Patients' experiences following breast cancer treatment: an exploratory survey of personal and work experiences of breast cancer patients from three European countries.

Improved treatments for early breast cancer have led to a significant increase in overall survival. While evidence regarding potential long-term sequelae of adjuvant treatments exists, relatively little research reports patients' own perceptions of change before and after adjuvant chemotherapy (AC). This study aimed to identify key ongoing issues associated with AC in daily life. An online survey developed for this study was completed by 198 women (mean age 49.7 years) in the UK, France and Germany who had AC 1-5 years previously for oestrogen receptor positive, HER2 negative early breast cancer. Women without AC and endocrine therapy, those treated with Trastuzumab or who had recurrent disease were excluded. A third of women who responded were currently unable to perform their former family role. The majority had needed support, particularly with child care, during treatment. While 54% were in full-time employment before diagnosis this had reduced to 32% following AC. Of those women still working, over half reported difficulties with tiredness or concentration. Most (85.8%) were satisfied with healthcare professionals' treatment information, but only 29.7% received information about returning to work. This exploratory survey highlights areas of women's lives affected 1-5 years following AC for early breast cancer. The impact on returning to work and issues surrounding childcare particularly, require further study.

[Sexual pain disorders in females and males]. / Douleurs sexuelles de l'homme et de la femme.

INTRODUCTION: The occurrence of pain during sex is one of the most common complaints in gynecological and sexological practice but nonetheless one of the most difficult problems to deal with and treat effectively. METHODS: A literature review was conducted on Medline considering the articles listed until January 2012 dealing with sexual pain in women and men. RESULTS: The different descriptions of painful intercourse (dyspareunia, vestibulo-vulvodynies, vaginismus) are not separate entities but the result of the interaction of many factors including genital pain, emotional and behavioral responses to penetration, caresses, desire and excitement, in a context of possible organic pathology (infection, endometriosis, inflammatory or dermatological disease, morphological or pelvic abnormality, hormonal deficiency) sometimes associated with chronic pain phenomena self-sustained by neurogenic inflammation. The clinical expression of sexual pain is as variable as its causes are many. The etiological investigation is essential but should not omit the sexological context and the need for appropriate management. The neurogenic inflammation and hypersensitivity impose an algological approach associated to etiological and sexological treatment. CONCLUSION: Chronic sexual pains, whether they are superficial or deep, can be the sign of organic or psycho-sexual (primary or secondary) disorders. The development of a "therapeutic program" helps patients, allows them to restore self-confidence and leads to the disappearance of the symptom in more than half cases.

[Hypoactive sexual desire disorder, HSDD]. / Qu'est-ce que le trouble du désir sexuel hypo-actif ?

Hypoactive Sexual Desire Disorder (HSDD) is the most common Female Sexual Dysfunction (FSD) affecting adult women of any age, including postmenopausal women. HSDD may have significant effects on the relationships and emotional balance of women and constitutes the most common form of FSD observed in clinical practice. HSDD is characterised by a deficiency or lack of sexual fantasies and desire for sexual activity, causing serious distress or interpersonal difficulties, and it is not exclusively caused by the effects of another psychiatric disorder, pathology or substance (such as medication). HSDD pathophysiology is not yet well understood, but it is thought to involve an imbalance between factors controlling inhibition and excitation of sexual desire in the brain. Many physicians are reluctant to discuss sexual desire problems with their patients for various reasons, such as insufficient knowledge of the field, an absence of efficient treatments and time constraints. Even though current treatment options are limited, a better understanding of the physiopathology behind HSDD may help develop new therapies.

Therapeutic options for postmenopausal female sexual dysfunction.

BACKGROUND: Female sexual dysfunction (FSD) is a multidimensional problem combining biological, psychological and interpersonal elements of multiple etiologies. Menopause-related sexual dysfunction may not be reversible without therapy. Hormonal deficiency does not usually decrease in severity over time. Many options are available for the successful treatment of postmenopausal FSD. OBJECTIVE: To review the pharmacological and non-pharmacological therapies available for postmenopausal FSD, focusing on practical recommendations for managing postmenopausal women with sexual complaints, through a literature review of the most relevant publications in this field. PSYCHOSOCIAL THERAPY: This type of therapy (basic counselling, physiotherapy and psychosexual intervention) is considered an adaptable step-by-step approach for diagnostic and therapeutic strategies, normally combined with biomedical interventions to provide optimal outcomes. PHARMACOLOGICAL THERAPY: For postmenopausal FSD, many interventional options are now available, including hormonal therapies such as estrogens, testosterone, combined estrogen/testosterone, tibolone and dehydroepiandrosterone. CONCLUSIONS: Menopause and its transition represent significant risk factors for the development of sexual dysfunction. FSD impacts greatly on a patient's quality of life. Consequently, it is receiving more attention thanks to the development of effective treatments. Non-pharmacological approaches should be used first, focusing on lifestyle and psychosexual therapy. If required, proven effective hormonal and non-hormonal therapeutic options are available.

