Cancer and Sexual Health

Preface

Contents

Contributors

Part I:Normal Sexual Function

Chapter 1: Functional Anatomy of the Male Sex Organs

Introduction

Penis

Skin and Fascia

Tunica Albigunea

Corpora Cavernosa and Spongiosum

Associated Musculature

Penile Vascular Anatomy (Fig. 1.2)

Lymphatics

Innervation

Urethra (Fig. 1.3)

Testis

Epididymis

Vas Deferens

The Prostate

Seminal Vesicles

References

Chapter 2: Functional Anatomy of the Female Sex Organs

Introduction

General Structural Relationships

External Genital Anatomy

Clitoris

Bulbs

Labia Majora

Labia Minora

Urethra

Blood Supply of the External Genitalia

Innervation of the External Genitalia

Internal Genital Anatomy

Vagina

Uterus

Uterine Corpus (or Body)

Cervix

Ovaries and Uterine Tubes

Blood Supply of the Internal Genitalia

Innervation of the Internal Genitalia (see Fig. 2.12)

References

Chapter 3: Physiology of Libido

Introduction

Sexual Arousal

Sexual Desire

Sexual Reward

Sexual Inhibition

Conclusions

References

Chapter 4: Physiology of Orgasm

Introduction

Definitions of Orgasm

Common Features of Orgasm in Males and Females

Mental Experience

Cardiovascular Phenomenon

Pelvic Musculature Contractions

Rectal Sphincter Contractions

Activation or Deactivation of Areas in the Brain

Facial Grimacing

Hyperventilation

Vocalizations

Release of Prolactin and Oxytocin

Differences Between Female and Male Orgasms

Female Orgasm

Uterine Contractions

Typologies of Female Orgasm

Female Orgasms with Urethral Emission

Objective Signs of Orgasm in Women

Specific Brain Activity During Female Orgasm

The Male Orgasm

The Male Orgasm with Ejaculation of semen

The Male Orgasm Without Ejaculation of Semen

The Post Ejaculatory Refractory Time (PERT)

Orgasms Induced by Prostatic Massage

Specific Brain Activity During Male Orgasms

Typology of Male Orgasms

Special Considerations

Can We Tell When Someone is Faking an Orgasm?

Orgasm and Enhancing its Intensity of Pleasure

Female Orgasm and Reproduction

Female Orgasm After the Menopause

Male Orgasm with Aging

Postorgasmic Illness Syndrome

Do Orgasms have Health Benefits Other than Pleasure?

Addendum

References

Chapter 5: Physiology of Female Genital Sexual Arousal

Introduction

Physiology

Central Factors in Female Sexual Arousal

Peripheral Factors in Female Sexual Arousal

Sex Steroid Hormones and Female Genital Sexual Arousal

Androgens: Physiology and Pathophysiology

Androgens: Clinical Data

Estrogens/Progestins: Physiology and Pathophysiology

Estrogens/Progestins: Clinical Data

Clinical Female Genital Sexual Arousal Disorder Syndrome Associated with Low Estradiol

Neurotransmitters and Female Genital Sexual Arousal

Vascular Blood Flow

Summary

References

Chapter 6: Physiology of Erection

Introduction

Neurological Regulation of Erectile Function

Cerebral Control of Penile Erection

Autonomic Control of Penile Erection

Somatic Nervous System and Penile Erection

Tissue Level Mechanisms of Penile Erection

Molecular Mechanisms of Penile Erection

Penile Detumescence

Tissue Level Mechanisms of Penile Detumescence

Neuronal Regulation of Penile Detumescence

Molecular Mechanisms of Penile Detumescence

Psychological Factors and Penile Detumescence

Endocrine Factors and Penile Erection

Conclusion

References

Chapter 7: Physiology of Ejaculation

Introduction

Peripheral Anatomical Organization

Organs Participating in Emission

Epididymis

Ductus (or Vas) Deferens

Seminal Vesicles

Prostate Gland

Bulbo-Urethral (or Cowper’s) Glands

Organs Participating in Expulsion

Bladder Neck and Urethra

Striated Muscles

Neural Pathways

Afferents

Efferents

Central Nervous System Network

Spinal Organization

Supraspinal Organization

Neurochemical Regulation

Dopaminergic Control

Serotonergic Control

Oxytocinergic Control

Human Brain Functioning

The Trigger for Expulsion

References

Part II:Disorders of Sexual Function

Chapter 8: Classifying Female Sexual Dysfunction

Introduction

Historical Overview of the Development of Classification of FSD

The DSM System

Definitions Reconsidering the DSM Definitions

The First Consensus Conference

Circular Model Versus a Linear Model and the Second Consensus Conference

DSM-V a Suggestion for New Definitions

DSM-V

Sexual Desire and Arousal Disorders

Sexual Aversion Disorder (SAD)

