.4%). The circumstances when they first wanted to be castrated varied greatly. Most (46.3%) wished to achieve an idealized self motivated by gender dysphoria, body integrity dysphoria, or wanting to be conspicuously non-sexual. The top themes we identified related to the respondents' perceptions of the pros of genital ablation were physical appearance, psychological benefit (i.e., a "eunuch calm"), and being non-sexual. Conversely, themes related to the cons they saw in having no genitals ranged from no disadvantages to loss of sexual/reproductive capability. Some perceived performing genital injury as a step toward ultimate castration or nullification. The respondents similarly varied in whether they saw any loss in having non-functional testicles. Perceptions in this regard appeared to differ depending on whether the respondents were taking supplemental androgens post-castration. Motivations for castration vary greatly between individuals. Clinicians need to understand men's diverse perceptions on castration in order to provide appropriate care for individuals with strong castration desire.

Knowledge and Attitudes Regarding Surgical Castration in Men Receiving Androgen Deprivation Therapy for Metastatic Prostate Cancer and Their Relationship to Health-Related Quality of Life.

OBJECTIVE: To determine the attitudes and education regarding surgical castration in men receiving androgen deprivation therapy (ADT) for metastatic prostate cancer (mCaP). METHODS: We identified 142 patients receiving ADT for mCaP at our institution without prior orchiectomy who were then sent 2 surveys via mail: (1) A questionnaire to assess knowledge and understanding of ADT treatment alternatives and (2) the functional assessment of cancer therapy - prostate (FACT-P) questionnaire which determines health-related quality of life (HRQOL). Two cohorts were created based on the answer to "would you be interested in surgical orchiectomy?" and demographic, CaP and HRQOL were compared between the surgical castration yes (SC+) and surgical castration no (SC-) cohorts. A second analysis identified predictors of worse HRQOL. RESULTS: Of 68 (47.9%) patients that responded to the survey, only 39 (59.1%) recalled a discussion regarding treatment alternatives to ADT and only 22 (33.3%) recalled a discussion regarding orchiectomy. There were 24 (40.0%) patients that stated interest in undergoing orchiectomy (SC+) as an alternative to ADT with the only independent risk factor being "…bother from the number of clinical appointments required for ADT…" Patients most bothered by side effects and cosmetic changes associated with ADT reported lower HRQOL scores on the FACT-P. CONCLUSIONS: Few men on ADT knew about surgical alternatives, implying that educational deficits may be a significant factor in the decline in the utilization of orchiectomy. Changes in healthcare economics, utilization and delivery brought on by a global pandemic should warrant a fresh look at the use of surgical castration.

Satisfaction and genital perception after orchiectomy for prostate cancer: does the technique matter? A randomized trial.

OBJECTIVES: Bilateral extracapsular or total orchiectomy (BEO) for prostate cancer is presumed to have psychological consequences after the surgery due to perception of an empty scrotum. Bilateral subcapsular orchiectomy (BSO) was designed to preserve perception of palpable testes. We compared the patients' satisfaction and genital perception following BEO and BSO. MATERIALS AND METHODS: Prostate cancer patients eligible for androgen deprivation therapy who opted for orchiectomy were enrolled in prospective randomized study. Patients with bleeding disorder or uncorrected coagulopathy, poor performance score, and psychiatric problems were excluded. Outlook to life and own health in-general, overall satisfaction to the procedure and genital perception was evaluated using modified Fugl-Meyer questionnaire (FMQ) which was administered before and after 3 months of the surgery. Patients were randomized to BEO and BSO groups at the time of surgery using block randomization. Primary outcome was to compare the genital perception of testicular loss and patients' satisfaction to BSO and BEO. Secondary outcomes included testosterone and PSA control, operative time, and complications. RESULTS: Total 35 patients were enrolled in each group which was comparable. There was no difference in PSA control at 3 months. Mean operative time and blood loss were significantly lesser in BEO group. FMQ score at 3 months did not show significant difference. Majority of the patients in both groups were satisfied with procedure and the aesthetic value of scrotum after surgery. However, 84% in BSO group did not feel that testes were removed on self-examination, as compared to 28% in BEO group. Majority patients in both groups did not report physical or psychological discomfort from change in scrotal content. CONCLUSIONS: Results showed that patients' satisfaction and genital perception following BSO and BEO were similar. Feeling of remaining intrascrotal contents after BSO did not had added psychological advantage in terms of perception of genitalia.