Impact of gamma-radiation on antigenic properties of cow's milk beta-lactoglobulin.

This study evaluated the effects of gamma-radiation on the antigenic properties of beta-lactoglobulin in cow's milk. Liquid and lyophilized samples of cow's milk and whey were irradiated with gamma-cells (60Co) at dose levels of 3, 5, and 10 kGy, at room temperature in the presence of air. Effects of treatment on proteins were monitored by Lowry's method, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and enzyme-linked immunosorbent assay. Radiation did not affect the molecular-weight distributions of proteins, but it did reduce their solubility. Furthermore, results showed that irradiation at 10 kGy increased the recognition of milk and whey powders by anti-beta-lactoglobulin (beta-Lg) rabbit immunoglobulin G, with the other samples remaining antigenically stable. These results indicate that gamma-rays do not reduce cow's milk beta-lactoglobulin antigenicity.

Effect of 5 years of dental studies on the oral health of Tunisian dental students.

This study is a follow-up of one made in 1998-99 on first-year dental students in Monastir. Now in their fifth year, we assessed the effect of dental studies on students' oral health practices and dental health. Of the 155 students in the first study, 140 were still enrolled. Periodontal troubles, malocclusion and dental decay affected 84.3%, 80.0% and 43.0% of the students respectively. Compared with the previous study, students had achieved a better dental health status--tooth brushing rate was much higher, prevalence of dental decay and periodontal pockets had decreased, and DMF index had improved. However, the prevalence of smoking, bleeding and calculus had not changed, and the frequency of malocclusion had increased.

Effect of 5 years of dental studies on the oral health of Tunisian dental students

This study is a follow- up of one made in 1998- 99 on first- year dental students in Monastir. Now in their fifth year, we assessed the effect of dental studies on students' oral health practices and dental health. Of the 155 students in the first study, 140 were still enrolled. Periodontal troubles, malocclusion and dental decay affected 84.3%, 80.0% and 43.0% of the students respectively. Compared with the previous study, students had achieved a better dental health status - tooth-brushing rate was much higher, prevalence of dental decay and periodontal pockets had decreased, and DMF index had improved. However, the prevalence of smoking, bleeding and calculus had not changed, and the frequency of malocclusion had increased

[High frequency ultrasonography and celluscore: an improvement in the objective evaluation of cellulite phenomenon]. / L'ultrasonographie à haute fréquence et le celluscore : un progrès dans l'évaluation objective du phénomène de cellulite.

As they usually do not have any serious effect on health condition, cellulite phenomenons are not considered as potentially hazardous by general practitioners; unfortunately they involve almost all the feminine population after the forties and may really induce bad side effects either psychological or physical whatever the confusing origin of that cutaneous deformation: heredity, nutrition, circulatory and hormonal diseases etc. Trying to appreciate in a more scientific way this superficial skin disorder, we have developed a computerised questionnaire which can be combined with the finest upto date way of skin exploration, high frequency ultrasonography. It seems possible to consider now cellulite as the result of various disorders which can be separate into fibrotic or retentional phenomenons (surrounding superficial fat tissues) and the direct adipocyte reaction (adiposis). We hope to be able in the future to extend the treatment of cellulite beyond the limits of liposuction which seems until today the only way to bring some improvement to that phenomenon in spite of the very delicacy of the surgical approach.

[Menopause, andropause and sexual function]. / Ménopause, andropause et fonction sexuelle.

