Sexual Concerns after (Pelvic) Radiotherapy: Is There Any Role for the Radiation Oncologist?

INTRODUCTION: Sexual function is an important aspect of quality of life, and may be impaired after (pelvic) radiation. AIM: The aim of this study was to identify practice, responsibility attitudes, knowledge, and barriers of Dutch radiation oncologists regarding sexual counseling. METHODS: A cross-sectional survey was performed using a 28-item questionnaire sent to all members of the Dutch Society for Radiotherapy and Oncology. MAIN OUTCOME MEASURES: Self-reported practice, knowledge, barriers, need for training and responsibility attitudes in regard to demographic characteristics. RESULTS: Of the surveyed sample, 54.6% of the radiation oncologists completed the instrument (n = 119). Frequency of discussing sexual function was fluctuating, depending on the type of tumor. The majority of the responding radiation oncologists (75%) agreed that discussing sexual function is their responsibility, about one-third (33.6%) pointed at the involved specialist (surgeon, urologist, gynecologist, or oncologist), a fifth also considered the general practitioner responsible (21%). Additional training about discussing sexuality was required according to 44.4%, the majority agreed that sexual counseling should be a regular component of radiation oncology residency (n = 110, 94%). Barriers most mentioned included patient is too ill (36.2%), no angle or reason for asking (32.4%), advanced age of the patient (27%) and culture/religion (26.1%). For prostate cancer patients, phosphodiesterase 5 inhibitor information was supplied regularly (49.2%) and often (40.7%). CONCLUSIONS: Radiation oncologists generally perform sexual counseling in case of pelvic radiation therapy, but not consistently in case of gastrointestinal, breast, and other cancers. The majority of radiation oncologists considered counseling on sexual functioning as a part of their job, some also pointed at the referring specialist or general practitioner. The findings suggest that awareness about sexual dysfunction is present among radiation oncologists, but responsibility for active counseling is uncertain. Results emphasize the need for providing educational and practical training, as well as a list for specialized referral.

Female sexual abuse evaluation in the urological practice: results of a Dutch survey.

INTRODUCTION: There is a strong association between urological complaints and a history of sexual abuse, especially in females. It is not known whether urologists integrate these facts in their daily practice. AIM: To evaluate whether Dutch urologists address the issues of sexual abuse in their female patients and to evaluate their perception of sexual abuse prevalences. METHODS: A five-item anonymous questionnaire was mailed to all 405 registered members of the Dutch Urology Association (urologists and residents). MAIN OUTCOME MEASURES: The results of the survey. RESULTS: One hundred eighty-six surveys of eligible respondents were returned (45.9% response rate). A total of 68.8% stated that they always ask their female patients about sexual abuse before doing the physical examination. Overall, 79.3% said to do so when a patient has certain urological complaints: 77.6% in case of lower abdominal pain, 62.1% in urgency or frequency, 41.4% in incontinence, 29.3% in urinary tract infections, and 3.4% in hematuria. The majority of the respondents (74.3%) estimated the frequency of sexual abuse in their urological clinic to be equal or less than 10%. CONCLUSION: Nearly 70% of the responding Dutch urologists and residents ask their female patients about possible sexual abuse. They estimate the frequency of sexual abuse in their female patients to be equal or less than 10%.

"Diagnostic investigation of the pelvic floor": a helpful tool in the approach in patients with complaints of micturition, defecation, and/or sexual dysfunction.

INTRODUCTION: Pelvic floor dysfunction is recognized to be related to lower urinary tract dysfunction and to lower gastrointestinal symptoms, and is an influential factor in dysfunction and subsequent behavior of the genital system in both men and women. Caregivers should be informed regarding normal pelvic floor function in general and should be able to identify specific aspects of pelvic floor dysfunction in patients with related symptoms. In our hospital, this diagnostic consultation is indicated as Diagnostic Investigation of Pelvic Floor Function (DIPFF). AIM: This study looked at pelvic floor dysfunction related to specific complaints. METHODS: DIPFF consists of a medical history, a physical examination, including the International Continence Society (ICS) pelvic organ prolapse quantification system in female patients, and a biofeedback registration using a vaginal or anal probe. Based on our experience, we defined an elevated rest tone as greater than 2 microV using intravaginal or intra-anal electromyography. MAIN OUTCOME MEASURES: Stratification of patients with a single complaint, a combination of two or three complaints of the micturition, defecation or sexual (all compartments of the pelvic floor) resulted in subgroups of respectively 30, 74, and 133 patients. RESULTS: A total of 238 patients with complaints of micturition, defecation, and/or sexual function were included in this study. Electromyographic analysis revealed an elevated rest tone of the pelvic floor in 141 patients. In 184 patients, we found an involuntary relaxation of the pelvic floor. CONCLUSION: In our retrospective study, we found that 77.2% of patients who presented to the clinic with urinary, gastro or sexual complaints had measurable pelvic floor dysfunction (69.3% overactive rest tone and 7.9% under active rest tone). In relation to the ICS terminology, there is a need for a well-defined normal vs. elevated rest tone of the pelvic floor.