French veterinarians' opinions and practices regarding early neutering of cats: a convenience sampling survey interpreted in an international context.

BACKGROUND: Although data are still needed, early neutering of cats appears to be as safe as neutering at the traditional age of six months or older and beneficial to the individual and the population. The aim of this observational study was to obtain an overview of veterinarians' opinions and practices about feline early neutering (ie, until the age of four months). METHODS: In this retrospective work, a web survey was distributed to French practitioners. RESULTS: A total of 609 veterinarians returned the survey. Majority of the veterinarians (56 per cent) reported never performing early neutering, 42 per cent reported performing it inconsistently, and 2 per cent reported consistently performing it. When carried out, it was mainly on kittens from commercial breeding, following breeders' request, and performed at the age of three months. An overwhelming majority (93 per cent) of veterinarians performing early neutering reported no incidents. Veterinarians who did not practise early neutering neutered mostly (81 per cent) kittens from four to six months of age. CONCLUSION: In conclusion, early neutering is still not a common practice among French veterinarians. Opinions differed as to its advantages and disadvantages, although reported incidents were scarce. Veterinarians who do not perform early neutering reported a lack of interest in this practice rather than reluctance.

Change in Norwegian consumer attitudes towards piglet castration: increased emphasis on animal welfare.

BACKGROUND: Male piglets are surgically castrated at a young age primarily to prevent pork meat from being tainted with boar taint, an offensive taste and odor that can be present in uncastrated male pigs. The practice of surgical castration is considered to be both stressful and painful for the piglets, and is therefore under scrutiny due to animal welfare concerns. Rearing of intact males or vaccination against boar taint (immunocastration) are two potential alternatives to surgical castration, but in order to successfully implement either of these alternatives, consumer acceptance of the different methods must be taken into consideration as it will be central for future sales of pork products. A consumer survey mapping Norwegian consumers' attitudes toward piglet castration was conducted to explore whether the consumers' position regarding castration has changed since an almost identical study was completed in 2008. RESULTS: The internet-based survey found that Norwegian consumers are comfortable with the current practice of surgical castration with anesthesia, but also that they are open to the alternative method of vaccination against boar taint. When provided additional information stating that vaccination against boar taint may not be able to reduce boar taint to the levels that castration with anesthesia does, consumer skepticism towards vaccination increased. When evaluating castration methods, animal welfare was the most important influencing factor. Since the original survey from 2008, animal welfare was also the single factor that has increased the most among a set of assessment criteria when purchasing pork products. CONCLUSION: Norwegian consumers regard animal welfare as an important factor both when purchasing pork products and when evaluating different methods of castration, and animal welfare as a factor has increased in importance since the initial survey in 2008. Although the current practice of castration using local anesthesia is still widely accepted among consumers, the acceptance of today's method has declined since the original survey in 2008.

A retrospective internet-based survey of French cat breeders about early-age neutering.

OBJECTIVES: The aim of this study was to analyse cat breeders' application of and opinions concerning early-age (ie, <16 weeks old) neutering in cats in France. METHODS: This study analysed a retrospective cohort. A web survey was designed for French cat breeders and was published in June 2017 on the Facebook page of Livre Officiel des Origines Félines, the official feline studbook for purebred cats born in France. The early-age cat neutering habits, opinions and expectations of breeders were collected. RESULTS: A total of 999 breeders returned the questionnaire. Almost half of the breeders (49%) reported consistently requesting neutering of kittens before selling them, 32% claimed that they never requested it and the remaining 19% reported that they inconsistently requested it. When performed, 83% of breeders had kittens neutered at 12 weeks of age; for a large majority of these breeders (94%), the neutering was undertaken on their own initiative. Various reasons for neutering were provided, including the prevention of uncontrolled breeding, short- and long-term welfare benefits for neutered cats, and practical and economic reasons. Reported incidents related to early-age neutering were scarce. Nearly half of breeders who did not apply early-age neutering to their kittens cited a veterinarian's unwillingness to perform the surgery as a cause. CONCLUSIONS AND RELEVANCE: A large majority of surveyed French cat breeders supported early-age neutering that would occur before kittens were sold, most of the time at the age of 3 months. These breeders reported high satisfaction with early-age neutered cats, with a low number of incidents and accidents reported.