Female Orgasmic Disorder (FOD)

Dyspareunia

Conclusion

References

Chapter 9: Hypoactive Sexual Desire Disorder

Diagnosis

Theoretical Models of Sexual Desire

Assessment of HSDD (Table 9.2)

Differential Diagnosis

HSDD Prevalence in Epidemiological Studies

Factors Implicated with Sexual Desire

Biological Factors

Psychological Factors

Relationship

Cancer

Prevalence of Low Desire and HSDD in Cancer Patients

Direct Effects of Cancer on HSDD: Biological, Psychological, and Relational

Biological

Psychological Factors

Relational Factors

Effect of Cancer Treatment on HSDD

Chemotherapy

Radiation Therapy

Breast Conservation

Oophorectomy

Conclusions

References

Chapter 10: Disorders of Female Sexual Arousal

Disorders of Female Sexual Arousal

Definitions and Problems

Diagnostic Criteria for Female Sexual Arousal Disorder

Models of Sexual Response

Problems with the DSM conceptualization of FSAD

Proposed Criteria for the DSM-V

Epidemiology

Lifetime Prevalence of FSAD

Prevalence of FSAD in Cancer Patients

Correlates of FSAD

Physiological Correlates

Physiological Considerations for Cancer Patients

Psychological Correlates for FSAD

Psychological Considerations for Cancer Patients

FSAD in Partners of Patients

Assessment

Clinical Assessment of FSAD

Treatment Overview of FSAD

Biological Interventions

Topical Lubricants

Vasoactive Agents

Central Nervous System Acting Agents

Hormonal Agents

Psychological Interventions

Persistent Genital Arousal Disorder

Conclusion

References

Chapter 11: Disorders of Female Orgasm

Introduction

Definitions of Female Orgasm Disorder

The Prevalence of Female Orgasmic Disorder

The Impact of Cancer on Women’s Sexual Health

Effects of Specific Cancer Treatments on Orgasm Function

The Treatment of Female Orgasmic Disorder

Psychological Approaches (Table 11.1)