After about fifty years of age, at the time of the menopause and the andropause (androgenic deficiency), men as well as women can have the same type of complaint, but it is facing time that women have a different view from men. Time is coded into a woman's body, whereas it is by 'social' time that men are more often determined. On the sexual level there is a slow-down in the sexual reactions of both men and women. One should not forget, however, that the cure for sexual problems in women sometimes involves the treatment of male sexual dysfunction (erection problems, premature ejaculation, absence of ejaculation). Therapeutically, hormonal replacement therapy is undoubtedly a help, if there are no medical contra-indications and if the patient is in agreement. If the complaint is also sexual then a more specific, therapeutic treatment may often be necessary, associating hormone treatment with erection inducers.

[The experience of menstruation and its disorders in 603 women using contraception in 1999]. / Le vécu des règles et de leurs troubles chez 603 femmes sous contraception en 1999.

AIM: An epidemiological survey completed during the first quarter of 1999 assesses the frequency of menstrual disorders as well as their effects on the lives of women using contraception. MATERIALS AND METHODS: The results presented involve a sample of 603 women, with 405 using the pill and 198 fitted with an IUD. The average age of onset of menstruation in the sampled population was 12.8 years. Although most women declared that they felt no anxiety at the time, over one-third of the women surveyed explained that they felt a certain hesitancy in discussing the topic. Even today, certain feelings, such as shame or pride, are still evoked in the interviews. Although over half believe that it is normal to menstruate, the process is nevertheless considered "somewhat bothersome" by certain women who also refer to "purification." Traditional cultural perspectives remain a strong influence. Menstrual disorders predating the initial use of contraception were reported in 150 women (occasional intermenstrual bleeding, 130 cases; other anomalies excluding metrorrhagia, 27 cases). Even if most of the women believe these problems to be inevitable, they also claim to be relatively troubled by these disorders, which often involve a considerable degree of discomfort. Such disorders are significantly more frequent in the "IUD" group, as well as in women who claim a very early onset of menstruation and those who consider explanations provided by the physician as "insufficient." CONCLUSION: The difference creates a certain fear with respect to any social or individual norm that may have been internalized. Thus the information presented in this study may provide ways and means to better understand women in general and our women patients in particular.

[Menopause and sexuality]. / Menopause et sexualite.

Many researchers have noted a direct correlation between sexual difficulties and E2 level, when E2 < 50 pg/ml. But sexual behavior also interferes with sexuality. In Bachmann and coll. study, sexually active women ranging from 60 to 70, without HRT had higher mean levels of E2 and T than sexually inactive women. Of course the numerous complaints of that period (hot flushes, asthenia, tachycardia...) are creating physical and psychological conditions rather damaging for sexuality. They may also induce a state of true suffering with a loss of self esteem resulting in a more introverted way of life. In other cases, it is the psychological context in it self (depression, anxiety, relational difficulty with the partner or even male sexual problems) which is interfering. An actual amelioration of sexual life can be obtained with HRT plus or a minima percutaneous androgenotherapy in some cases. The treatment is indeed an asset for the therapeutic support, even from the psychotherapeutic point of view.

[Sexual disorders after radical prostatectomy and their treatment. Psychological aspects]. / Les troubles sexuels après prostatectomie radicale et leurs traitements. Aspects psychologiques.

Forty-one men who had undergone radical prostatectomy and their wives were interviewed in order to evaluate the erectile disorders encountered after this operation and to facilitate therapeutic impact. Twenty-three of the women stated they were satisfied with their sexual intercourse before the operation and among them, 16 (70%) stated they were unsatisfied after their husband's operation. Among these 16 couples, 10 accepted sexual counselling which led to satisfaction with sexual intercourse in 8 couples. Sexual counselling was the only therapy needed in 1 couple, 4 men received intracavernous injections and 3 used a vacuum system. These results, as well as the impact of integrating the sexual partner in the treatment protocol for erectile impairment were discussed.

[Prostaglandin E1 in the treatment of erectile insufficiency. Comparison of efficacy and tolerance based on different etiologies]. / Prostaglandine E1 dans le traitement de l'insuffisance érectile. Efficacité et tolérance comparées selon différentes étiologies.