Patient Attitudes Toward Testicular Prosthesis Placement After Orchiectomy.

Orchiectomy is the standard of care for many testicular conditions. Testicular prosthesis placement (TPP) can mitigate psychosocial burden, restore self-image, and improve quality of life for patients requiring orchiectomy. Limited data exist regarding patient attitudes and counseling on TPP in the United States. The objective of this study was to characterize patient experiences after TPP, rationale for pursuing/declining TPP, and satisfaction levels. Patients with a history of urologic conditions warranting orchiectomy were identified and sent an anonymous survey addressing demographics, pre/post counseling, attitudes toward TPP, satisfaction rates, and postoperative complications. Sixteen percent (76/480) of patients completed the survey. Of these, 50.8% (32/63) undergoing orchiectomy were counseled by their surgeon about TPP, and 22.2% (14/63) received a prosthesis. The most common reasons for declining TPP included lack of concern for cosmetic appearance and lack of counseling. Leading reasons for pursuing TPP included improving self-confidence and cosmetic appearance. Although 71% (10/14) of patients were satisfied with TPP, they did highlight areas for improvement. Twenty percent (2/10) felt their implant was too high, 60% (6/10) felt their implant was too firm, 10% (1/10) endorsed discomfort during sex, and 30% (3/10) felt that TPP did not match their size expectations. Despite these findings, 71% (10/14) reported that they would have TPP again and 79% (11/14) would recommend TPP to others. TPP improves body image and quality of life following orchiectomy. Provider counseling plays an important role in influencing a patient's decision to undergo TPP. Areas of improvement include implant positioning and more effective replication of testicular consistency.

Combined dipeptidyl peptidase-4 inhibitor with low-dose testosterone exerts greater efficacy than monotherapy on improving brain function in orchiectomized obese rats.

Both obesity and orchiectomy lead to the development of brain pathologies and cognitive decline. Testosterone replacement therapy (2 mg/kg/day TRT) and dipeptidyl peptidase-4 inhibitor (vildagliptin) improved cognition in orchiectomized rats, and obese rats. However, both had no beneficial effects in brain of orchiectomized-obese rats. TRT (>2 mg/kg/day) is possible to attenuate brain defects in those rats, but high dose of TRT causes adverse effects. Then, combined effect of low-dose TRT (1 mg/kg/day) and vildagliptin on brain and cognitive functions in orchiectomized-obese rats should be investigated. Sixty male rats were fed with either a normal diet (ND) or a high-fat diet (HFD) for 28 weeks. At week 13, both ND and HFD-fed rats had either a sham-operation or an orchiectomy. At week 25, orchiectomized rats were treated with either: a vehicle, 2 mg/kg/day TRT, vildagliptin (3 mg/kg/day) or a combined vildagliptin with 1 mg/kg/day TRT for 4 weeks. Then, metabolic parameters, brain and cognitive functions were determined. Hippocampal oxidative stress, apoptosis, dendritic spine loss, microglial hyperactivity, and cognitive decline were found in orchiectomized ND-fed rats and sham-operated HFD-fed rats. Interestingly, orchiectomy aggravated these brain pathologies and cognitive decline in HFD-fed rats. In orchiectomized ND-fed rats, all treatments restored brain and cognitive functions. In orchiectomized HFD-fed rats, monotherapies ameliorated these brain pathologies, while the combined therapies had the greatest beneficial effect on the brains. These findings suggest the combined therapies may be the best therapeutic approach for restoring brain functions in the orchiectomized-obese condition.

Vortioxetine reverses medial prefrontal cortex-mediated cognitive deficits in male rats induced by castration as a model of androgen deprivation therapy for prostate cancer.