Directed Masturbation

Anxiety Reduction Techniques

Other Techniques

Pharmacological Approaches

Conclusion

References

Chapter 12: Sexual Pain Disorders

Introduction

Classification of Sexual Pain Disorders

Sexual Pain Disorders

Pain Related to a Specific Disorder

Vulvodynia

Epidemiology

Etiology

Psychosocial Factors

Assessment

Treatment

Dyspareunia in Postmenopausal Women

Vaginismus

Sexual Pain Disorders in Men

Dyspareunia and the Cancer Patient

Treatment-Related Side Effects

Treatment of Cancer-Related Sexual Pain

Summary

References

Chapter 13: Erectile Dysfunction: Prevalence and Pathophysiology

Introduction

Epidemiology of Erectile Dysfunction

Pathophysiology of Erectile Dysfunction

Overview

Ageing

Vascular Disease

Endocrine Factors

Neurological Factors

Conclusions

References

Chapter 14: Androgen Deficiency

Definition

Physiology of Hypothalamus-Pituitary-Gonadal Axis

Causes of Hypogonadism

Effects of Hypogonadism

Bone

Body Composition

Cognition and Mood

Metabolic Effects

Cardiovascular Effects

Sexual Function

Diagnosis of Hypogonadism

Treatment

Androgen Deficiency in the Female Patient

Physiology of Hypothalamic-Pituitary-Ovarian (HPO) Axis

Causes of Hypogonadism

Hypogonadotropic Hypogonadism

Eugonadotropic Hypogonadism

Hypergonadotropic Hypogonadism

Effects of Androgen Deficiency in Women

Diagnosis of Androgen Deficiency in Women

Treatment of Androgen Deficiency in Women

Conclusions

References

Chapter 15: Peyronie’s Disease

Definition

History

Etiology and Molecular Mechanisms

Evaluation of the PD Patient

Peyronie’s Disease Following Radical Prostatectomy

Nonsurgical Therapy for Peyronie’s Disease

Oral Therapies

L-Arginine

Pentoxifylline

Colchicine

Potassium Para-Aminobenzoate

Transdermal Agents

Intralesional Therapies

Steroids

Collagenase

Verapamil

Interferon

Penile Traction Devices

Surgical Treatment of Peyronie’s Disease

Tunica Albuginea Plication

Peyronie’s Plaque Incision/Partial Excision and Grafting

Straightening with Penile Prosthesis

References

Chapter 16: Disorders of Ejaculation and Male Orgasm

Introduction

The Anatomy and Physiology of the Ejaculatory Response

Premature Ejaculation

Introduction

Defining Premature Ejaculation

Epidemiology of Premature Ejaculation

Classification of Premature Ejaculation

The Aetiology of Premature Ejaculation

Premature Ejaculation and Performance Anxiety

Premature Ejaculation and Co-Morbid ED

Premature Ejaculation and Other Sexual Dysfunctions

Premature Ejaculation and Partner Sexual Dysfunction

Premature Ejaculation and Hyperthyroidism

Premature Ejaculation and Chronic Prostatitis

Delayed Ejaculation, Anejaculation, and Anorgasmia

Definition, Terminology, and Characteristics of Men with Delayed Ejaculation

Terminology and Definition

The Prevalence of Delayed Ejaculation and Characteristics of Men with DE

Pathophysiologies Commonly Leading to Ejaculatory Disorders, Including DE

Congenital Disorders

Traumatic Damage

Infective Disorders

Neurological Disorders

Male Pelvic Cancers

Prostate Cancer

Rectal Carcinoma

Testicular Cancer

Spinal Cord Injury

Psychological Aetiologies of Delayed Ejaculation

Conclusion

References

Chapter 17: Priapism

Background

Epidemiology of Priapism and Patient Populations at Risk

Diagnosis of Priapism

Pathophysiology of Priapism

Ischemic Priapism

Nonischemic Priapism

Stuttering Priapism

Medical Management

Surgical Management

Priapism and Cancer

References

Part III:Patient Assessment

Chapter 18: The Sexual Health Interview: Male

Introduction

Background Review

Helping Communication About Sex Between Patients and Physicians

Enhancing the Opportunity

Getting Started

Preparing the Patient

Taking a Sexual History from the Man

Erectile Function

General Comments

Conclusions

References

Chapter 19: The Sexual Health Interview: Female

Introduction

Epidemiology and Rationale

Sexual Problems in Women with Cancer

Need for Improved Sexual Health Dialogs

Patient Barriers to Sexual Health Dialogs

Physician Barriers to Sexual Health Discussions

Detection of Hypoactive Desire and Related Female Sexual Problems

Barriers to Sexual Health Dialogs in Female Cancer Patients

Physicians’ Desire for Sexual Health Education

Models for the Female Sexual Response

The Female Sexual Disorders: An Overview of Classification

Understanding Sexual Desire and its Components

Organizing a Biopsychosocial Approach to Sexual Dysfunction

The Three Windows Approach to Understanding Biopsychosocial Factors

Optimal Sexual History Taking

Screening and Detection of Sexual Problems

The Screening Sexual History

Screening with a “Ubiquity Statement”

The Screening Sexual History in Patients with Cancer

Developing the Narrative Thread

The Sexual Problem Interview

Language

Responding to Emotions

Using Patient-Centered Dialog to Explore Sexual Problems

Discussing Specific Sexual Practices

Essentials of a Complete Sexual History

Use of Questionnaires

Partner Issues

Empathic Delineation and Reframing Problems

The Interview as a Therapeutic Intervention

The P-LI-SS-IT Model

Conclusions

References

Chapter 20: Communication About Sexuality and Cancer

Introduction

Background Prevalence of Non-Communication

Who Should Communicate?

