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While previous literature has continuously demonstrated the negative effects of cancer and its treatment on fertility and sexuality, evidence-based interventions to alleviate fertility-related distress and sexual dysfunction are lacking. This study protocol describes the internal pilot study and randomized controlled trial of an internet-delivered psychoeducational intervention: Fex-Can 2.0. The primary objective is to determine efficacy of Fex-Can 2.0 in terms of reduction of fertility-related distress and sexual dysfunction at end of the 12-week intervention. The internal pilot study will assess feasibility of the study, determined according to pre-specified progression criteria and individual interviews. The study has a randomized controlled design, with an internal pilot phase. The intervention group will receive Fex-Can 2.0, consisting of psychoeducational- and behavior change content. The control group will be allocated to standard care. Primary outcomes are fertility-related distress (RCAC) and sexual function and satisfaction (PROMIS SexFS Brief Sexual Profile). Secondary outcomes include body image (BIS), emotional distress (HADS), health-related quality of life (EORTC QLQ-C30), need satisfaction and frustration scale (NSFS), fertility- and sex-related knowledge, and self-efficacy related to fertility and sex life. Outcomes will be assessed at baseline, directly after the intervention, and 12 weeks later. During the internal pilot, data on trial recruitment, data collection, drop out, and adherence will be collected to assess feasibility. Semi-structured interviews will be conducted to further assess acceptability of Fex-Can 2.0. This randomized controlled trial aims to evaluate whether Fex-Can 2.0 is superior to standard care, in terms of reducing fertility-related distress and sexual dysfunction in young adults diagnosed with cancer. If proven efficacious, the Fex-Can 2.0 intervention may be a valuable resource in health care, with the potential to significantly improve the care of young adults experiencing fertility-related distress and/or sexual dysfunction following cancer. ClinicalTrials.gov ISRCTN18040643.

Background Over half of men who receive treatment for prostate suffer from a range of sexual problems that affect negatively their sexual health, sexual intimacy with their partners and their quality of life. In clinical practice, however, care for the sexual side effects of treatment is often suboptimal or unavailable. The goal of the current study is to test a web-based intervention to support the recovery of sexual intimacy of prostate cancer survivors and their partners after treatment. Methods The study team developed an interactive, web-based intervention, tailored to type of treatment received, relationship status (partnered/non-partnered) and sexual orientation. It consists of 10 modules, six follow the trajectory of the illness and four are theme based. They address sexual side effects, rehabilitation, psychological impacts and coaching for self-efficacy. Each includes a video to engage participants, psychoeducation and activities completed by participants on the web. Tailored strategies for identified concerns are sent by email after each module. Six of these modules will be tested in a randomized controlled trial and compared to usual care. Men with localized prostate cancer with partners will be recruited from five academic medical centers. These couples ( N  = 140) will be assessed prior to treatment, then 3 months and 6 months after treatment. The primary outcome will be the survivors’ and partners’ Global Satisfaction with Sex Life, assessed by a Patient Reported Outcome Measure Information Systems (PROMIS) measure. Secondary outcomes will include interest in sex, sexual activity, use of sexual aids, dyadic coping, knowledge about sexual recovery, grief about the loss of sexual function, and quality of life. The impact of the intervention on the couple will be assessed using the Actor-Partner Interaction Model, a mixed-effects linear regression model able to estimate both the association of partner characteristics with partner and patient outcomes and the association of patient characteristics with both outcomes. Discussion The web-based tool represents a novel approach to addressing the sexual health needs of prostate cancer survivors and their partners that—if found efficacious—will improve access to much needed specialty care in prostate cancer survivorship. Trial registration Clinicaltrials.gov registration # NCT02702453 , registered on March 3, 2016.

Sexual function is a vital aspect of quality of life among adolescent and young adult (AYA) (ages 15-39 years) cancer survivors. Sexual function encompasses physical, psychosocial, and developmental factors that contribute to sexual health, all of which may be negatively impacted by cancer and treatment. However, limited information is available to inform the care of AYA cancer survivors in this regard. This scoping review, conducted by the Children's Oncology Group AYA Oncology Discipline Committee, summarizes available literature regarding sexual function among AYA cancer survivors, including relevant psychosexual aspects of romantic relationships and body image. Results suggest that, overall, AYA cancer survivors experience a substantial burden of sexual dysfunction. Both physical and psychosocial sequelae influence survivors' sexual health. Interventions to support sexual health and psychosexual adjustment after cancer treatment are needed. Collaborations between the Children's Oncology Group and adult-focused cooperative groups within the National Cancer Institute's National Clinical Trials Network are warranted to advance prospective assessment of sexual dysfunction and test interventions to improve sexual health among AYA cancer survivors.