RATIONALE: Androgen deprivation therapy (ADT) is an effective treatment for prostate cancer, but induces profound cognitive impairment. Little research has addressed mechanisms underlying these deficits or potential treatments. This is an unmet need to improve quality of life for prostate cancer survivors. OBJECTIVES: We investigated mechanisms of cognitive impairment after ADT in rats and potential utility of the multimodal serotonin-targeting drug, vortioxetine, to improve the impairment, as vortioxetine has specific efficacy against cognitive impairment in depression. METHODS: Male Sprague-Dawley rats were surgically castrated. Vortioxetine (28 mg/kg/day) was administered in the diet. The attentional set-shifting test was used to assess medial prefrontal cortex (mPFC) executive function. Afferent-evoked field potentials were recorded in the mPFC of anesthetized rats after stimulating the ventral hippocampus (vHipp) or medial dorsal thalamus (MDT). Gene expression changes were assessed by microarray. Effects of vortioxetine on growth of prostate cancer cells were assessed in vitro. RESULTS: ADT impaired cognitive set shifting and attenuated responses evoked in the mPFC by the vHipp afferent, but not the MDT. Both the cognitive impairment and attenuated vHipp-evoked responses were reversed by chronic vortioxetine treatment. Preliminary investigation of gene expression in the mPFC indicates that factors involved in neuronal plasticity and synaptic transmission were down-regulated by castration and up-regulated by vortioxetine in castrated animals. Vortioxetine neither altered the growth of prostate cancer cells in vitro nor interfered with the antiproliferative effects of the androgen antagonist, enzalutamide. CONCLUSIONS: These results suggest that vortioxetine may be useful in mitigating cognitive impairment associated with ADT for prostate cancer.

Management of self-inflicted orchiectomy in psychiatric patient. Case report and non-systematic review of the literature.

INTRODUCTION: Self-inflicted orchidectomy and auto-castration, also known as "Eshmun complex" is a rare phenomenon. The aim of our study it to present the management of a patient who performed a self orchiectomy and propose a non-systematic review of literature about self-orchiectomy. MATERIAL AND METHOD: A 27-years old male Patient with psychiatric disorder was admitted to our ward to have been cutted his scrotum with scissors and cut away his left testicle causing active bleeding from the left spermatic artery. The patient underwent emergency surgery with clamping of the spermatic cord and hemostasis of the wound. RESULTS: After surgery the clinical condition of the patient remained good during whole hospitalization. Urgent psychiatric evaluation was performed in order to administer proper therapy for acute management. To best of our knowledge, only 11 cases of self-orchidectomy are reported in literature and all of them except 1 case, underwent surgical exploration. CONCLUSIONS: Self-orchidectomy is an extremely rare phenomenon, often associated with psychiatric disorders, compounded by the use of drugs. In our opinion, emergency surgery should be the first choice of treatment, offering diagnostic and hemostatic purpose in a single act, aimed to prevent acute and postacute complications.

ESMO Consensus Conference on testicular germ cell cancer: diagnosis, treatment and follow-up.

The European Society for Medical Oncology (ESMO) consensus conference on testicular cancer was held on 3-5 November 2016 in Paris, France. The conference included a multidisciplinary panel of 36 leading experts in the diagnosis and treatment of testicular cancer (34 panel members attended the conference; an additional two panel members [CB and K-PD] participated in all preparatory work and subsequent manuscript development). The aim of the conference was to develop detailed recommendations on topics relating to testicular cancer that are not covered in detail in the current ESMO Clinical Practice Guidelines (CPGs) and where the available level of evidence is insufficient. The main topics identified for discussion related to: (1) diagnostic work-up and patient assessment; (2) stage I disease; (3) stage II-III disease; (4) post-chemotherapy surgery, salvage chemotherapy, salvage and desperation surgery and special topics; and (5) survivorship and follow-up schemes. The experts addressed questions relating to one of the five topics within five working groups. Relevant scientific literature was reviewed in advance. Recommendations were developed by the working groups and then presented to the entire panel. A consensus vote was obtained following whole-panel discussions, and the consensus recommendations were then further developed in post-meeting discussions in written form. This manuscript presents the results of the expert panel discussions, including the consensus recommendations and a summary of evidence supporting each recommendation. All participants approved the final manuscript.

Bilateral subcapsular orchiectomy versus bilateral total orchiectomy: Comparison of the quality of life post-orchiectomy.