Barriers to Communication

Attitudes of Staff

Communicating with Patients

Communication with Partners

Communication with Families

Language Barriers

Communication with LGBT Individuals

Ethnicity

Disability

Barriers Related to Location

Clinician Education

Patient Information

Information to Public

Research

Conclusions

References

Chapter 21: Validated Questionnaires in Female Sexual Function Assessment

Introduction

Using Psychometrics to Evaluate an Instrument

Female Sexual Function Assessment Instruments (Tables 21.1–21.4)

Sexual Activity Questionnaire (SAQ)

Use in Cancer Populations

Sexual Function – Vaginal Changes Questionnaire (SVQ)

Use in Cancer Populations

The Female Sexual Function Index (FSFI)

Use in Cancer Populations

Derogatis Interview for Sexual Functioning (DISF/DISF-SR)

Use in Cancer Populations

Derogatis Sexual Functioning Inventory (DSFI)

Use in Cancer Populations

Brief Index of Sexual Functioning – Women (BISF-W)

Use in Cancer Populations

Changes in Sexual Functioning Questionnaire (CSFQ)

Use in Cancer Populations

Golombok-Rust Inventory of Sexual Satisfaction (GRISS)

Use in Cancer Populations

McCoy Female Sexuality Questionnaire (MSFQ)

Use in Cancer Populations

Other Measures of Female Sexual Functioning

Sexual Satisfaction Assessment Instruments

The Global Measure of Sexual Satisfaction (GMSEX)

The Index of Sexual Satisfaction (ISS)

The Pinney Sexual Satisfaction Inventory (PSSI)

The Female Sexual Distress Scale (FSDS)

The Sexual Satisfaction Scale for Women (SSS-W)

