Cancer and Sexual Health (eBook)

Preface 6
Contents 8
Contributors 12
Part I:Normal Sexual Function 20
Chapter 1: Functional Anatomy of the Male Sex Organs 21
Introduction 21
Penis 21
Skin and Fascia 21
Tunica Albigunea 22
Corpora Cavernosa and Spongiosum 23
Associated Musculature 24
Penile Vascular Anatomy (Fig. 1.2) 24
Lymphatics 26
Innervation 26
Urethra (Fig. 1.3) 26
Testis 27
Epididymis 28
Vas Deferens 28
The Prostate 29
Seminal Vesicles 29
References 29
Chapter 2: Functional Anatomy of the Female Sex Organs 31
Introduction 31
General Structural Relationships 31
External Genital Anatomy 32
Clitoris 32
Bulbs 34
Labia Majora 35
Labia Minora 35
Urethra 36
Blood Supply of the External Genitalia 37
Innervation of the External Genitalia 37
Internal Genital Anatomy 38
Vagina 38
Uterus 39
Uterine Corpus (or Body) 39
Cervix 40
Ovaries and Uterine Tubes 40
Blood Supply of the Internal Genitalia 40
Innervation of the Internal Genitalia (see Fig. 2.12) 40
References 41
Chapter 3: Physiology of Libido 42
Introduction 42
Sexual Arousal 42
Sexual Desire 45
Sexual Reward 46
Sexual Inhibition 47
Conclusions 47
References 48
Chapter 4: Physiology of Orgasm 51
Introduction 51
Definitions of Orgasm 51
Common Features of Orgasm in Males and Females 52
Mental Experience 52
Cardiovascular Phenomenon 52
Pelvic Musculature Contractions 52
Rectal Sphincter Contractions 53
Activation or Deactivation of Areas in the Brain 53
Facial Grimacing 53
Hyperventilation 54
Vocalizations 54
Release of Prolactin and Oxytocin 54
Differences Between Female and Male Orgasms 54
Female Orgasm 54
Uterine Contractions 55
Typologies of Female Orgasm 56
Female Orgasms with Urethral Emission 56
Objective Signs of Orgasm in Women 56
Specific Brain Activity During Female Orgasm 57
The Male Orgasm 57
The Male Orgasm with Ejaculation of semen 57
The Male Orgasm Without Ejaculation of Semen 57
The Post Ejaculatory Refractory Time (PERT) 58
Orgasms Induced by Prostatic Massage 58
Specific Brain Activity During Male Orgasms 58
Typology of Male Orgasms 59
Special Considerations 59
Can We Tell When Someone is Faking an Orgasm? 59
Orgasm and Enhancing its Intensity of Pleasure 59
Female Orgasm and Reproduction 60
Female Orgasm After the Menopause 60
Male Orgasm with Aging 61
Postorgasmic Illness Syndrome 61
Do Orgasms have Health Benefits Other than Pleasure? 61
Addendum 65
References 62
Chapter 5: Physiology of Female Genital Sexual Arousal 66
Introduction 66
Physiology 68
Central Factors in Female Sexual Arousal 68
Peripheral Factors in Female Sexual Arousal 69
Sex Steroid Hormones and Female Genital Sexual Arousal 69
Androgens: Physiology and Pathophysiology 70
Androgens: Clinical Data 71
Estrogens/Progestins: Physiology and Pathophysiology 72
Estrogens/Progestins: Clinical Data 73
Clinical Female Genital Sexual Arousal Disorder Syndrome Associated with Low Estradiol 73
Neurotransmitters and Female Genital Sexual Arousal 74
Vascular Blood Flow 75
Summary 76
References 76
Chapter 6: Physiology of Erection 84
Introduction 84
Neurological Regulation of Erectile Function 84
Cerebral Control of Penile Erection 84
Autonomic Control of Penile Erection 85
Somatic Nervous System and Penile Erection 85
Tissue Level Mechanisms of Penile Erection 85
Molecular Mechanisms of Penile Erection 86
Penile Detumescence 88
Tissue Level Mechanisms of Penile Detumescence 88
Neuronal Regulation of Penile Detumescence 88
Molecular Mechanisms of Penile Detumescence 88
Psychological Factors and Penile Detumescence 89
Endocrine Factors and Penile Erection 90
Conclusion 90
References 90
Chapter 7: Physiology of Ejaculation 92
Introduction 92
Peripheral Anatomical Organization 92
Organs Participating in Emission 93
Epididymis 93
Ductus (or Vas) Deferens 93
Seminal Vesicles 93
Prostate Gland 93
Bulbo-Urethral (or Cowper’s) Glands 93
Organs Participating in Expulsion 94
Bladder Neck and Urethra 94
Striated Muscles 94
Neural Pathways 94
Afferents 94
Efferents 94
Central Nervous System Network 96
Spinal Organization 96
Supraspinal Organization 96
Neurochemical Regulation 98
Dopaminergic Control 98
Serotonergic Control 99
Oxytocinergic Control 99
Human Brain Functioning 100
The Trigger for Expulsion 100
References 102
Part II:Disorders of Sexual Function 105
Chapter 8: Classifying Female Sexual Dysfunction 106
Introduction 106