OBJECTIVE: Bilateral subcapsular orchiectomy (BSO) is said to be more aesthetic and psychologically satisfying when compared to bilateral total orchiectomy (BTO). This study compared the quality of life (QoL) of men with advanced prostate cancer who had BTO to those who had BSO, with an emphasis on their perception of self or identity as a man. SUBJECTS AND METHODS: Sixty-one patients with advanced prostate cancer opting for bilateral orchiectomy were recruited. Pre-orchiectomy and at 1 month and 3 months post-orchiectomy, the Functional Assessment of Cancer Therapy for Prostate cancer (FACT-P) questionnaires were administered and scored. RESULTS: Thirty (49.18%) patients had BTO (BTO group), while 31 (50.82%) patients had BSO (BSO group) for advanced prostate cancer. On comparison of the two groups, there were no statistically significant differences in FACT-P scores at 1 month and 3 months. The subscale scores also showed no significant statistical difference except for the physical well-being score at 3 months post-orchiectomy, which was lower in the BSO group (P = 0.041). The average scores of Item P5 (I am able to feel like a man) which were used to assess the sex-role identity declined on an average over 3 months with no statistically significant difference on comparison of the two groups. CONCLUSION: The QoL scores (FACT-P and FACT-G) assessed over 3 months post-orchiectomy did not differ on comparison of the BTO group and the BSO group. Performing a BSO in our region did not result in any psychological benefit when compared to performing a BTO.

Effect of castration on social behavior and hormones in male Japanese macaques (Macaca fuscata).

Population control is essential for animal welfare and human safety in free-ranging or captive settings, especially when resources are limited. As an alternative to lethal control, contraceptive methods such as castration in males can be a practical solution, because the testicles are a visual cue to determine which males have been sterilized. However, careful analyses should be carried out to ensure no disruption in the social structure of the population. Japanese macaques (Macaca fuscata) live in a society centered around dominance rank and matrilineal kin relationships. Testosterone and glucocorticoids have been correlated with dominance rank in humans and other species, but previous studies in Japanese macaques were inconclusive. This study aimed to investigate behavioral and physiological differences between castrated and intact male Japanese macaques, and to examine the effect of season and behavior in hormonal concentrations in intact males. Our subjects were six intact males from Jigokudani Monkey Park (Japan) and 13 castrated males from Born Free Primate Sanctuary (USA). We collected behavioral data using both focal and ad libitum sampling, and fecal samples for determination of testosterone (fT) and glucocorticoids (fGC) by enzyme immunoassay. We found that castrated males exhibited a social hierarchy, but not a linear hierarchy, as was the case in intact males. Castrated males were less aggressive than intact males, probably because fT concentrations were lower in the castrated males. Age was positively correlated with fGC levels, while fT concentrations were lower in old males than younger adult males. Fecal T levels correlated with both rank and atmospheric temperature. In intact males, both fGC and fT levels were elevated during the mating season. We found a negative correlation between fGC levels and the amount of grooming received. Our findings indicate that castration had a minimal impact on sociality, with season, temperature, and rank all influencing male sex steroid levels in intact males. Our study indicates that castration can be adopted as a population control mechanism without drastically altering the social relationships of males.

Influence of hands-on experience on pig farmers' attitude towards alternatives for surgical castration of male piglets.

This study evaluates the influence of practical experience with alternatives for surgical castration (SC) on farmer attitudes. Nineteen farmers in Flanders were surveyed before (ex-ante) and after (ex-post) performing each of five treatments on farm: 1) SC with analgesia (SCAN); 2) SC with CO2 anaesthesia (SCCO2); 3) immunocastration (IM); 4) production of entire males (EM); and 5) SC without pain relief (SCN). For SCCO2 and SCAN, farmers mainly experienced disadvantages in terms of increased labour, costs and complexity. Hands-on experience promoted EMas a valid alternative for SCN due to the actual and perceived improvement in performance and profitability as well as the reduced labour demands. Experience with IM did not fully fulfil the favourable ex-ante expectations resulting in a level of dissatisfaction and a less favourable general attitude ex-post.

Psychological effects of androgen-deprivation therapy on men with prostate cancer and their partners.

The clinical benefits of androgen-deprivation therapy (ADT) for men with prostate cancer (PC) have been well documented and include living free from the symptoms of metastases for longer periods and improved quality of life. However, ADT comes with a host of its own serious side effects. There is considerable evidence of the adverse cardiovascular, metabolic, and musculoskeletal effects of ADT. Far less has been written about the psychological effects of ADT. This review highlights several adverse psychological effects of ADT. The authors provide evidence for the effect of ADT on men's sexual function, their partner, and their sexual relationship. Evidence of increased emotional lability and depressed mood in men who receive ADT is also presented, and the risk of depression in the patient's partner is discussed. The evidence for adverse cognitive effects with ADT is still emerging but suggests that ADT is associated with impairment in multiple cognitive domains. Finally, the available literature is reviewed on interventions to mitigate the psychological effects of ADT. Across the array of adverse effects, physical exercise appears to have the greatest potential to address the psychological effects of ADT both in men who are receiving ADT and in their partners.

