Breast Cancer and Sexual Function

As the most common malignancy affecting women within the United States, breast cancer can bring about multiple physical and psychological challenges. Among the greatest challenges are those associated with female sexual function. 

Chemotherapy, endocrine therapy, surgeries and radiation can all have a large effect in altering a woman's sexual health and function. Sexual concerns result in significant emotional distress, including sadness/depression, issues related to personal appearance, stigma, and negative impacts on personal relationships. 

In this article, we discuss some of the specific challenges that present with each type of treatment and the socio-physical impact they have on survivorship. Among the most detrimental to sexual function, are the use of chemotherapy and endocrine therapy. Additionally, anatomical changes that transpire in patients who have undergone surgery or radiation therapy (RT), disrupt perceptions of body image. Here we will discuss and also review the contemporary literature to determine effective management and treatment of sexual dysfunction.

Below:  Sexual health in women

Clinical trials of interventions in breast cancer survivors

Intervention	N	Trial	Results
Topical testosterone (25)	21	Phase I/II	Significant improvement in dyspareunia and dryness
Transdermal testosterone (26)	150	RCT	Compared to placebo, no difference in sexual function scores at 4 or 8 weeks of intervention
Vaginal dehydroepiandrosterone (33)	441*	RCT	Compared to placebo, improvement in sexual satisfaction scores
Aqueous 4% lidocaine (30,31)	49	RCT	Compared to normal saline, significant improvement in pain; resumption of sexual intercourse in 17 of 20 women who had previously abstained
Vaginal pH-balanced gel (28)	86	RCT	Compared to placebo, nonsignificant improvement in vaginal dryness and dyspareunia
Polycarbophil-based vaginal moisturizer (29)	45	RCT	Compared to placebo, trend towards improved dyspareunia scores. Both groups had improvement in average vaginal dryness

RCT, randomized controlled trial. *, breast and gynecologic cancer survivors included in this study.

Full article at:   http://goo.gl/MMyGHu

By:  Boswell EN1, Dizon DS1.

• 1 Dana-Farber Cancer Institute, 2 The Oncology Sexual Health Program, The Massachusetts General Hospital Cancer Center, Boston, MA 06114, USA.
• Transl Androl Urol. 2015 Apr;4(2):160-8. doi: 10.3978/j.issn.2223-4683.2014.12.04. 

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Adolescent Boys with Autism Spectrum Disorder Growing Up: Follow-Up of Self-Reported Sexual Experience

Systematic research on sexual development in adolescents with autism spectrum disorder (ASD) remains scant, notwithstanding the often-suggested relation between ASD, atypical, and even sexually offensive behaviours. 

This study compared follow-up data related to lifetime sexual experience (LTSE) in a homogeneous group of adolescent boys with ASD (n = 30), aged 16-20, with a matched group of boys in the general population (n = 60). Most boys in the ASD and control groups reported masturbation and having experienced an orgasm. 

The proportion of boys with ASD that had no partnered sexual experience was larger than in the control group. This difference was mostly explained by significantly fewer boys with ASD, compared with controls, who reported experience with kissing and petting; no significant differences emerged relating to more intimate partnered sexual experiences. The results suggest the existence of a subgroup of boys who have not (yet) entered the arena of partnered sexual experiences-a finding in line with research in adult samples. 

There were no differences relating to sexual abuse or coercion. Exploration of the partnered experiences revealed a variety of types of partners, mostly of comparable age. Several boys with ASD had not anticipated their sexual debut. Although they felt ready for it, some boys reported regret afterward. 

The hypothesised sexual developmental trajectories are subject to further research, but the sexual experience in this sample and the assumed developmental differences indicate the need for early, attuned, and comprehensive sexuality-related education and communication.

Full article at:   http://goo.gl/e5qXxa

By:  Dewinter J1,2, Vermeiren R3,4, Vanwesenbeeck I5,6, Van Nieuwenhuizen C7,8.