Summary

References

Chapter 22: Validated Questionnaires in Male Sexual Function Assessment

Introduction

Symptoms Scales and Questionnaires

Comprehensive Male Sexual Dysfunction Scales

Golombok Rust Inventory of Sexual Satisfaction

International Index of Erectile Function

Delayed Ejaculation Scales-Male Anorgasmia

Male Sexual Health Questionnaire

Premature Ejaculation Measures

Premature Ejaculation Profile

Index of Premature Ejaculation

Premature Ejaculation Diagnostic Tool

Treatment Satisfaction Scales

Treatment Satisfaction Scale

Erectile Dysfunction Inventory for Treatment and Satisfaction

Psychological and Interpersonal Relationship Scale

Sexual Quality of Life Scales

Sexual Life Quality Questionnaire

Self-Esteem and Relationship Questionnaire

Sexual Quality of Life: Male

Cancer-Specific Scales and Validation Data in Cancer Patients

Expanded Prostate Cancer Index Composite/UCLA Prostate Cancer Index

Validation of Scales in a Cancer Population

Summary and Conclusions

Appendix

Medical, Psychosocial, and Sexual Assessment Questionnaire

Erection

Libido/Interest

Ejaculation/Orgasm/Satisfaction

Satisfaction

Previous Consultations

References

Chapter 23: Evaluation of the Female with Sexual Dysfunction

Examination of the Female Cancer Patient

Specialized Testing for the Sexual Health Assessment

Laboratory Testing

Sonography

Advanced Testing

Vulvoscopy

Vaginal Photoplethysmography

Functional Magnetic Resonance Imaging

Quantitative Sensory Testing

Perinometry

Psychosexual Assessment After Cancer Diagnosis and Treatment

Surgical Considerations

Radiation Therapy Considerations

Chemotherapy Considerations

Hormone Therapy Considerations

Sexuality and Relationship Considerations

Other Psychological Considerations

Issues of Sexuality

Conclusions

References

Chapter 24: Evaluation of Male Sexual Dysfunction

Male Sexual Dysfunctions and Cancer Survivors

Changing Paradigms in the Evaluation of Erectile Dysfunction

Questionnaires and Sexual Function Symptom Scores

Questionnaires and Cancer Survivors

Medical, Sexual, and Psychosocial History

Medical History

Sexual History

Psychosexual History for the Nonmental Health Professional

Physical Examination

Laboratory Testing

Hormonal Evaluation

Cancer Survivors and Gonadal Status

Review of Findings

Specialist Consultation and Referral

Vascular Evaluations of Erectile Dysfunction

First-Line Evaluation of Penile Blood Flow

Second-Line Evaluations of Penile Blood Flow

Penile Doppler Sonography

Recommendations of the ICSM on Penile Vascular Testing

Selective Internal Pudendal Arteriography

Nocturnal Penile Tumescence

Hypoactive Sexual Desire

Ejaculatory Disorders

Cancer Survivors and Ejaculatory Dysfunction

Specific Ejaculatory Dysfunctions

Conclusions

References

Chapter 25: The Impact of Cancer on the Partner’s Sexuality

Introduction

What is Sexuality? Concepts of Human Sexuality

Human Sexuality from a Systems Perspective: The Four Component Sexual Model

The Impact of Cancer on Sexuality from a Systems Perspective

Impact of Cancer on the Partner’s Sexuality from a Systems Perspective

Impact of Male Sexual Dysfunction on Partners

Impact of Female Sexual Dysfunction on Male Partners

Impact of Cancer Diagnosis and Treatment on the Partner’s Sexuality

Psychological Impact of Cancer on Partner

Sexual and Intimacy Effects of Cancer on the Partner

Psychosocial Impact on the Partner of Men with Prostate Cancer

Impact on the Partner of Women with Breast Cancer

Clinical Intervention of Health Care Professionals

Conclusion

References

Chapter 26: Gay and Lesbian Patients with Cancer

Introduction

Health Care Provider Assumptions

Special Considerations for Lesbians

Special Considerations for Gay Men

Prostate Cancer

Colorectal Cancer

Attitudes of Health Care Providers to Gay/Lesbian Patients

Homophobia

Heterosexism

Disclosure of Same Sex Attraction or Relationship

How Oncology Care Providers Can Help

PLISSIT Model

Conclusion

References

Part IV:Cancer and Sex

Chapter 27: The Impact of a Cancer Diagnosis on Sexual Health

Introduction

The Psychological Response to a Cancer Diagnosis and Its Impact on Sexual Functioning

Partners Perception of Diagnosis and Affects on Sexuality (Table 27.2)

The Lack of Discussion of Sexuality at Diagnosis (Table 27.3)

Conclusion

References

Chapter 28: Breast Cancer

Breast Cancer Epidemiology and Population Data on Sexuality

The Interactive Biopsychosocial Model Applied to Sexualityand Breast Cancer

Sexuality and the Breast Cancer Care Continuum

Breast Cancer Risk Factors and Sexuality

Breast Cancer Screeningand Sexuality

Average-Risk Women Screening Guidelines

Very High-Risk Women Screening Guidelines

Diagnosis

Treatment

Surgery

Chemotherapy

Adjuvant Chemotherapy

Taxanes

Trastuzumab/Herceptin

Radiation

Hormonal Therapy: Pre- and Perimenopausal Women

Aromatase Inhibitors

Zoledronic Acid

Adjuvant Hormonal Therapy: Postmenopausal Women

Targeted Palliative Therapies

Bevacizumab

Lapatinib

Complications from Cancer Therapy

Treatment of Sexual Problems in Breast Cancer Survivors

Vaginal Dryness

Pain with Intercourse

Vaginal Stenosis

Vaginismus

Low or Absent Sexual Desire and Difficulty with Arousal and Orgasm

Role of Psychotherapy, Sex Therapy, Couples and Marital Therapy, Psychiatric Medications

Cancer Survivorship and Health Maintenance

Bone Health

Cardiovascular Health

Key Research Questions and Needs to Advance Care of Sexuality Issues in People with Breast Cancer or Elevated Breast Cancer Risk

References

Chapter 29: Gynecological Cancers

General Considerations

The Etiopathogenetic Framework of Sexual Dysfunction in Genital Cancer Patients

Cancer of the Vulva

Impact of the Disease and Treatment Procedures

Prevalence and Incidence of Sexual Dysfunction and Contributing Factors

Cancer of the Vagina

Impact of the Disease and Treatment

Prevalence, Incidence of Sexual Dysfunction, and Contributing Factors

Cancer of the Cervix

Impact of the Disease and Treatment

Prevalence, Incidence of Sexual Dysfunction, and Contributing Factors

Quality of Life Studies

Differences Between Treatment Procedures (Table 29.1)

Specific Physical Findings and Sexual Dysfunction (Table 29.2)