Testicular prostheses in patients with testicular cancer - acceptance rate and patient satisfaction.

BACKGROUND: The loss of a testicle to cancer involves much emotional impact to young males. Little is known about the number of patients with testicular germ cell tumour (GCT) who would accept a testicular prosthesis. Also, knowledge about the satisfaction of implant recipients with the device is limited. METHODS: A retrospective chart analysis was performed on 475 consecutive GCT patients. Prior to orchiectomy, all patients were offered prosthesis insertion. Acceptance of implant was noted along with age, clinical stage, histology and year of surgery. 171 implant recipients were interviewed using an 18 item questionnaire to analyze satisfaction with the prosthesis. Statistical analysis involved calculating proportions and 95% confidence intervals. Multivariate analysis was performed to look for interrelations between the various items of satisfaction with the implant. RESULTS: 26.9% of the patients accepted a prosthesis. The acceptance rate was significantly higher in younger men. Over-all satisfaction with the implant was "very high" and "high" in 31.1% and 52.4%, respectively. 86% would decide again to have a prosthesis. Particular items of dis-satisfaction were: implant too firm (52.4%), shape inconvenient (15.4%), implant too small (23.8%), position too high (30.3%). Living with a permanent partner had no influence on patient ratings. Multivariate analysis disclosed numerous inter-relations between the particular items of satisfaction. CONCLUSIONS: More than one quarter of GCT patients wish to have a testicular prosthesis. Over-all satisfaction with implants is high in more than 80% of patients. Thus, all patients undergoing surgery for GCT should be offered a testicular prosthesis. However, surgeons should be aware of specific items of dis-satisfaction, particularly shape, size and consistency of the implant and inconvenient high position of the implant within the scrotum. Appropriate preoperative counselling is paramount.

Cognitive impairment and potential biological and psychological correlates of neuropsychological performance in recently orchiectomized testicular cancer patients.

OBJECTIVE: The aim of this study was to determine the prevalence of cognitive impairment (CI) in newly diagnosed and orchiectomized testicular cancer (TC) patients prior to systemic treatment, and to explore biological and psychological correlates. METHODS: Sixty-six TC patients were compared with 25 healthy men on neuropsychological tests and a measure of cognitive complaints. CI status and a global composite score (representing overall neuropsychological performance) were calculated for each participant. Possible psychological (depression, anxiety, stress, and post-traumatic stress symptoms) and biological (cortisol, IL-6, TNF-α, and CRP) correlates and predictors of patients' cognitive functioning were explored. RESULTS: TC patients had lower scores on 6 out of 11 neuropsychological outcomes (p < 0.01) in processing speed, attention, and working memory, verbal learning and memory, and verbal fluency. Prevalence of CI among TC patients was 58%, significantly exceeding the frequency in healthy men (p < 0.01). Patients' cortisol levels predicted overall neuropsychological performance (p = 0.04). Cognitive complaints were associated with IL-6 (p = 0.02) and all psychological distress measures (p < 0.001). CONCLUSIONS: The prevalence of CI in recently orchiectomized TC patients was unexpectedly high with patients performing more poorly than healthy controls on a majority of neuropsychological outcomes. Cortisol is a potential predictor of neuropsychological performance in TC patients prior to cytotoxic treatment.

Orchiectomy and radiotherapy for stage I-II testicular seminoma: a prospective evaluation of short-term effects on body image and sexual function.