• 1Scientific Centre for Care and Welfare (Tranzo), Tilburg University, PO Box 90153 (T618), 5000 LE, Tilburg, The Netherlands. jeroen.dewinter@antwerpen.be.
• 2GGzE Centre for Child and Adolescent Psychiatry, PO Box 909 (DP1104), 5600 AX, Eindhoven, The Netherlands. jeroen.dewinter@antwerpen.be.
• 3Curium-LUMC, Leiden University Medical Centre, PO box 15, 2300 AA, Leiden, The Netherlands.
• 4Department of Child and Adolescent Psychiatry, VU Medical Centre Amsterdam, PO Box 303, 1115 ZG, Duivendrecht, The Netherlands.
• 5Interdisciplinary Social Science, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands.
• 6Rutgers, PO Box 9022, 3506 GA, Utrecht, The Netherlands.
• 7Scientific Centre for Care and Welfare (Tranzo), Tilburg University, PO Box 90153 (T618), 5000 LE, Tilburg, The Netherlands.
• 8GGzE Centre for Child and Adolescent Psychiatry, PO Box 909 (DP1104), 5600 AX, Eindhoven, The Netherlands. 
• Eur Child Adolesc Psychiatry. 2016 Jan 20.

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Evaluating a Sexual Health Patient Education Resource

This article shares the findings of an evaluation of a patient teaching resource for sexual health entitled Everything Nobody Tells You About Cancer Treatment and Your Sex Life: From A to Z, which was accomplished through systematic conceptualization, construction, and evaluation with women diagnosed with breast or gynecologic cancer. This resource, which has evolved from patient-focused research and has been tested in the clinical setting, can be used in patient education and support. Oncology professionals are committed to addressing quality-of-life concerns for patients across the trajectory of illness. Sexuality is a key concern for patients and impacts relationships and overall quality of life. Through careful assessment, patient education, and support, clinicians can ensure that sexuality is respected as an essential part of patient-centered care.

… The women who responded to the survey were predominantly Caucasian, educated, and middle class. Thus, their view may not be representative of minority women living with cancer. Therefore, we cannot generalize our findings to a larger general population. The A to Z Guide was written as a resource for women to help them anticipate the sexual health changes their bodies would experience throughout cancer treatment and to validate their experiences throughout survivorship.

Our team has continued to refine The A to Z Guide as we receive input from readers. Since the guide was released and made available for download on partner websites, we have received overwhelmingly positive response from users both nationally and internationally. The guide is being used by cancer centers; survivorship clinics; breast, gynecologic, lymphedema, and pelvic radiation support groups; nursing and medical schools; and family medicine clinics. It is our hope that more clinicians will make use of this resource, as it is free and can be downloaded in two formats: one designed for on-screen reading and one collated to print as a booklet.

Oncology professionals are committed to addressing QOL concerns for patients across the trajectory of illness. Sexuality is a key concern for patients, as it impacts relationships and overall QOL (Matzo, 2015). Through careful assessment, patient education, and support, oncology advanced practitioners can ensure that sexuality is respected as an essential part of patient-centered care (Matzo, 2010).

Below:  Respondents’ Scoring of The A to Z Guide

Full article at:  http://goo.gl/fSoo0d

By:  Marianne Matzo, PhD, APRN-CNP, FPCN, FAAN ,1 Sandi Troup, BSN, RN,2 Kamal Hijjazi, PhD, RN,3 and Betty Ferrell, PhD, FAAN4

¹ College of Nursing and Stephenson Cancer Center, University of Oklahoma Sciences Center, Oklahoma City, Oklahoma;

² Stephenson Cancer Center, University of Oklahoma Sciences Center, Oklahoma City, Oklahoma;

³ College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma;

⁴City of Hope, Los Angeles, California

Correspondence to: Marianne Matzo, PhD, APRN-CNP, FPCN, FAAN, Stephenson Cancer Center, Department of Geriatric Medicine, 1100 N. Stonewall Avenue, Oklahoma City, OK 73117. E-mail: mmatzo@ouhsc.edu

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Sex Education Groups in a Psychiatric Day Hospital: Clinical Observations

Although the prevalence of sexual dysfunction is high among individuals diagnosed with severe and chronic mental illness, the topic of sexuality is often not part of standard psychiatric assessment. 

Discussions about sexuality could improve patients' quality of life. This article outlines the development and implementation of a sex education group for patients admitted to a psychiatric day hospital in Montreal, Quebec, Canada, along with clinical observations. 

The series was well received by patients who felt that attending the group helped normalize their sexual concerns by providing a safe place in which to learn and to talk about sexuality.

Purchase full article at:   http://goo.gl/3vFXYm

By:  Persson TJ1, Drury KM1, Gluch E2, Wiviott G3.

• 1 Department of Psychology Concordia University , Montreal , Quebec , Canada.
• 2 English Montreal School Board , Montreal , Quebec , Canada.
• 3 McGill University Health Centre , Montreal , Quebec , Canada. 

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Female Sexual Subjectivity and Verbal Consent to Receiving Oral Sex

Women are less likely than men are to report receiving oral sex from their partners. Elements of sexual subjectivity may have implications for women's communication of consent to specific sexual acts. 