Historical Overview of the Development of Classification of FSD 107
The DSM System 107
Definitions Reconsidering the DSM Definitions 108
The First Consensus Conference 108
Circular Model Versus a Linear Model and the Second Consensus Conference 108
DSM-V a Suggestion for New Definitions 112
DSM-V 112
Sexual Desire and Arousal Disorders 114
Sexual Aversion Disorder (SAD) 114
Female Orgasmic Disorder (FOD) 114
Dyspareunia 115
Conclusion 115
References 115
Chapter 9: Hypoactive Sexual Desire Disorder 117
Diagnosis 117
Theoretical Models of Sexual Desire 118
Assessment of HSDD (Table 9.2) 121
Differential Diagnosis 122
HSDD Prevalence in Epidemiological Studies 125
Factors Implicated with Sexual Desire 125
Biological Factors 125
Psychological Factors 126
Relationship 127
Cancer 127
Prevalence of Low Desire and HSDD in Cancer Patients 128
Direct Effects of Cancer on HSDD: Biological, Psychological, and Relational 128
Biological 128
Psychological Factors 128
Relational Factors 129
Effect of Cancer Treatment on HSDD 130
Chemotherapy 130
Radiation Therapy 130
Breast Conservation 131
Oophorectomy 131
Conclusions 132
References 133
Chapter 10: Disorders of Female Sexual Arousal 136
Disorders of Female Sexual Arousal 136
Definitions and Problems 137
Diagnostic Criteria for Female Sexual Arousal Disorder 137
Models of Sexual Response 137
Problems with the DSM conceptualization of FSAD 138
Proposed Criteria for the DSM-V 139
Epidemiology 139
Lifetime Prevalence of FSAD 139
Prevalence of FSAD in Cancer Patients 140
Correlates of FSAD 141
Physiological Correlates 141
Physiological Considerations for Cancer Patients 142
Psychological Correlates for FSAD 143
Psychological Considerations for Cancer Patients 143
FSAD in Partners of Patients 145
Assessment 145
Clinical Assessment of FSAD 146
Treatment Overview of FSAD 148
Biological Interventions 148
Topical Lubricants 148
Vasoactive Agents 149
Central Nervous System Acting Agents 149
Hormonal Agents 150
Psychological Interventions 150
Persistent Genital Arousal Disorder 151
Conclusion 152
References 153
Chapter 11: Disorders of Female Orgasm 158
Introduction 158
Definitions of Female Orgasm Disorder 158
The Prevalence of Female Orgasmic Disorder 159
The Impact of Cancer on Women’s Sexual Health 160
Effects of Specific Cancer Treatments on Orgasm Function 161
The Treatment of Female Orgasmic Disorder 162
Psychological Approaches (Table 11.1) 162
Directed Masturbation 162
Anxiety Reduction Techniques 165
Other Techniques 166
Pharmacological Approaches 166
Conclusion 170
References 170
Chapter 12: Sexual Pain Disorders 173
Introduction 173
Classification of Sexual Pain Disorders 173
Sexual Pain Disorders 175
Pain Related to a Specific Disorder 175
Vulvodynia 175
Epidemiology 176
Etiology 176
Psychosocial Factors 177
Assessment 178
Treatment 179
Dyspareunia in Postmenopausal Women 181
Vaginismus 182
Sexual Pain Disorders in Men 184
Dyspareunia and the Cancer Patient 184
Treatment-Related Side Effects 184
Treatment of Cancer-Related Sexual Pain 185
Summary 186
References 186
Chapter 13: Erectile Dysfunction: Prevalence and Pathophysiology 193
Introduction 193
Epidemiology of Erectile Dysfunction 193
Pathophysiology of Erectile Dysfunction 195
Overview 195
Ageing 195
Vascular Disease 197
Endocrine Factors 198
Neurological Factors 199
Conclusions 199
References 199
Chapter 14: Androgen Deficiency 204
Definition 204
Physiology of Hypothalamus-Pituitary-Gonadal Axis 204
Causes of Hypogonadism 206
Effects of Hypogonadism 208
Bone 208
Body Composition 209
Cognition and Mood 209
Metabolic Effects 209
Cardiovascular Effects 210
Sexual Function 211
Diagnosis of Hypogonadism 211
Treatment 212
Androgen Deficiency in the Female Patient 213
Physiology of Hypothalamic-Pituitary-Ovarian (HPO) Axis 213
Causes of Hypogonadism 214
Hypogonadotropic Hypogonadism 214
Eugonadotropic Hypogonadism 216
Hypergonadotropic Hypogonadism 216
Effects of Androgen Deficiency in Women 218
Diagnosis of Androgen Deficiency in Women 219
Treatment of Androgen Deficiency in Women 219
Conclusions 221
References 221
Chapter 15: Peyronie’s Disease 225
Definition 225
History 225
Etiology and Molecular Mechanisms 225
Evaluation of the PD Patient 226
Peyronie’s Disease Following Radical Prostatectomy 229
Nonsurgical Therapy for Peyronie’s Disease 229
Oral Therapies 231