Female sexual function after surgery for stress urinary incontinence: transobturator suburethral tape vs. tension-free vaginal tape obturator.

INTRODUCTION: The transobturator suburethral tape (TOT) and tension-free vaginal tape obturator (TVT-O) procedures are relatively new incontinence treatment procedures. Studies on the influence on sexual function as a result of these procedures are limited. AIM: The influence of TOT or TVT-O for the surgical treatment of stress urinary incontinence (SUI) on female sexual function. METHODS: We evaluated 77 sexually active patients after TVT-O (N = 34, mean age 53.2 years) and TOT (OB-TAPE, Porges) (N = 44, mean age 52.0 years) placement for SUI based on the responses to a mailed questionnaire 3 months after the operation. MAIN OUTCOME MEASURE: Difference in postoperative sexual complaints related to the TVT-O (inside-out) and TOT (outside-in) procedure. RESULTS: Postoperative TOT and TVT-O: There was almost no difference in frequency of sexual intercourse and an improvement of the continence during intercourse; continence was reported in 33 patients (42.3%) before and 67 patients (78.4%) after operation. The appreciation of sexual intercourse was improved in 15 patients (19.2%) and worsened in eight patients (10.3%). Postoperative TVT-O vs. TOT: No difference was seen in lost of lubrication, clitoral tumescence reduction, and clitoral sensibility reduction between both procedures. Pain because of vaginal narrowing was seen significantly more in the TOT procedure group. CONCLUSION: Overall, in this study, the technique of TOT gave rise to more sexual dysfunction than TVT-O. However, because of the successful outcome on incontinence, both procedures had, overall, a positive effect on sexual function. The cause of significant more pain during intercourse as a result of vaginal narrowing in the TOT procedure requires further investigation. Like other studies, this study demonstrated that incontinence surgery can have a positive and negative outcome on sexual function. It is important to put this issue in the informed consent.

Female sexual function and activity following cystectomy and continent urinary tract diversion for benign indications: a clinical pilot study and review of literature.

INTRODUCTION: There are limited data on female sexual function after cystectomy for benign indications. AIMS: To evaluate postoperative sexual items following cystectomy and continent urinary diversion for benign indications (e.g., severe incontinence, interstitial cystitis) in female patients. Furthermore, to review the studies investigating changes in women's sexual function after cystectomy. METHODS: In a retrospective study, 21 out of 23 patients (91%) who underwent a cystectomy for a benign indication completed a questionnaire. These women had a median age at the date of operation of 47.3 years (range 25-66 years) and a mean follow-up of 11.9 years. Questions on preoperative and postoperative sexuality, postoperative sexual activity, sexual appreciation, and the Female Sexual Function Index (FSFI) in patients at present were evaluated. Electronic databases were searched for the published studies investigating female sexual function after cystectomy. MAIN OUTCOME MEASURES: Female sexual function was evaluated by the FSFI domain scores and postoperative sexual appreciation questions. RESULTS: Sexual complaints before operation were present in 48% of the patients. The most common complaints reported were incontinence during intercourse, pain, and loss of libido. Seventeen out of 21 patients (81%) were sexually active preoperatively, 14 were still active postoperatively, and two preoperative inactive patients became active. Sexual inactivity postoperatively is mainly due to patient-related or combination of patient- and partner-related issues (70%), such as with pain during intercourse, loss of libido, and impaired body image. In the sexually active group, the majority (62.5%) showed improved or unchanged intercourse postoperatively. In the FSFI in 11 sexually active patients (52%) at present, domains of desire, arousal, lubrication, orgasm, and pain scored above average. The domain of satisfaction scored below average. CONCLUSIONS: Despite extensive surgery, female sexuality may remain unchanged or even improve, following cystectomy and continent diversion for benign indication. Sexual inactivity postoperatively needs more attention in respect to sexual counseling. Overall, the results are reassuring.