Sexually active women (n = 237) between 18 and 71 years of age (M = 28.85 years) completed an online survey measuring sociodemographic variables, entitlement to pleasure from partner, self-efficacy in achieving sexual pleasure, and consent communication at last receptive oral sex event. Participants were predominantly White (84.8%, n = 201) and in exclusive or monogamous sexual relationships (54.9%, n = 130). The authors used a 4-step test of mediation to determine whether self-efficacy in achieving sexual pleasure mediated the relation between entitlement to pleasure from partner and verbal consent communication. 

Self-efficacy emerged as a significant predictor of verbal consent communication (p <.01) in the fourth step, while entitlement to pleasure dropped out of the model (p >.05), indicating full mediation. Therefore, entitlement to pleasure predicted verbal consent to oral sex as a function of self-efficacy in achieving sexual pleasure. Sex-positive educational interventions may improve disparities between men and women in receiving oral sex from their partners. 

Results of this study offer insight into the ways in which culture-level forces affect interpersonal and intraindividual sexual health behaviors.

Purchase full article at:   http://goo.gl/RvTQwD

By:  Sonya Satinsky^a* & Kristen N. Jozkowski^b

^a Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas, USA

^b Department of Health, Human Performance & Recreation, University of Arkansas, Fayetteville, Arkansas, USA

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Evaluation of Holistic Sexuality Education: A European Expert Group Consensus Agreement

Objectives 

Holistic sexuality education (HSE) is a new concept in sexuality education (SE). Since it differs from other types of SE in a number of important respects, strategies developed for the evaluation of the latter are not necessarily applicable to HSE. In this paper the authors provide a basis for discussion on how to evaluate HSE. 

Methods 

First, the international literature on evaluation of SE in general was reviewed in terms of its applicability to HSE. Second, the European Expert Group on Sexuality Education extensively discussed the requirements of its evaluation and suggested appropriate indicators and methods for evaluating HSE. 

Results 

The European experience in SE is scarcely represented in the general evaluation literature. The majority of the literature focuses on impact and neglects programme and implementation evaluations. Furthermore, the current literature demonstrates that evaluation criteria predominantly focus on the public health impact, while there is not yet a consensus on sexual well-being criteria and aspects of positive sexuality, which are crucial parts of HSE. Finally, experimental designs are still considered the gold standard, yet several of the conditions for their use are not fulfilled in HSE. Realising that a new evaluation framework for HSE is needed, the European expert group initiated its development and agreed upon a number of indicators that provide a starting point for further discussion. 

Conclusions 

Aside from the health impact, the quality of SE programmes and their implementation also deserve attention and should be evaluated. To be applicable to HSE, the evaluation criteria need to cover more than the typical public health aspects. Since they do not register long-term and multi-component characteristics, evaluation methods such as randomised controlled trials are not sufficiently suitable for HSE. The evaluation design should rely on a number of different information sources from mixed methods that are complemented and triangulated to build a plausible case for the effectiveness of SE in general and HSE in particular.

Purchase full article at:   http://goo.gl/RYgbAv

By:  Ketting E1, Friele M2, Michielsen K3; European Expert Group on Sexuality Education.

• 1 * University Medical Centre, Radboud University , Nijmegen , the Netherlands.
• 2 Federal Centre for Health Education (BZgA) , Cologne , Germany.
• 3 International Centre for Reproductive Health, Ghent University , Ghent , Belgium.
• Eur J Contracept Reprod Health Care. 2016 Feb;21(1):68-80. doi: 10.3109/13625187.2015.1050715. Epub 2015 May 29. 

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Factors Facilitating Implementation of School-Based Sexuality Education in Portugal

Objectives 

The aims of the study were to examine in Portuguese schools the facilitating factors at micro- and exosystem levels generally associated with more effective implementation of sexuality education (SE). 

Methods 

A representative sample of principals/lead teachers from 296 Portuguese schools completed a questionnaire about SE at school that included items related to factors at micro- and exosystem levels. Bivariate and multivariate logistic regression analyses were performed to examine factors associated with the development of an SE project. 

Results 

The majority of schools (96%) implemented some form of SE. Specifically, 79% of schools had developed an SE project. The odds that a school had designed an SE project increased significantly when the school did not implement extracurricular activities only (odds ratio [OR] 7.9), when it had an SE team (OR 7.2) and when it had established partnerships (OR 4.5). Bivariate and multivariate logistic regression models for each factor and each level revealed that other variables were associated with the development of a project, such as the perceived support offered by the regional education department. 