L-Arginine 231
Pentoxifylline 231
Colchicine 231
Potassium Para-Aminobenzoate 232
Transdermal Agents 232
Intralesional Therapies 233
Steroids 233
Collagenase 233
Verapamil 233
Interferon 234
Penile Traction Devices 234
Surgical Treatment of Peyronie’s Disease 234
Tunica Albuginea Plication 235
Peyronie’s Plaque Incision/Partial Excision and Grafting 238
Straightening with Penile Prosthesis 240
References 240
Chapter 16: Disorders of Ejaculation and Male Orgasm 243
Introduction 243
The Anatomy and Physiology of the Ejaculatory Response 244
Premature Ejaculation 246
Introduction 246
Defining Premature Ejaculation 247
Epidemiology of Premature Ejaculation 250
Classification of Premature Ejaculation 250
The Aetiology of Premature Ejaculation 251
Premature Ejaculation and Performance Anxiety 252
Premature Ejaculation and Co-Morbid ED 253
Premature Ejaculation and Other Sexual Dysfunctions 253
Premature Ejaculation and Partner Sexual Dysfunction 253
Premature Ejaculation and Hyperthyroidism 254
Premature Ejaculation and Chronic Prostatitis 254
Delayed Ejaculation, Anejaculation, and Anorgasmia 255
Definition, Terminology, and Characteristics of Men with Delayed Ejaculation 255
Terminology and Definition 255
The Prevalence of Delayed Ejaculation and Characteristics of Men with DE 256
Pathophysiologies Commonly Leading to Ejaculatory Disorders, Including DE 257
Congenital Disorders 257
Traumatic Damage 257
Infective Disorders 257
Neurological Disorders 257
Male Pelvic Cancers 258
Prostate Cancer 258
Rectal Carcinoma 258
Testicular Cancer 259
Spinal Cord Injury 259
Psychological Aetiologies of Delayed Ejaculation 260
Conclusion 261
References 261
Chapter 17: Priapism 267
Background 267
Epidemiology of Priapism and Patient Populations at Risk 268
Diagnosis of Priapism 269
Pathophysiology of Priapism 271
Ischemic Priapism 271
Nonischemic Priapism 271
Stuttering Priapism 272
Medical Management 272
Surgical Management 276
Priapism and Cancer 282
References 284
Part III:Patient Assessment 287
Chapter 18: The Sexual Health Interview: Male 288
Introduction 288
Background Review 288
Helping Communication About Sex Between Patients and Physicians 290
Enhancing the Opportunity 291
Getting Started 292
Preparing the Patient 293
Taking a Sexual History from the Man 293
Erectile Function 294
General Comments 296
Conclusions 296
References 296
Chapter 19: The Sexual Health Interview: Female 298
Introduction 298
Epidemiology and Rationale 298
Sexual Problems in Women with Cancer 299
Need for Improved Sexual Health Dialogs 299
Patient Barriers to Sexual Health Dialogs 300
Physician Barriers to Sexual Health Discussions 300
Detection of Hypoactive Desire and Related Female Sexual Problems 300
Barriers to Sexual Health Dialogs in Female Cancer Patients 301
Physicians’ Desire for Sexual Health Education 301
Models for the Female Sexual Response 302
The Female Sexual Disorders: An Overview of Classification 303
Understanding Sexual Desire and its Components 303
Organizing a Biopsychosocial Approach to Sexual Dysfunction 303
The Three Windows Approach to Understanding Biopsychosocial Factors 304
Optimal Sexual History Taking 304
Screening and Detection of Sexual Problems 304
The Screening Sexual History 304
Screening with a “Ubiquity Statement” 305
The Screening Sexual History in Patients with Cancer 306
Developing the Narrative Thread 306
The Sexual Problem Interview 306
Language 307
Responding to Emotions 307
Using Patient-Centered Dialog to Explore Sexual Problems 308
Discussing Specific Sexual Practices 308
Essentials of a Complete Sexual History 309
Use of Questionnaires 309
Partner Issues 309
Empathic Delineation and Reframing Problems 310
The Interview as a Therapeutic Intervention 310
The P-LI-SS-IT Model 310
Conclusions 311
References 311
Chapter 20: Communication About Sexuality and Cancer 313
Introduction 313
Background Prevalence of Non-Communication 313
Who Should Communicate? 314
Barriers to Communication 314
Attitudes of Staff 314
Communicating with Patients 315
Communication with Partners 315
Communication with Families 316
Language Barriers 316
Communication with LGBT Individuals 317
Ethnicity 317
Disability 318
Barriers Related to Location 318
Clinician Education 319
Patient Information 319
Information to Public 320
Research 320
Conclusions 320
References 320