Contributing Factors

Endometrium Carcinoma

Impact of the Disease and Treatment

Prevalence, Incidence of Sexual Dysfunction, and Contributing Factors

Cancer of the Ovaries

The Impact of the Disease and Treatment

Prevalence, Incidence of Sexual Dysfunction, and Contributing Factors

Assessment of Sexual Functioning

Therapy

Psychological Interventions

Local Nonhormonal and Mechanical Interventions

Lubricants

Vaginal Dilatation

Hormonal

Local Estrogen

Summary and Conclusion

References

Chapter 30: Pelvic Surgery for Urological Cancers

Anatomy of Erectile Function

Arterial Supply

Accessory Pudendal Arteries

Venous Drainage

Neuroanatomy

Corporal Smooth Muscle

Erectile Dysfunction Prevalence

Erectile Dysfunction Pathophysiology

Neural Trauma

Corporal Smooth Muscle Alterations

Venous Leak

Radical Prostatectomy-Associated Sexual Dysfunctions

Anejaculation

Orgasm Alterations

Peyronie’s Disease

Penile Length Alterations

References

Chapter 31: Pelvic Radiation in Men

Introduction

Methods for the Evaluation of Erectile Dysfunction

Definition of Potency

Etiology of Postradiation Erectile Dysfunction

Incidence of Erectile Dysfunction After Radiotherapy for Prostate Cancer

Incidence of Erectile Dysfunction After External-Beam Radiotherapy

Incidence of Erectile Dysfunction After Brachytherapy

Incidence of Erectile Dysfunction After Radiotherapy for Bladder Cancer

Incidence of Erectile Dysfunction After Radiotherapy for Penile Cancer

Incidence of Erectile Dysfunction After Radiotherapy for Testicular Cancer

Incidence of Erectile Dysfunction After Radiotherapy for Colorectal Cancer

Ejaculatory and Other Sexual Dysfunctions

Therapy of Postradiation Erectile Dysfunction

Prevention of Postradiation Erectile Dysfunction

Conclusion

References

Chapter 32: Pelvic Radiation in Women

Radiotherapy for Cancer in the Pelvis

Late Effects of Radiotherapy

Assessment of Sexual Function

Psycho-sexual Effects of Pelvic Radiation

Sexual Problems After Pelvic Radiation

Gynaecological Cancer

Rectal Cancer

Anal Cancer

Bladder Cancer

Intervention for Female Sexual Dysfunction

Premature Ovarian Failure

Hormone Replacement Therapy

Post-irradiation Vaginitis/Vaginal Mucositis

Oestrogen

Benzydamine

Hyperbaric Oxygen Therapy

Vaginal Dilators

Conclusion

References

Chapter 33: Impact of Chemotherapy and Hormone Therapy on Female Sexual Health

Introduction

Impact of Chemotherapy on Female Sexual Health

Impact of Hormone Therapy on Female Sexual Health

Management Strategies for Female Sexual Symptoms Related to Chemotherapy and Hormone Therapy

References

Chapter 34: Impact of Androgen Deprivation Therapy on Men’s Sexual Health

Introduction

Role of Testosterone on Male Sexual Health

Physiology of Testosterone

Hypothalamus-Pituitary-Testis Axis

Production of Androgens by the Adrenal Gland

Mechanism of Action of Androgen Deprivation Therapy

Medical Castration

Surgical Castration

Antiandrogens

Inhibition of Androgen Synthesis

Androgen Deprivation Therapy Effects on Sexual Function

Erectile Function

Ejaculation

Libido

Genital Changes

Assessment of Patients on Androgen Deprivation Therapy

Therapeutic Strategies for Patients on Androgen Deprivation Therapy

Intermittent Versus Continuous Androgen Deprivation Therapy

Penile Rehabilitation

Conclusions

References

Chapter 35: Colorectal Cancer

Overview of Treatment of Colon and Rectal Cancer

The Impact of Colorectal Cancer Diagnosis on Psycho-Sexual Functioning

The Impact of a Stoma on Sexual Functioning

The Impact of Treatment of Rectal Cancer on Male Sexual Functioning (Table 35.1)

The Impact of Treatment of Rectal Cancer on Female Sexual Function

Counseling and Treatment

References

Chapter 36: Stem Cell Transplant

Description of HSCT

Challenges from the Start of HSCT

Challenges After HSCT

Treatment Factors Contributing to Sexual Dysfunction

Chemotherapy and TBI

Graft Versus Host Disease and Sexuality

The Interaction of Physiological, Behavioral, Psychological, and Social Effects on Sexuality After HSCT

Other Issues Contributing to Sexual Function

Psychological Factors Contributing to Sexual Dysfunction

Determining Who Is at Greater Risk for Sexual Dysfunction After HSCT

Evaluating Sexual Functioning After HSCT

Medical Treatment Options

Behavioral Treatment Options

Research Needs in the HSCT Population

Conclusions

References

Chapter 37: Sexual Health in the Terminally III

Introduction

Sexuality and Intimacy in Cancer and Palliative Care

Experiencing a Cancer Diagnosis

Effects of Cancer Treatment on Sexuality and Intimacy

Treatment Ends: Now What?