Prostaglandin E1 (PGE1) is widely used for the treatment of impotence. We retrospectively studied 322 patients who had received injection of prostaglandin E1 from 1991 to 1993 and attempted to divide them into different subgroups as a function of the aetiology of the impotence in order to determine whether there is a difference in efficacy and tolerance. The complete work up included at least two consultations with a sex therapist, a pharmaco-Doppler examination, cavernometry, plethysmography of the nocturnal erections and blood chemistry with assay of the free testosterone in all patients. Erections compatible with penetration were observed after prostaglandin E1 injection in 85.4% of the patients (all aetiologies). Very favourable results were obtained in the group of patients with an arterial defect (n =36) since erections allowing intercourse were obtained in 83.3%. For the patients with occlusive venous dysfunction (cavernous leakage) (n = 35) the injections were less effective but led to satisfactory results in 74.3%. The results were excellent (94.7%) in the cases of psychogenic impotence (n = 113). Finally, in patients with diabetes related impotence (n = 21), the treatment was much less effective giving only 52.3% of positive results. In several cases (n = 151) we were able to compare the effectiveness of PGE1 with that of papaverine alpha blockers. For the patients with an arterial defect, PGE1 was slightly more effective. For patients with an occlusive venous dysfunction, PGE1 was always more effective than papaverine and finally, for patients with diabetes, the papaverine-alpha blocker combination was more effective than PGE1 in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)

[The multiple interactions between infertility and sexuality]. / Les multiples interactions entre l'infertilité et la sexualité.

After investigating into literature and clinical experience, we shall line out in this study 4 types of interactions between sexuality and infertility: sexual causes to feminine (vaginism, with and without heavy dyspareunia) or masculine (impotency, ante-portas ejaculation, anejaculation, dysejaculation), infertility; influence of tests and of treatments for infertility on sexual life; influence of infertility on sexuality focusing on the various ambiguous feelings (of culpability, inferiority, aggressivity, passivity); and last, the psychological and sexual interactions with medical assisted procreation, reinforcing the sexual separation of man and woman if the body is considered a machine. Psychosomatic guidance of the couple during these steps (with reassurance as the being helped conception) will allow maintaining on removing sexual attraction.

[Chronic prostatodynia and psychosomatic care]. / Prostadynie chronique et prise en charge psychomatique.

Depression is a regular accompaniment of all chronic painful conditions. A study was conducted to assess the effect of treatment of the depressive factor in patients with chronic prostatodynia. Effects were compared of psychosomatic therapy (psychotherapy, relaxation, etc.) alone in 9 patients (group I) and the same psychosomatic care plus treatment with amineptine and clobazam in 9 patients (group II). Results showed that 2 patients recovered and 3 were improved (62%) with 1 drop-out in group II, versus recovery and 2 improvements (42%) with 2 drop outs in group I. These findings are analyzed and discussed.

[Induced abortion: shock and after-effects?]. / L'interruption volontaire de grossesse, quel choc, quelles suites?

PIP: It is generally agreed that the incidence of serious psychic side effects after abortion is very low. Most women undergoing abortion appear to experience nothing more than temporary depression that spontaneously resolves, and some surveys suggest that the psychic state may be improved under some circumstances after abortion. A minority of women, however, suffer considerably after abortion and their experiences, as elsewhere in psychopathology, shed light on the less obvious experience of other women. The author uses case studies to illuminate the dynamic and subconscious effects of abortion, which are revealed in attitudes, symptoms, or comments. Whether or not a woman seeks an abortion, the very fact of carrying an unwanted child can be enough to provoke psychic symptoms. If the partner abandons the woman because of her pregnancy, the blow may be even more strongly felt, resulting in a mixture of pain and aggression. The symptoms and the connection with a past abortion may remain unrecognized until a subsequent, desired pregnancy. Symptoms after an abortion may include frigidity, vaginismus, dyspareunia, pain, or poor tolerance of contraception desired at the conscious level. The manifestations are not specific and may occur after childbirth or at any other time. No matter how well accepted abortion seems to be by society, it is different from any other surgical procedure and it may therefore have some aftereffects. Social acceptance may provide some comfort but it is not enough to compensate for personal conflicts. Sometimes the conflict is expressed in the sexual relationship with the partner, who is considered responsible for the abortion. The effects of an abortion on a relationship depend in part of how satisfactory the relationship was before the pregnancy. Repeated requests for abortion may result from a woman's intrapsychic conflicts. It is well known that the desire to be pregnant is not always accompanied by a desire for motherhood. Pregnancy may be an expression of narcissistic need or a means of defense against feelings of unworthiness or doubts about identity. Guilt feelings may be increased by ambivalence about the abortion, by religious beliefs, or even by the desire for children at a later time. Feelings of guild over an abortion are often provoked by society. The practitioner can play an important role in identifying women at risk of serious psychic sequelae by listening attentively to their manifestations of ambivalence and distress.^ieng