Chapter 21: Validated Questionnaires in Female Sexual Function Assessment 323
Introduction 323
Using Psychometrics to Evaluate an Instrument 323
Female Sexual Function Assessment Instruments (Tables 21.1–21.4) 324
Sexual Activity Questionnaire (SAQ) 324
Use in Cancer Populations 326
Sexual Function – Vaginal Changes Questionnaire (SVQ) 329
Use in Cancer Populations 329
The Female Sexual Function Index (FSFI) 329
Use in Cancer Populations 330
Derogatis Interview for Sexual Functioning (DISF/DISF-SR) 330
Use in Cancer Populations 331
Derogatis Sexual Functioning Inventory (DSFI) 331
Use in Cancer Populations 332
Brief Index of Sexual Functioning – Women (BISF-W) 332
Use in Cancer Populations 332
Changes in Sexual Functioning Questionnaire (CSFQ) 333
Use in Cancer Populations 333
Golombok-Rust Inventory of Sexual Satisfaction (GRISS) 334
Use in Cancer Populations 334
McCoy Female Sexuality Questionnaire (MSFQ) 334
Use in Cancer Populations 335
Other Measures of Female Sexual Functioning 335
Sexual Satisfaction Assessment Instruments 335
The Global Measure of Sexual Satisfaction (GMSEX) 336
The Index of Sexual Satisfaction (ISS) 337
The Pinney Sexual Satisfaction Inventory (PSSI) 337
The Female Sexual Distress Scale (FSDS) 337
The Sexual Satisfaction Scale for Women (SSS-W) 338
Summary 338
References 339
Chapter 22: Validated Questionnaires in Male Sexual Function Assessment 344
Introduction 344
Symptoms Scales and Questionnaires 344
Comprehensive Male Sexual Dysfunction Scales 345
Golombok Rust Inventory of Sexual Satisfaction 345
International Index of Erectile Function 346
Delayed Ejaculation Scales-Male Anorgasmia 346
Male Sexual Health Questionnaire 346
Premature Ejaculation Measures 347
Premature Ejaculation Profile 347
Index of Premature Ejaculation 347
Premature Ejaculation Diagnostic Tool 347
Treatment Satisfaction Scales 348
Treatment Satisfaction Scale 348
Erectile Dysfunction Inventory for Treatment and Satisfaction 348
Psychological and Interpersonal Relationship Scale 349
Sexual Quality of Life Scales 349
Sexual Life Quality Questionnaire 349
Self-Esteem and Relationship Questionnaire 349
Sexual Quality of Life: Male 350
Cancer-Specific Scales and Validation Data in Cancer Patients 350
Expanded Prostate Cancer Index Composite/UCLA Prostate Cancer Index 350
Validation of Scales in a Cancer Population 351
Summary and Conclusions 351
Appendix 351
Medical, Psychosocial, and Sexual Assessment Questionnaire 351
Erection 352
Libido/Interest 352
Ejaculation/Orgasm/Satisfaction 352
Satisfaction 352
Previous Consultations 352
References 353
Chapter 23: Evaluation of the Female with Sexual Dysfunction 355
Examination of the Female Cancer Patient 355
Specialized Testing for the Sexual Health Assessment 356
Laboratory Testing 356
Sonography 357
Advanced Testing 357
Vulvoscopy 357
Vaginal Photoplethysmography 357
Functional Magnetic Resonance Imaging 357
Quantitative Sensory Testing 358
Perinometry 358
Psychosexual Assessment After Cancer Diagnosis and Treatment 358
Surgical Considerations 358
Radiation Therapy Considerations 359
Chemotherapy Considerations 359
Hormone Therapy Considerations 359
Sexuality and Relationship Considerations 359
Other Psychological Considerations 359
Issues of Sexuality 360
Conclusions 360
References 360
Chapter 24: Evaluation of Male Sexual Dysfunction 361
Male Sexual Dysfunctions and Cancer Survivors 361
Changing Paradigms in the Evaluation of Erectile Dysfunction 362
Questionnaires and Sexual Function Symptom Scores 365
Questionnaires and Cancer Survivors 365
Medical, Sexual, and Psychosocial History 366
Medical History 366
Sexual History 367
Psychosexual History for the Nonmental Health Professional 368
Physical Examination 369
Laboratory Testing 369
Hormonal Evaluation 370
Cancer Survivors and Gonadal Status 371
Review of Findings 372
Specialist Consultation and Referral 372
Vascular Evaluations of Erectile Dysfunction 374
First-Line Evaluation of Penile Blood Flow 374
Second-Line Evaluations of Penile Blood Flow 374
Penile Doppler Sonography 374
Recommendations of the ICSM on Penile Vascular Testing 377
Selective Internal Pudendal Arteriography 377
Nocturnal Penile Tumescence 379
Hypoactive Sexual Desire 379
Ejaculatory Disorders 380
Cancer Survivors and Ejaculatory Dysfunction 381
Specific Ejaculatory Dysfunctions 382