Background Given the negative impact of breast cancer and its treatment on women’s self-efficacy in various areas, including sexual function, investigating and understanding ways to enhance sexual function is crucial. The current study aimed to examine the impact of sexual counseling and education based on self-efficacy theory on the sexual function of women with breast cancer. Method The trial was a randomized controlled trial with a parallel design, including a pre-test, post-test, and one-month follow-up. Fifty married breast cancer survivors, having a disorder in at least one domain of sexual function (score below 3.9) and meeting other research criteria, visited clinics and hematology departments of hospitals in Bushehr (a city in southern Iran) between 2023 and 2024 were purposefully selected and randomly assigned to intervention and control groups using block randomization. The intervention group received two educational sessions and three counseling sessions based on the self-efficacy theory. Data collection utilized demographic information forms and a sexual function index for women, which consists of 19 questions that assess six domains of women’s sexual function (desire, arousal, lubrication, orgasm, satisfaction, and pain during intercourse) over a period of 4 weeks and completed by participants during the pre-test, post-test, and follow-up stages. Descriptive statistics (mean, standard deviation, percentage, frequency) and analytical tests, including the independent t-test, Mann‒Whitney U test, Chi-square test, and Fisher’s exact test and repeated-measures analysis of variance (ANOVA) followed by post hoc LSD test were used for data analysis, considering a significance level of less than 0.05 in all cases. Result The mean age of patients in the intervention and control groups was 44.42 ± 4.88 and 43.44 ± 5.20, respectively. The two groups did not have statistically significant differences in demographic and disease-related variables ( P  > 0.05). An independent t-test showed no significant difference between the two groups in terms of the average pre-test sexual function score and its domains ( P  > 0.05). Changes in overall sexual function and the arousal, orgasm, lubrication, and satisfaction domains from pre-test to post-test and from pre-test to follow-up increased in the intervention group and decreased in the control group, with statistically significant differences between the two groups ( P  < 0.05). However, the average changes from post-test to follow-up were not statistically significant between the two groups. Conclusion The total FSFI scores and most of its domains in the intervention group were higher than those in the control group, which can be attributed to the impact of sexual education and counseling. Therefore, the use of this non-invasive, cost-effective, and straightforward method along with other medical approaches is recommended. Trial registration IRCT20231102059930N1, 4 December 2023, Prospectively registered, at http//www.irct.ir.

Abstract This Position Statement has been endorsed by the International Menopause Society, The Endocrine Society, The European Menopause and Andropause Society, The International Society for Sexual Medicine, The International Society for the Study of Women's Sexual Health, The North American Menopause Society, The Federacion Latinoamericana de Sociedades de Climaterio y Menopausia, The Royal College of Obstetricians and Gynecologists, The International Society of Endocrinology, The Endocrine Society of Australia, and The Royal Australian and New Zealand College of Obstetricians and Gynecologists.* The only evidence-based indication for testosterone for women is for HSDD. There are insufficient data for using testosterone for any other symptom/condition or for disease prevention.

Purpose To assess sexual/vaginal health issues and educational intervention preferences in women with a history of breast or gynecologic cancer. Methods Patients/survivors completed a cross-sectional survey at their outpatient visits. Main outcome measures were sexual dysfunction prevalence, type of sexual/vaginal issues, awareness of treatments, and preferred intervention modalities. Descriptive frequencies were performed, and results were dichotomized by age, treatment status, and disease site. Results Of 218 eligible participants, 109 (50%) had a history of gynecologic and 109 (50%) a history of breast cancer. Median age was 49 years (range 21–75); 61% were married/cohabitating. Seventy percent ( n  = 153) were somewhat-to-very concerned about sexual function/vaginal health, 55% ( n  = 120) reported vaginal dryness, 39% ( n  = 84) vaginal pain, and 51% ( n  = 112) libido loss. Many had heard of vaginal lubricants, moisturizers, and pelvic floor exercises (97, 72, and 57%, respectively). Seventy-four percent ( n  = 161) had used lubricants, 28% moisturizers ( n  = 61), and 28% pelvic floor exercises ( n  = 60). Seventy percent ( n  = 152) preferred the topic to be raised by the medical team; 48% ( n  = 105) raised the topic themselves. Most preferred written educational material followed by expert discussion (66%, n  = 144/218). Compared to women ≥50 years old (41%, n  = 43/105), younger women (54%, n  = 61/113) preferred to discuss their concerns face-to-face ( p  = 0.054). Older women were less interested in online interventions (52%, p  < 0.001), despite 94% having computer access. Conclusion Female cancer patients/survivors have unmet sexual/vaginal health needs. Preferences for receiving sexual health information vary by age. Improved physician–patient communication, awareness, and educational resources using proven sexual health promotion strategies can help women cope with treatment side effects.