Conclusions 

The results highlight the importance of variables at micro- and exosystem levels as facilitating factors, and reinforce the ecological approach as being well suited for SE/health education in schools. The findings have implications for policy-makers as well as for practice.

Purchase full article at:   http://goo.gl/mYgjEN

By:  Rocha AC1,2, Duarte C1,2.

• 1 * Faculty of Psychology and Education Sciences, University of Porto , Porto , Portugal.
• 2 Center for Psychology, University of Porto , Porto , Portugal.
• Eur J Contracept Reprod Health Care. 2016 Feb;21(1):30-8. doi: 10.3109/13625187.2015.1057809. Epub 2015 Jun 18. 

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Dress Nicer = Know More? Young Children’s Knowledge Attribution and Selective Learning Based on How Others Dress

This research explored whether children judge the knowledge state of others and selectively learn novel information from them based on how they dress. 

The results indicated that 4- and 6-year-olds identified a formally dressed individual as more knowledgeable about new things in general than a casually dressed one (Study 1). 

Moreover, children displayed an overall preference to seek help from a formally dressed individual rather than a casually dressed one when learning about novel objects and animals (Study 2). 

These findings are discussed in relation to the halo effect, and may have important implications for child educators regarding how instructor dress might influence young students’ knowledge attribution and learning preferences.

Below:  Mean Proportion of Trials Choosing the Formally Dressed Individual Across Studies

Full article at:  http://goo.gl/uOEWz2

By:  Kyla P. McDonald, Lili Ma

Department of Psychology, Ryerson University, Toronto, Ontario, Canada

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Factors Associated with Sex Work among At-Risk Female Youth in Cambodia: A Cross-Sectional Study

In Cambodia, despite great achievements in reducing the prevalence of HIV in the general population, reducing new HIV infections among young at-risk women remains a challenge. 

This study was designed to examine the prevalence of risky behaviors of sexually active female youth in Cambodia and to explore risk factors associated with engagement in transactional sex. We surveyed sexually active female youth aged 10-24 enrolled at risk "hotspots" in eight provinces in Cambodia. We collected data on demographic factors, sexual behavior, and factors hypothesized to be associated with transactional sex. Multivariable logistic regression was used to identify associations between demographic and sexual behavior and transactional sex. 

Of the 280 respondents, the mean age was 21.2, and 48.1% had been paid for sex in the past year. After adjustment, at-risk females who were never have been married, have completed less than 6 years of school, have 1 or more parents who had died, be a heavy alcohol drinker, have used a condom with their boyfriend during last sexual encounter, and have ever had an HIV test were more likely to engage in sex work. 

Our findings suggest that prevention strategies for female youth at risk of engagement in sex work should include upstream structural interventions that aim to encourage girls' education and empowerment. 

In addition, tailored sex education and behavior change messaging about the risks of heavy drinking, condom use with romantic partners, and the importance of frequent HIV testing for at-risk youth and sex workers should be designed and delivered to youth currently engaging in sex work.

Purchase full article at: http://goo.gl/qrRU3W

By: Brody C1, Tuot S2, Chhea C3, Saphonn V4, Yi S1,2.

• 1a Public Health Program, College of Education and Health Sciences , Touro University California, Vallejo , CA , USA.
• 2b Research Center , KHANA , Phnom Penh , Cambodia.
• 3c School of Public Health , National Institute of Public Health , Phnom Penh , Cambodia.
• 4d Faculty of Medicine , University of Health Sciences , Phnom Penh , Cambodia.  

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Qualitative Exploration of Sexual Experiences Among Adults on the Autism Spectrum: Implications for Sex Education

The increasing prevalence of autism since the 1990s has led to growing demand for sex education that meets the needs of persons on the autism spectrum. Yet there is a dearth of research documenting the firsthand experiences and perspectives of autistic individuals.

A thematic analysis was conducted of in-depth, Internet-facilitated interviews with 24 adults on the autism spectrum who were recruited from Internet community spaces between November 2012 and May 2013. Inclusion criteria were self-identification as a person on the autism spectrum, being a U.S. resident, being aged 18 or older, and having the ability to communicate orally or through writing.