Conclusions 383
References 383
Chapter 25: The Impact of Cancer on the Partner’s Sexuality 387
Introduction 387
What is Sexuality? Concepts of Human Sexuality 387
Human Sexuality from a Systems Perspective: The Four Component Sexual Model 388
The Impact of Cancer on Sexuality from a Systems Perspective 389
Impact of Cancer on the Partner’s Sexuality from a Systems Perspective 390
Impact of Male Sexual Dysfunction on Partners 392
Impact of Female Sexual Dysfunction on Male Partners 394
Impact of Cancer Diagnosis and Treatment on the Partner’s Sexuality 394
Psychological Impact of Cancer on Partner 394
Sexual and Intimacy Effects of Cancer on the Partner 395
Psychosocial Impact on the Partner of Men with Prostate Cancer 396
Impact on the Partner of Women with Breast Cancer 397
Clinical Intervention of Health Care Professionals 397
Conclusion 398
References 398
Chapter 26: Gay and Lesbian Patients with Cancer 400
Introduction 400
Health Care Provider Assumptions 400
Special Considerations for Lesbians 401
Special Considerations for Gay Men 401
Prostate Cancer 401
Colorectal Cancer 402
Attitudes of Health Care Providers to Gay/Lesbian Patients 402
Homophobia 402
Heterosexism 403
Disclosure of Same Sex Attraction or Relationship 403
How Oncology Care Providers Can Help 404
PLISSIT Model 404
Conclusion 405
References 405
Part IV:Cancer and Sex 407
Chapter 27: The Impact of a Cancer Diagnosis on Sexual Health 408
Introduction 408
The Psychological Response to a Cancer Diagnosis and Its Impact on Sexual Functioning 409
Partners Perception of Diagnosis and Affects on Sexuality (Table 27.2) 410
The Lack of Discussion of Sexuality at Diagnosis (Table 27.3) 412
Conclusion 414
References 414
Chapter 28: Breast Cancer 416
Breast Cancer Epidemiology and Population Data on Sexuality 416
The Interactive Biopsychosocial Model Applied to Sexualityand Breast Cancer 418
Sexuality and the Breast Cancer Care Continuum 420
Breast Cancer Risk Factors and Sexuality 420
Breast Cancer Screeningand Sexuality 421
Average-Risk Women Screening Guidelines 421
Very High-Risk Women Screening Guidelines 421
Diagnosis 425
Treatment 426
Surgery 426
Chemotherapy 429
Adjuvant Chemotherapy 431
Taxanes 431
Trastuzumab/Herceptin 436
Radiation 436
Hormonal Therapy: Pre- and Perimenopausal Women 436
Aromatase Inhibitors 438
Zoledronic Acid 438
Adjuvant Hormonal Therapy: Postmenopausal Women 439
Targeted Palliative Therapies 439
Bevacizumab 440
Lapatinib 440
Complications from Cancer Therapy 440
Treatment of Sexual Problems in Breast Cancer Survivors 441
Vaginal Dryness 441
Pain with Intercourse 443
Vaginal Stenosis 445
Vaginismus 446
Low or Absent Sexual Desire and Difficulty with Arousal and Orgasm 447
Role of Psychotherapy, Sex Therapy, Couples and Marital Therapy, Psychiatric Medications 448
Cancer Survivorship and Health Maintenance 450
Bone Health 450
Cardiovascular Health 451
Key Research Questions and Needs to Advance Care of Sexuality Issues in People with Breast Cancer or Elevated Breast Cancer Risk 451
References 451
Chapter 29: Gynecological Cancers 457
General Considerations 457
The Etiopathogenetic Framework of Sexual Dysfunction in Genital Cancer Patients 458
Cancer of the Vulva 458
Impact of the Disease and Treatment Procedures 458
Prevalence and Incidence of Sexual Dysfunction and Contributing Factors 458
Cancer of the Vagina 459
Impact of the Disease and Treatment 459
Prevalence, Incidence of Sexual Dysfunction, and Contributing Factors 459
Cancer of the Cervix 459
Impact of the Disease and Treatment 459
Prevalence, Incidence of Sexual Dysfunction, and Contributing Factors 460
Quality of Life Studies 460
Differences Between Treatment Procedures (Table 29.1) 460
Specific Physical Findings and Sexual Dysfunction (Table 29.2) 462
Contributing Factors 464
Endometrium Carcinoma 466
Impact of the Disease and Treatment 466
Prevalence, Incidence of Sexual Dysfunction, and Contributing Factors 466
Cancer of the Ovaries 467
The Impact of the Disease and Treatment 467
Prevalence, Incidence of Sexual Dysfunction, and Contributing Factors 467
Assessment of Sexual Functioning 468
Therapy 468
Psychological Interventions 469
Local Nonhormonal and Mechanical Interventions 470
Lubricants 470
Vaginal Dilatation 471
Hormonal 471
Local Estrogen 471
Summary and Conclusion 472
References 473