Sexuality in the Palliative or Terminal Settings

Discussing Patient Sexuality in Palliative and Terminal Care

The Why of Sex

The Direct Physical Benefits of Sexual Expression

The How of Sex in the Palliative Stage?

Various Reactions and Topics in the Palliative–Terminal Phase

The Role of the Medical and Helping Professionals

Various Organizational Problems and Solutions

Introducing Discussions About Patient Sexuality and Intimacy

Creating Space/Room for Undisturbed Intimacy

Various Physical Problems and Solutions

Conclusions

References

Part V:Treatment Strategies

Chapter 38: Survivorship: An Overview

Introduction

Definition of Survivorship

Current Focus on Survivorship

A National Survivorship Agenda

Challenges of Survivorship

Models of Survivorship Care

Current and Evolving Clinic Models

Providing a Care Plan for Survivorship

Cancer and Sexuality: Where Does Survivorship Fit In

Oncology Clinician Practice Related to Sexual Health

Sexual Health as an Exemplar for Survivorship Care

Improving Clinical Practice

Institutional Program Development

National Advocacy

References

Chapter 39: Nutriceuticals in Sexual Health

Introduction (Part 1): Heart Health=Sexual Health (Ageless Education)

Introduction (Part 2): Heart Health=Sexual Health and Promoting Probability

Conclusion

References

Chapter 40: Medical Treatments for Sexual Problems in Women

Introduction

Iatrogenic Menopause

Fertility Preservation

Embryo Cryopreservation

Cryopreservation of Mature Oocytes

Cryopreservation of Immature Oocytes After In Vitro Maturation (Without Gonadotropin Stimulation)

Gonadotropin-Releasing Hormone Analogue Treatment

Cryopreservation of Ovarian Tissue

Medical Therapies of Sexual Disorders in Cancer Survivors

Hormone Therapy

Systemic

Estrogens

Estrogen and Progestins

Estrogen/Androgen Combination Therapy

Transdermal Testosterone Specifically for Women

Synthetic Steroids

Topical Hormonal Therapies

Nonhormonal Central Nervous System Acting Drugs

Antidepressants in Sexual Problems and Depression

Bupropion

Synergy Between Antidepressants and HRT in Addressing Sexual Disorders

Antidepressant Drugs in the Treatment of Menopausal and Sexual Symptoms

Nonhormonal Topical Treatments

Vasoactive Agents in Women

Botulin Toxin

Future Treatment Options

Flibanserin

Psychosocial Interventions

Conclusion

References

Chapter 41: Surgical Treatments for Sexual Problems in Women

Introduction

Vulvar Anatomy

Terminology

Vestibulodynia

Clitoral Phimosis

Perineoplasty

Bartholin’s Gland

Conclusions

References

Chapter 42: Sex Therapy in Female Sexual Dysfunction

Introduction

Gender Differences withSexual Function After Cancerand Physician Impact withPatient Response

Clinical Considerations for Diagnosis and Treatment of Women with Genital and Breast Cancer

Psychosocial Implicationsof Cancer on Women and Their Sexual Function

Mental Health Interventions (Table 42.1)

Support Groups

Hypnotherapy

Psychotherapy

Cultural Differences in Sexual Functioning for Women with Cancer

References

Chapter 43: Erectile Function Preservation for Men with Cancer

Introduction

Erectile Tissue Structure and Function

Cancer Treatments and Erectile Tissue Damage

Pelvic Surgery

Pelvic Radiation

Androgen Deprivation Therapy

Erectile Tissue Damage and Erectile Dysfunction

Erectile Tissue Preservation and Cancer Treatments

Erectile Tissue Preservation: Animal Study Data (Table 43.1)

Erectile Tissue Preservation: Human Study Data (Table 43.2)