Participants were aged 18-61 and were living in the community at the time of interview, most with limited extrafamilial support. They were less likely than the general population to be heterosexual or gender-conforming and were more likely to have experienced romantic or sexual debut after age 18. Participants' most common concerns were courtship difficulties and sensory dysregulation in the context of partnered sexuality. These concerns were exacerbated by inadequate and inappropriate sex education experiences. Participants addressed challenges by using sensory barriers (e.g., latex gloves); planning when and how to have sex; negotiating alternatives to sexual scripts predicated on nondisabled experience; and practicing explicit and intentional communication.

Individuals on the autism spectrum would benefit from sex education that normalizes differences (e.g., in identities and experiences of sexuality), is offered throughout young adulthood, addresses disability-relevant sensory and communication needs, and includes practicing neurotypical sociosexual norms.

Via:  http://goo.gl/huiels Purchase full article at: http://goo.gl/0tnB24

By: Barnett JP1,2, Maticka-Tyndale E3.

• 1Assistant professor, Wright State University, Dayton, Ohio
• 2An affiliate faculty member, University of Windsor, Windsor, Ontario, Canada
• 3Distinguished university professor and Canada Research Chair in Social Justice and Sexual Health, University of Windsor. 

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A Rights-Based Sexuality Education Curriculum for Adolescents: 1-Year Outcomes From a Cluster-Randomized Trial

The purpose of this study was to evaluate the impact of a rights-based sexuality education curriculum on adolescents' sexual health behaviors and psychosocial outcomes 1 year after participation.

Within 10 urban high schools, ninth-grade classrooms were randomized to receive a rights-based curriculum or a basic sex education (control) curriculum. The intervention was delivered across two school years (2011-2012, 2012-2013). Surveys were completed by 1,447 students at pretest and 1-year follow-up. Multilevel analyses examined curriculum effects on behavioral and psychosocial outcomes, including four primary outcomes: pregnancy risk, sexually transmitted infection risk, multiple sexual partners, and use of sexual health services.

• Students receiving the rights-based curriculum had higher scores than control curriculum students on six of nine psychosocial outcomes, including 
• sexual health knowledge, 
• attitudes about relationship rights, 
• partner communication, 
• protection self-efficacy, 
• access to health information, 
• and awareness of sexual health services. 
• These students also were more likely to report use of sexual health services and more likely to be carrying a condom relative to those receiving the control curriculum. 
• No effects were found for other sexual health behaviors, possibly because of low prevalence of sexual activity in the sample.

The curriculum had significant, positive effects on psychosocial and some behavioral outcomes 1 year later, but it might not be sufficient to change future sexual behaviors among younger adolescents, most of whom are not yet sexually active. Booster education sessions might be required throughout adolescence as youth initiate sexual relationships.

Via:  http://ht.ly/SLvuJ  Purchase full article at:  http://ht.ly/SLvUS 

By: Rohrbach LA1, Berglas NF2, Jerman P2, Angulo-Olaiz F2, Chou CP1, Constantine NA3.

• 1Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
• 2Center for Research on Adolescent Health and Development, Public Health Institute, Oakland, California.
• 3Center for Research on Adolescent Health and Development, Public Health Institute, Oakland, California; Division of Community Health and Human Development, School of Public Health, University of California, Berkeley, California. 

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Dr Google, Porn and Friend-of-a-Friend: Where Are Young Men Really Getting Their Sexual Health Information?

Young men are vulnerable when it comes to sexual health. They attend the general practitioner (GP) less often than females and are less likely to be offered testing for sexually transmissible infections. Access to accurate health information and education is a cornerstone of primary prevention, yet we know very little about how, where and why young people obtain information about sexual health.

One-on-one semi-structured interviews were conducted with 35 male students aged 16-19 years from two Victorian educational institutions for trade skills until data saturation was reached. Interviews were audio-recorded, transcribed and thematically analysed.

• The young men were poorly informed about sexual health. 
• Their existing knowledge mainly came from school-based sexual health education, which while valued, was generally poorly recalled and provided only a narrow scope of physiological information. 
• Young men seek sexual health information from various sources including family, the Internet, friends and pornography, with information from the latter three sources perceived as unreliable. 
• GPs were seen as a source of trust-worthy information but were not accessed for this purpose due to embarrassment. 
• Young men preferred the GP to initiate such conversations. 
• A desire for privacy and avoidance of embarrassment heavily influenced young men's preferences and behaviours in relation to sexual health information seeking.

The current available sources of sexual health information for young men are failing to meet their needs. Results identify potential improvements to school-based sexual education and online resources, and describe a need for innovative technology-based sources of sexual health education.

Via:  http://ht.ly/SDA3J  Purchase full article at:  http://ht.ly/SDAng 

By: Litras A, Latreille S, Temple-Smith M.

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