Chapter 30: Pelvic Surgery for Urological Cancers 476
Anatomy of Erectile Function 476
Arterial Supply 476
Accessory Pudendal Arteries 476
Venous Drainage 477
Neuroanatomy 477
Corporal Smooth Muscle 478
Erectile Dysfunction Prevalence 478
Erectile Dysfunction Pathophysiology 479
Neural Trauma 479
Corporal Smooth Muscle Alterations 480
Venous Leak 481
Radical Prostatectomy-Associated Sexual Dysfunctions 481
Anejaculation 481
Orgasm Alterations 481
Peyronie’s Disease 482
Penile Length Alterations 483
References 484
Chapter 31: Pelvic Radiation in Men 488
Introduction 488
Methods for the Evaluation of Erectile Dysfunction 488
Definition of Potency 488
Etiology of Postradiation Erectile Dysfunction 489
Incidence of Erectile Dysfunction After Radiotherapy for Prostate Cancer 489
Incidence of Erectile Dysfunction After External-Beam Radiotherapy 489
Incidence of Erectile Dysfunction After Brachytherapy 489
Incidence of Erectile Dysfunction After Radiotherapy for Bladder Cancer 492
Incidence of Erectile Dysfunction After Radiotherapy for Penile Cancer 493
Incidence of Erectile Dysfunction After Radiotherapy for Testicular Cancer 494
Incidence of Erectile Dysfunction After Radiotherapy for Colorectal Cancer 496
Ejaculatory and Other Sexual Dysfunctions 497
Therapy of Postradiation Erectile Dysfunction 497
Prevention of Postradiation Erectile Dysfunction 497
Conclusion 498
References 498
Chapter 32: Pelvic Radiation in Women 502
Radiotherapy for Cancer in the Pelvis 502
Late Effects of Radiotherapy 503
Assessment of Sexual Function 505
Psycho-sexual Effects of Pelvic Radiation 506
Sexual Problems After Pelvic Radiation 507
Gynaecological Cancer 507
Rectal Cancer 512
Anal Cancer 514
Bladder Cancer 515
Intervention for Female Sexual Dysfunction 516
Premature Ovarian Failure 516
Hormone Replacement Therapy 516
Post-irradiation Vaginitis/Vaginal Mucositis 516
Oestrogen 516
Benzydamine 517
Hyperbaric Oxygen Therapy 517
Vaginal Dilators 517
Conclusion 518
References 518
Chapter 33: Impact of Chemotherapy and Hormone Therapy on Female Sexual Health 524
Introduction 524
Impact of Chemotherapy on Female Sexual Health 525
Impact of Hormone Therapy on Female Sexual Health 527
Management Strategies for Female Sexual Symptoms Related to Chemotherapy and Hormone Therapy 528
References 530
Chapter 34: Impact of Androgen Deprivation Therapy on Men’s Sexual Health 534
Introduction 534
Role of Testosterone on Male Sexual Health 535
Physiology of Testosterone 536
Hypothalamus-Pituitary-Testis Axis 536
Production of Androgens by the Adrenal Gland 536
Mechanism of Action of Androgen Deprivation Therapy 537
Medical Castration 537
Surgical Castration 538
Antiandrogens 538
Inhibition of Androgen Synthesis 538
Androgen Deprivation Therapy Effects on Sexual Function 538
Erectile Function 539
Ejaculation 540
Libido 540
Genital Changes 541
Assessment of Patients on Androgen Deprivation Therapy 541
Therapeutic Strategies for Patients on Androgen Deprivation Therapy 542
Intermittent Versus Continuous Androgen Deprivation Therapy 542
Penile Rehabilitation 543
Conclusions 543
References 543
Chapter 35: Colorectal Cancer 547
Overview of Treatment of Colon and Rectal Cancer 547
The Impact of Colorectal Cancer Diagnosis on Psycho-Sexual Functioning 548
The Impact of a Stoma on Sexual Functioning 549
The Impact of Treatment of Rectal Cancer on Male Sexual Functioning (Table 35.1) 550
The Impact of Treatment of Rectal Cancer on Female Sexual Function 553
Counseling and Treatment 555
References 556
Chapter 36: Stem Cell Transplant 559
Description of HSCT 559
Challenges from the Start of HSCT 560
Challenges After HSCT 560
Treatment Factors Contributing to Sexual Dysfunction 561
Chemotherapy and TBI 561
Graft Versus Host Disease and Sexuality 562
The Interaction of Physiological, Behavioral, Psychological, and Social Effects on Sexuality After HSCT 562
Other Issues Contributing to Sexual Function 563
Psychological Factors Contributing to Sexual Dysfunction 563
Determining Who Is at Greater Risk for Sexual Dysfunction After HSCT 564
Evaluating Sexual Functioning After HSCT 565
Medical Treatment Options 566
Behavioral Treatment Options 568
Research Needs in the HSCT Population 570
Conclusions 570
References 570
Chapter 37: Sexual Health in the Terminally III 574
Introduction 574
