Objective: Breast cancer survivors report adverse sexual effects (sexual morbidity) such as disrupted sexual function, sexual distress and body dissatisfaction. However, most studies have failed to evaluate the persistence of these effects in long-term survivors. The present study comprehensively assessed the prevalence and predictors of sexual/body image problems among survivors three or more years post diagnosis.Design/outcome measures: Eighty-three breast cancer survivors completed surveys a median of seven years post diagnosis. Survey items probed demographic, diagnostic and clinical information, in addition to sexual activity, sexual function (Female Sexual Function Index [FSFI]), body image, and distress regarding body changes and sexual problems (Female Sexual Distress Scale-revised; FSDS-R).Results: Seventy-seven percent of all participants and 60% of sexually active participants qualified for sexual dysfunction based on the FSFI. Between 37 and 51% met criteria for female sexual dysfunction, based on two FSDS-R clinical cut-offs. Body satisfaction was worse than normative values, while body change stress was mid-range. Notable sexual morbidity predictors included mastectomy, which was associated with worse sexual/body change distress, and post-treatment weight gain, which predicted greater body dissatisfaction/body change stress.Conclusions: Breast cancer survivors report substantial sexual morbidity years after treatment, especially after mastectomy or post-treatment weight gain. Breast cancer patients and their providers should be aware of these potential sexual effects. 相似文献
Thirty women who had prophylactic oophorectomy (PO) and thirty women undergoing ovarian cancer surveillance (OCS) completed a one-time in-depth telephone interview exploring information gathering and decision-making processes. There were close similarities between groups, including age, race, marital status, education, menopausal status, number undergoing genetic testing for BRCA mutations, and number of prophylactic mastectomies. The majority of participants indicated overall satisfaction with their final decision. However, many described the information gathering process as frustrating and anxiety provoking. Participants in both groups expressed a need to process medical information within the context of individual psychosocial needs and personal perceptions and experiences. There were recurrent themes with regard to informational and psychosocial needs and personal perceptions and experiences that impacted decision-making process for these women. The present paper is a companion paper to Swisher et al. (J Repr Med 2001, 46:87–94) with the focus of this paper to illustrate the medical informational processing needs identified by this group of women. 相似文献
Women at greatest risk for hereditary breast and ovarian cancer may consider prophylactic removal of breasts or ovaries as
a risk-reduction measure. This report describes uptake of risk-reduction mastectomy (RRM), risk-reduction oophorectomy (RRO),
and related factors in 62 high-risk women who received genetic counseling. Seven (11%) participants underwent RRM and 13 (21%)
underwent RRO. Of these women, 37% did not have BRCA testing, suggesting other factors influence decisions to undergo surgery.
Women who had indicated (pre-genetic counseling) their intent not to have surgery chose not to have surgery. Information received
during genetic counseling that women perceived as being most important for influencing risk-reduction surgery decisions was BRCA test result (positive or negative), followed by discussion
of family cancer history. Reasons for indecision about risk-reduction surgery included genetic testing results, concerns about
surgery, timing in life, and early menopause. The findings enhance our understanding of information that is helpful to women
considering this surgery. 相似文献
Background: For many trans males, having chest reconstruction is a very important part of the transitioning process. Guidelines from WPATH and the Endocrine Society suggest 16 to 18 years old as an acceptable age for this surgical intervention. In clinical practice, the decision depends on factors such as a person's desires, insurance coverage, and availability of local surgical experts. We present data about chest reconstructive surgeries in transgender youth from a Pediatric Gender Management (GeM) clinic.
Methods: For this retrospective, observational study, data were collected from GeM clinic patients seen from 10/1/2011 to 1/31/2017. All subjects consented or assented to being included in an IRB-approved clinical database.
Results: Of 210 patients from our clinic, 167 consented to being added to an institutional review board–approved database and followed prospectively. The average age at the initial visit was 15.2 years (range, 4.7–20.9). Among consenting subjects, 55 were trans females, 108 were trans males, and four identified as nonbinary. Fourteen subjects had chest reconstruction with the mean age being 17.2 years (range, 13.4–19.7); three subjects were under age 16. For five subjects, including the youngest one, insurance paid for the procedure. All participants but one were receiving testosterone treatment. Per the surgeons' preferences, testosterone was usually not temporarily stopped prior to the procedure. Six subjects had the procedure done locally; others sought surgical care out of the town, state, or country. All subjects were very satisfied with the aesthetics of the surgical outcome. The self-reported complication rate was low. Many more GeM clinic patients wish to have breast/chest surgery but lack of insurance coverage makes the surgery cost prohibitive.
Conclusion: For many trans males, chest reconstructive surgery is an integral part of the transition process. Patients' age at the time of surgical procedure varies greatly; some have chest surgery before age 16. In the United States, chest reconstruction surgery is usually not covered by insurance. Therefore, many patients seeking surgical care are forced to pay out of pocket. 相似文献
The Facing Our Risk of Cancer Empowered (FORCE) website is devoted to women at risk for hereditary breast and ovarian cancers.
One of the most frequently discussed topics on the archived messaged board has been prophylactic mastectomy (PM) for women
with a BRCA1/2 mutation. We reviewed the messages, over a 4 year period, of 21 high risk women and their “conversational”
partners who originally posted on a thread about genetic testing, genetic counseling and family history. We used a qualitative
research inductive process involving close reading, coding and identification of recurrent patterns, relationships and processes
in the data. The women sought emotional support, specific experiential knowledge and information from each other. They frequently
found revealing their post PM status problematic because of possible negative reactions and adopted self-protective strategies
of evasion and concealment outside of their web-based community. The FORCE message board was considered to be a safe place
in which the women could be truthful about their choices and feelings. Results are discussed in terms of Goffman’s concepts
“stigma” and “disclosure” and Charmaz’s concepts “interruptions,” “intrusions” and a “dreaded future.” 相似文献
AbstractBackground: Masculinizing mastectomy is the most requested gender affirming surgery (GAS) in trans men, followed by genital GAS. Mastectomy and total laparoscopic hysterectomy, with or without bilateral salpingo-oophorectomy (TLH?±?BSO), can both be performed in one single operation session. However, data on complication rates of the combined procedure is scarce and no consensus exists on the preferred order of procedures.Aims: To compare safety outcomes between mastectomy performed in a single procedure with those when performed in a combined procedure and assess whether the order of procedures matters when they are combined.Methods: A retrospective chart review was performed of trans men who underwent masculinizing mastectomy with or without TLH?±?BSO in a combined session. The effects of the surgical procedure on complication and reoperation rate of the chest were assessed using logistic regression.Results: In total, 480 trans men were included in the study. Of these, 212 patients underwent the combined procedure. The gynecological procedure was performed first in 152 (71.7%) patients. In the total sample, postoperative hematoma of the chest occurred in 11.3%; 16% in the combined versus 7.5% in the single mastectomy group (p?=?0.001). Reoperations due to hematoma of the chest were performed in 7.5% of all patients; 10.8% in the combined versus 4.9% in the single mastectomy group (p?=?0.017). The order of procedures in the combined group had no significant effect on postoperative hematoma of the chest (p?=?0.856), and reoperations (p?=?0.689).Conclusion: Combining masculinizing mastectomy with TLH?±?BSO in one session was associated with significantly more hematoma and reoperations compared with separately performing mastectomy. This increased risk of complications after a combined procedure should be considered when deciding on surgical options. The order of procedures in a combined procedure did not have an effect on safety outcomes. 相似文献