Summary

References

Chapter 44: Erectile Dysfunction: Pharmacological Therapy

Introduction

Historical Review of Modern Erectile Dysfunction Pharmacotherapy

Goals of Pharmacological Therapy

Oral Agents

Phosphodiesterase 5 Inhibitors

Sildenafil

Tadalafil

Vardenafil

Nonarteritic Ischemic Optic Neuropathy

Sudden Sensorineural Hearing Loss

PDE5 Inhibitors Failures

Dopamine Receptor Agonists

Apomorphine

Adrenergic Receptor Antagonists

Yohimbine

Phentolamine

Serotonergic Receptor Agonists

Trazodone

Other Oral Agents

Transdermal Agents

Intracavernosal Agents

Alpha-Adrenoreceptor Blocking Agents

Phentolamine

Phosphodiesterase Inhibitor

Papaverine

Adenylate Cyclase Activators

Alprostadil (Prostaglandin E 1)

Other Intracavernosal Agents

Intracavernosal Agent Combinations

Important Aspects of Intracavernous Injection Therapy

Transurethral Therapy

References

Chapter 45: Erectile Dysfunction: Devices

Introduction

Vacuum Erection Devices

Penile Implants

Noninflatable Penile Implants

Inflatable Penile Implants

Conclusion

References

Chapter 46: The Management of Premature Ejaculation

Introduction

History of Premature Ejaculation

Definition of Premature Ejaculation (Table 46.1)

Research of Definition

Animal Model of Premature Ejaculation

Normal and Abnormal Ejaculation Time

Classification of Premature Ejaculation

Lifelong Premature Ejaculation

Acquired Premature Ejaculation

Two New Subtypes of Premature Ejaculation

Natural Variable Premature Ejaculation

Premature-Like Ejaculatory Dysfunction

Genetics of Lifelong Premature Ejaculation

Drug Treatment of Premature Ejaculation (Table 46.2)

Daily Oral Medication

On-Demand Drug Treatment

SSRIs

Dapoxetine

Tramadol

PDE5 Inhibitors

Topical Anesthetics

Inadequate Intracavernous Self-Injection Therapy for PE

Psychologic Treatment of Premature Ejaculation

Psychotherapy

Stop-Start Method

The Squeeze Technique

Sensate Focus

Clinical Interview of Men with Complaints of Premature Ejaculation

Relevant Questions for Considering Different Treatment Options

Summary

References

Chapter 47: Testosterone Therapy in the Male Cancer Patient

Overview

Introduction

Testosterone Deficiency and the Prostate Cancer Patient

The Origin of the Prohibition Against TTh in Prostate Cancer Patients

Historical Experience with Testosterone and Prostate Cancer

The Original Report: Huggins and Hodges

Historical Experience with T Administration in Men with PCa

The Memorial-Sloan Kettering Experience

Modern Evidence Regarding Testosterone and the Risk of PCa

Natural History

Longitudinal Studies of Serum Testosterone and Subsequent Risk of Prostate Cancer

Clinical TTh Trials

TTh in Men with Prostatic Intraepithelial Neoplasia

Prostate Biopsy in Men with Low Testosterone

Testosterone Flare and PSA

Testosterone Treatment in Men with Prostate Cancer

Rationale

Testosterone Following Radical Prostatectomy

Testosterone Following Other Treatments for PCa

TTh in Men with Untreated or Recurrent PCa

Current Understanding of the Relationship of PCa and T

Conclusions

References

Chapter 48: Sex Therapy in Male Sexual Dysfunction

Introduction

Psychological and Sexual Impact on Men and Their Partners

The Men

The Partners

The Relationship

Psychosocial Interventions

Role of Sex Therapy and Psychotherapy

Review of Existing Psychosocial Programs

Other Suggestions Regarding Content and Timing of Interventions

Conclusion

References

Chapter 49: Restoring Intimacy in Relationships Affected by Cancer

Introduction

Prostate Cancer, Intimacy, and the Marital Relationship

Psychosocial Interventions Addressing Relationship Intimacy Needs

Patient-Focused Psychological Interventions

Partner-Focused Psychological Interventions

Couple-Focused Psychological Interventions

Future Directions

Conclusion

References

Chapter 50: Dating and Disclosure for Cancer Survivors

Introduction

Theoretical Perspectives on Disclosure

Dating and Disclosure in the Context of Cancer

Culture as Context

Age and Developmental Stage

Gender

Race/Ethnicity, Socioeconomic Status, and Religion

Sexual Orientation and Gender Identity

Patient Information and Resources

Clinical and Research Implications

Conclusion

References

Index