Sexuality and Intimacy in Cancer and Palliative Care 574
Experiencing a Cancer Diagnosis 574
Effects of Cancer Treatment on Sexuality and Intimacy 575
Treatment Ends: Now What? 575
Sexuality in the Palliative or Terminal Settings 575
Discussing Patient Sexuality in Palliative and Terminal Care 576
The Why of Sex 577
The Direct Physical Benefits of Sexual Expression 577
The How of Sex in the Palliative Stage? 578
Various Reactions and Topics in the Palliative–Terminal Phase 578
The Role of the Medical and Helping Professionals 579
Various Organizational Problems and Solutions 579
Introducing Discussions About Patient Sexuality and Intimacy 579
Creating Space/Room for Undisturbed Intimacy 580
Various Physical Problems and Solutions 580
Conclusions 583
References 583
Part V:Treatment Strategies 585
Chapter 38: Survivorship: An Overview 586
Introduction 586
Definition of Survivorship 586
Current Focus on Survivorship 587
A National Survivorship Agenda 587
Challenges of Survivorship 587
Models of Survivorship Care 589
Current and Evolving Clinic Models 589
Providing a Care Plan for Survivorship 590
Cancer and Sexuality: Where Does Survivorship Fit In 592
Oncology Clinician Practice Related to Sexual Health 592
Sexual Health as an Exemplar for Survivorship Care 593
Improving Clinical Practice 593
Institutional Program Development 593
National Advocacy 594
References 594
Chapter 39: Nutriceuticals in Sexual Health 597
Introduction (Part 1): Heart Health=Sexual Health (Ageless Education) 597
Introduction (Part 2): Heart Health=Sexual Health and Promoting Probability 598
Conclusion 614
References 615
Chapter 40: Medical Treatments for Sexual Problems in Women 621
Introduction 621
Iatrogenic Menopause 621
Fertility Preservation 622
Embryo Cryopreservation 622
Cryopreservation of Mature Oocytes 622
Cryopreservation of Immature Oocytes After In Vitro Maturation (Without Gonadotropin Stimulation) 623
Gonadotropin-Releasing Hormone Analogue Treatment 623
Cryopreservation of Ovarian Tissue 623
Medical Therapies of Sexual Disorders in Cancer Survivors 623
Hormone Therapy 625
Systemic 625
Estrogens 626
Estrogen and Progestins 626
Estrogen/Androgen Combination Therapy 626
Transdermal Testosterone Specifically for Women 627
Synthetic Steroids 627
Topical Hormonal Therapies 628
Nonhormonal Central Nervous System Acting Drugs 628
Antidepressants in Sexual Problems and Depression 628
Bupropion 628
Synergy Between Antidepressants and HRT in Addressing Sexual Disorders 629
Antidepressant Drugs in the Treatment of Menopausal and Sexual Symptoms 630
Nonhormonal Topical Treatments 630
Vasoactive Agents in Women 630
Botulin Toxin 630
Future Treatment Options 631
Flibanserin 631
Psychosocial Interventions 632
Conclusion 632
References 633
Chapter 41: Surgical Treatments for Sexual Problems in Women 636
Introduction 636
Vulvar Anatomy 636
Terminology 637
Vestibulodynia 637
Clitoral Phimosis 638
Perineoplasty 638
Bartholin’s Gland 639
Conclusions 639
References 640
Chapter 42: Sex Therapy in Female Sexual Dysfunction 641
Introduction 641
Gender Differences withSexual Function After Cancerand Physician Impact withPatient Response 641
Clinical Considerations for Diagnosis and Treatment of Women with Genital and Breast Cancer 642
Psychosocial Implicationsof Cancer on Women and Their Sexual Function 643
Mental Health Interventions (Table 42.1) 644
Support Groups 644
Hypnotherapy 644
Psychotherapy 644
Cultural Differences in Sexual Functioning for Women with Cancer 646
References 647
Chapter 43: Erectile Function Preservation for Men with Cancer 649
Introduction 649
Erectile Tissue Structure and Function 650
Cancer Treatments and Erectile Tissue Damage 650
Pelvic Surgery 650
Pelvic Radiation 652
Androgen Deprivation Therapy 652
Erectile Tissue Damage and Erectile Dysfunction 653
Erectile Tissue Preservation and Cancer Treatments 655
Erectile Tissue Preservation: Animal Study Data (Table 43.1) 656
Erectile Tissue Preservation: Human Study Data (Table 43.2) 659
Summary 662
References 663
Chapter 44: Erectile Dysfunction: Pharmacological Therapy 666
Introduction 666
Historical Review of Modern Erectile Dysfunction Pharmacotherapy 666
Goals of Pharmacological Therapy 667
Oral Agents 669
Phosphodiesterase 5 Inhibitors 669
Sildenafil 669
Tadalafil 673
Vardenafil 674
Nonarteritic Ischemic Optic Neuropathy 675