Background Men who undergo surgery for prostate cancer frequently experience significant side-effects including urinary and sexual dysfunction. These difficulties can lead to anxiety, depression and reduced quality of life. Many partners also experience psychological distress. An additional impact can be on the couple relationship, with changes to intimacy, and unmet psychosexual supportive needs in relation to sexual recovery and rehabilitation. The aim of this exploratory randomised controlled trial pilot study is to determine the feasibility and acceptability of a novel family-relational-psychosexual intervention to support intimacy and reduce distress among couples following prostate cancer surgery and to estimate the efficacy of this intervention. Methods/Design The intervention will comprise six sessions of psychosexual and relationship support delivered by experienced couple-support practitioners. Specialist training in delivering the intervention will be provided to practitioners and they will be guided by a detailed treatment manual based on systemic principles. Sixty-eight couples will be randomised to receive either the intervention or standard care (comprising usual follow-up hospital appointments). A pre-test, post-test design will be used to test the feasibility of the intervention (baseline, end of intervention and six-month follow-up) and its acceptability to couples and healthcare professionals (qualitative interviews). Both individual and relational outcome measures will assess sexual functioning, anxiety and depression, couple relationship, use of health services and erectile dysfunction medication/technologies. An economic analysis will estimate population costs of the intervention, compared to usual care, using simple modelling to evaluate the affordability of the intervention. Discussion Given the increasing incidence and survival of post-operative men with prostate cancer, it is timely and appropriate to determine the feasibility of a definitive trial through a pilot randomised controlled trial of a family-relational-psychosexual intervention for couples. The study will provide evidence about the components of a couple-based intervention, its acceptability to patients and healthcare professionals, and its influence on sexual and relational functioning. Data from this study will be used to calculate sample sizes required for any definitive trial. Trial registration ClinicalTrials.gov Identifier: NCT01842438 . Registration date: 24 April 2013; Randomisation of first patient: 13 May 2013

Hypothyroidism and hyperthyroidism are observationally associated with sex hormone concentrations and sexual dysfunction, but causality is unclear. We investigated whether TSH, fT4, hypo- and hyperthyroidism are causally associated with sex hormones and sexual function. We used publicly available summary statistics from genome-wide association studies on TSH and fT4 and hypo- and hyperthyroidism from the ThyroidOmics Consortium (N ≤ 54,288). Outcomes from UK Biobank (women ≤ 194,174/men ≤ 167,020) and ReproGen (women ≤ 252,514) were sex hormones (sex hormone binding globulin [SHBG], testosterone, estradiol, free androgen index [FAI]) and sexual function (ovulatory function in women: duration of menstrual period, age at menarche and menopause, reproductive lifespan, and erectile dysfunction in men). We performed two-sample Mendelian randomization (MR) analyses on summary level, and unweighted genetic risk score (GRS) analysis on individual level data. One SD increase in TSH was associated with a 1.332 nmol/L lower (95% CI:-0.717,-1.946; p = 2 × 10⁻⁵) SHBG and a 0.103 nmol/l lower (-0.051, V0.154; p = 9 × 10⁻⁵) testosterone in two-sample MR, supported by the GRS approach. Genetic predisposition to hypothyroidism was associated with decreased and genetic predisposition to hyperthyroidism with increased SHBG and testosterone in both approaches. The GRS for fT4 was associated with increased testosterone and estradiol in women only. The GRS for TSH and hypothyroidism were associated with increased and the GRS for hyperthyroidism with decreased FAI in men only. While genetically predicted thyroid function was associated with sex hormones, we found no association with sexual function.

Key PointsSexual Dysfunction in WomenSexual dysfunction in women is common and is associated with impaired well-being and quality of life.Many women with sexual dysfunction will not seek care unless prompted by their health care provider. However, there are no evidence-based screening recommendations for sexual dysfunction as part of routine care.Sexual well-being is determined by a complex interplay of biologic, psychological, and sociocultural factors. Therefore, an assessment of sexual dysfunction involves a comprehensive review of the patient’s general health and psychosocial circumstances and a history of the patient’s use of prescription and nonprescription medications and other drugs.Management pathways for sexual dysfunction include lifestyle modification, counseling and psychosexual therapies, physical therapy, and pharmacologic therapy.

Rectal cancer treatment can lead to sexual dysfunction. We designed a retrospective survey-based study to quantify rates of sexual dysfunction in rectal cancer survivors. Patients that underwent surgery for rectal cancer between 2005 and 2016 at our institution were identified, and the following were distributed: Quality of Life measure for oncology (QoL-30), Female Sexual Function Index (FSFI), and International Index of Erectile Function (IIEF). Survey response rate was 21%, 17 females and 30 males (n = 47). 50% of males recalled a physician asking about sexual function during or after treatments, compared to 18% of females (p = 0.034). More than 50% of those surveyed wished one of their physicians had discussed the possibility of sexual dysfunction. In men, the QoL-30 significantly correlated with IIEF orgasmic function (r = 0.50, p = 0.004) and IIEF overall satisfaction (r = 0.60, p < 0.001). Our findings demonstrate that rectal cancer patients experience posttreatment sexual dysfunction, desire discussion with their physicians on this topic, and that there are gender differences in how providers approach counseling regarding posttreatment sexual dysfunction. •Rectal cancer patients experience posttreatment sexual dysfunction.•Rectal cancer patients desire discussion with their physicians regarding sexual dysfunction.•There are gender differences in the way physicians approach sexual dysfunction counseling.•Sexual function has a correlation with quality of life in men.•Physicians should be educated on how to approach sexual dysfunction counseling with rectal cancer patients.