INTRODUCTION: Orchiectomy followed by infradiaphragmatic radiotherapy is a common treatment for stage I-II testicular seminoma. Long-term effects of orchiectomy and radiotherapy for testicular seminomas on body image and sexual function have been reported; however, few data are available on short-term effects. Patients are usually of reproductive age and sexually active; therefore, short-term effects on body image and sexual function should also be studied. AIMS: To prospectively evaluate short-term effects of orchiectomy and radiotherapy on body image and sexual function in testicular seminoma patients. METHODS: Questionnaires on body image and sexual function were prospectively distributed to all testicular seminoma patients treated between 1999 and 2013. The questionnaire distributed prior to radiotherapy was returned by 161 patients; 133 (82%) returned the second after 3 months, and 120 (75%) completed the questionnaire after 6 months. MAIN OUTCOME MEASURES: Body image and sexual function as assessed by a Dutch questionnaire on body image and sexuality after radiotherapy and orchiectomy. RESULTS: Median age was 36 years (range 18-70). After orchiectomy, 48% expressed fertility concerns, and 61% reported their body had changed. Six months after treatment, erectile rigidity was significantly decreased compared with prior to radiotherapy (P = 0.016), and 23% reported decreased sexual interest, activity, and pleasure. Changes in body image were significantly associated with decreased sexual interest, pleasure, and erectile function. Even though 45% reported that treatment negatively affected their sexual life, the number of sexually active patients remained stable at 91%. [Correction added on 12 November 2014, after first online publication: 'prior radiotherapy' was corrected to 'prior to radiotherapy'.] CONCLUSIONS: Short-term effects of treatment included fertility concerns and changes in body image. Reported erectile rigidity was significantly decreased after 6 months, as were sexual interest, activity, and pleasure. Disease and treatment had negative effects on sexual life, and changes in body image were associated with sexual dysfunction. Therefore, body image and sexual functioning should be addressed at an early stage in order to offer adequate treatment and counseling.

Pre-pubertal gonadectomy and the social consequences of acute ethanol in adolescent male and female rats.

It has previously been shown that pre-pubertal or adult gonadectomy (GX) increases ethanol intake in male rats. This study examined whether this sex-selective increase reflects a GX-induced maintenance in males of more adolescent-typical responsiveness to ethanol characterized by enhanced sensitivity to positive (e.g., socially facilitating) and a decreased sensitivity to adverse (e.g., socially inhibitory) effects of ethanol. Male and female Sprague-Dawley rats were pre-pubertally GX, sham (SH)-operated, or non-manipulated (NM) at postnatal day (P) 25. During the late adolescent transition into adulthood (P48 - baseline day), rats were given a saline injection, placed alone into a familiar test apparatus for 30min and then exposed for 10min to an unfamiliar partner of the same age and sex. On the following day (P49), similar testing occurred after administration of 0.5, 0.75, 1.0 or 1.25g/kg ethanol. At baseline, GX males and females displayed higher levels of social activity (especially adolescent-typical play and contact behavior) than SH and NM animals, with GX females displaying greater social activity than GX males. Neither males nor females demonstrated social facilitation at lower ethanol doses, regardless of hormonal status. Whereas the social inhibitory effects of higher doses of ethanol were similar across groups among females, SH males were less sensitive than both GX and NM males to ethanol-induced social inhibition. These results suggest that enhanced ethanol intake in GX males is not related to alterations in sensitivity to ethanol's social inhibitory effects. GX, however, results in retention of adolescent-typical social behaviors, with older GX adolescent rats resembling early adolescents in exhibiting elevated social activity-particularly play and contact behavior.

Surviving testicular cancer: the Lebanese lived experience.

BACKGROUND: Testicular cancer is thought to have a great impact on its survivors, yet there has been limited literature on the topic globally and no literature on the topic in Lebanon and the Arab region. OBJECTIVE: The purpose of this study was to explore the lived experience of Lebanese testicular cancer survivors and gain an in-depth understanding of the psychosexual aspect of their experience. METHODS: A hermeneutic phenomenological approach with semistructured digitally recorded interviews and observational field notes was utilized. A purposive sample of Lebanese testicular cancer survivors, aged between 18 and 50 years, in remission for at least 3 years, and willing to share personal information was recruited. Interviews were transcribed verbatim in Arabic. Data saturation was achieved at the seventh interview; a total of eight informants were recruited. The opening question was, "Tell me about your life since you got treated for testicular cancer," and was followed by probing questions. Two to three weeks after the initial interview, informants were called to validate the investigators' primary analysis. RESULTS: Six core themes emerged: cancer perception in the Lebanese culture; "do not show, do not tell"; cancer experience is a turning point; fertility, manhood, and relationships; coping with cancer; and preserved aspects of life. DISCUSSION: The findings provide an in-depth understanding of the experience of Lebanese testicular cancer survivors with a focus on the psychosexual aspect of this experience. The results suggest the need to educate patients about testicular cancer and its effect on their fertility.