Sudden Sensorineural Hearing Loss 675
PDE5 Inhibitors Failures 675
Dopamine Receptor Agonists 676
Apomorphine 676
Adrenergic Receptor Antagonists 676
Yohimbine 676
Phentolamine 677
Serotonergic Receptor Agonists 677
Trazodone 677
Other Oral Agents 677
Transdermal Agents 677
Intracavernosal Agents 677
Alpha-Adrenoreceptor Blocking Agents 678
Phentolamine 678
Phosphodiesterase Inhibitor 678
Papaverine 678
Adenylate Cyclase Activators 678
Alprostadil (Prostaglandin E 1) 678
Other Intracavernosal Agents 679
Intracavernosal Agent Combinations 679
Important Aspects of Intracavernous Injection Therapy 680
Transurethral Therapy 681
References 682
Chapter 45: Erectile Dysfunction: Devices 688
Introduction 688
Vacuum Erection Devices 688
Penile Implants 691
Noninflatable Penile Implants 692
Inflatable Penile Implants 694
Conclusion 697
References 697
Chapter 46: The Management of Premature Ejaculation 699
Introduction 699
History of Premature Ejaculation 699
Definition of Premature Ejaculation (Table 46.1) 699
Research of Definition 700
Animal Model of Premature Ejaculation 701
Normal and Abnormal Ejaculation Time 701
Classification of Premature Ejaculation 701
Lifelong Premature Ejaculation 701
Acquired Premature Ejaculation 702
Two New Subtypes of Premature Ejaculation 702
Natural Variable Premature Ejaculation 702
Premature-Like Ejaculatory Dysfunction 703
Genetics of Lifelong Premature Ejaculation 703
Drug Treatment of Premature Ejaculation (Table 46.2) 703
Daily Oral Medication 704
On-Demand Drug Treatment 705
SSRIs 705
Dapoxetine 705
Tramadol 705
PDE5 Inhibitors 706
Topical Anesthetics 706
Inadequate Intracavernous Self-Injection Therapy for PE 706
Psychologic Treatment of Premature Ejaculation 706
Psychotherapy 706
Stop-Start Method 707
The Squeeze Technique 707
Sensate Focus 707
Clinical Interview of Men with Complaints of Premature Ejaculation 707
Relevant Questions for Considering Different Treatment Options 708
Summary 708
References 709
Chapter 47: Testosterone Therapy in the Male Cancer Patient 711
Overview 711
Introduction 712
Testosterone Deficiency and the Prostate Cancer Patient 712
The Origin of the Prohibition Against TTh in Prostate Cancer Patients 712
Historical Experience with Testosterone and Prostate Cancer 713
The Original Report: Huggins and Hodges 713
Historical Experience with T Administration in Men with PCa 713
The Memorial-Sloan Kettering Experience 714
Modern Evidence Regarding Testosterone and the Risk of PCa 714
Natural History 714
Longitudinal Studies of Serum Testosterone and Subsequent Risk of Prostate Cancer 714
Clinical TTh Trials 715
TTh in Men with Prostatic Intraepithelial Neoplasia 715
Prostate Biopsy in Men with Low Testosterone 715
Testosterone Flare and PSA 715
Testosterone Treatment in Men with Prostate Cancer 716
Rationale 716
Testosterone Following Radical Prostatectomy 716
Testosterone Following Other Treatments for PCa 717
TTh in Men with Untreated or Recurrent PCa 717
Current Understanding of the Relationship of PCa and T 717
Conclusions 718
References 718
Chapter 48: Sex Therapy in Male Sexual Dysfunction 721
Introduction 721
Psychological and Sexual Impact on Men and Their Partners 722
The Men 722
The Partners 722
The Relationship 723
Psychosocial Interventions 723
Role of Sex Therapy and Psychotherapy 724
Review of Existing Psychosocial Programs 724
Other Suggestions Regarding Content and Timing of Interventions 725
Conclusion 726
References 727
Chapter 49: Restoring Intimacy in Relationships Affected by Cancer 729
Introduction 729
Prostate Cancer, Intimacy, and the Marital Relationship 729
Psychosocial Interventions Addressing Relationship Intimacy Needs 732
Patient-Focused Psychological Interventions 733
Partner-Focused Psychological Interventions 734
Couple-Focused Psychological Interventions 735
Future Directions 737
Conclusion 738
References 738
Chapter 50: Dating and Disclosure for Cancer Survivors 741
Introduction 741
Theoretical Perspectives on Disclosure 742
Dating and Disclosure in the Context of Cancer 743
Culture as Context 745
Age and Developmental Stage 745
Gender 746
Race/Ethnicity, Socioeconomic Status, and Religion 746
Sexual Orientation and Gender Identity 747
Patient Information and Resources 747
Clinical and Research Implications 749
Conclusion 750
References 751
Index 753