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Penile carcinoma: from first symptom to sexual function and life satisfaction following organ-sparing laser treatment
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to describe how patients with penile carcinoma experienced their symptoms, treatment seeking and the impact of the diagnosis and treatment on sexual function, sexual activity and life satisfaction. The thesis contains two studies of patients treated with organ-sparing laser therapy, a retrospective study (Papers II and III) of 46 patients treated between 1986-2000 and a prospective study (Papers I and IV) of 50 patients between 2005 and 2009 and additional 34 partners. In both studies face-to-face interviews were used with a structured questionnaire; and self-assessment instruments IIEF-5, LiSat-11, and HADS. An ad hoc comparator population of men aged 34–74 years from a nationally representative investigation of sexual life and life satisfaction in Swedes was chosen for some of the questions concerning sexuality and life satisfaction. We found a delay of more than 6 months in 37% of the patients in the retrospective study and 65% of the patients in the prospective study. The single most important reason for patients’ delay was embarrassment. Nine patients had a doctors’ delay of more than 3 months from first special visit until diagnosis. Eight of these patients consulted dermatologists and were subjected to repeated biopsies, leaving premalignant results (I, II). All patients younger than 75 years (34/46) in the retrospective study reported that they were sexual active before treatment, 80% of these had resumed their activity by the time of the interview. Furthermore, except for satisfaction with somatic health, similar—or even higher—proportions of patients than comparators were satisfied with life as a whole and with other domains of life including satisfaction with sexual life (III). We found that 21/29 couples were sexually active with intercourse before treatment and 17 couples resumed their activity. Two items differed markedly from the comparators; considerably fewer patients were satisfied with their somatic health, and satisfaction with sexual life (at 12 months follow-up). Couples with an active partner-related sexuality at 12 months follow-up, reported coherence in high satisfaction with life as a whole (IV).In conclusion, patients with penile carcinoma delay for a long time after identifying symptoms before seeking contact with the health care system. This delay is mainly caused by embarrassment in describing the symptom to health care personnel and deficient knowledge about the disease. Organ- sparing technique offers good, satisfying cosmetic results and the possibility of maintaining sexual activity and function to a great extent.

Place, publisher, year, edition, pages
Örebro: Örebro universitet , 2012. , p. 101
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 73
Keywords [en]
Penile carcinoma, sexuality, life satisfaction, treatment-seeking, sexual function, Sexual dysfunction, delay, organ-sparing
National Category
Medical and Health Sciences Cancer and Oncology Urology and Nephrology
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-24417ISBN: 978-91-7668-891-5 (print)OAI: oai:DiVA.org:oru-24417DiVA, id: diva2:544531
Public defence
2012-10-19, Wilandersalen, Universitetssjukhuset, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Note

Varierande stavning av förnamnet Elisabet förekommer.

Available from: 2012-08-24 Created: 2012-08-15 Last updated: 2017-10-17Bibliographically approved
List of papers
1. Initial symptoms and delay in patients with penile carcinoma
Open this publication in new window or tab >>Initial symptoms and delay in patients with penile carcinoma
2012 (English)In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 46, no 5, p. 319-325Article in journal (Refereed) Published
Abstract [en]

Objective: This study aimed to assess initial symptoms and factors associated with patients' and doctors' delay in penile carcinoma.

Material and methods: Fifty consecutive patients with penile carcinoma treated with an organ-sparing technique and nine with partial amputation were enrolled in a prospective study at the Department of Urology, Örebro University Hospital, between 2005 and 2009. Face-to-face structured interviews in combination with self-assessment forms were used for the patients' descriptions of clinical symptoms, treatment seeking and reasons for delay. Data were also extracted from the medical records confirming time-lag between GP assessment, specialist care and time for diagnosis.

Results: Erythema, rash and eczema were the most common initial symptoms (35%). In total, 65% had a patients' delay of more than 6 months, and among these there was a small, but not statistically significant, predominance for pT1 and pTis tumours. Living with a stable partner did not affect the delay. The most common reason for patients' delay was the feeling of embarrassment over symptoms localized in a sexual body area. Nine patients had a doctors' delay of more than 3 months from first special visit to diagnosis. Eight of these patients consulted dermatologists and were subjected to repeated biopsies, leaving premalignant results.

Conclusions: A considerable proportion of the patients had a patients' delay of more than 6 months, perhaps due to benign initial symptoms as erythema, rash or eczema. Psychological factors such as embarrassment and denial may also be involved, as well as insufficient awareness or knowledge. 

Place, publisher, year, edition, pages
London, United Kingdom: Informa Healthcare, 2012
Keywords
Delay, doctors’ delay, initial symptoms, patients’ delay, penile carcinoma
National Category
Medical and Health Sciences Surgery Urology and Nephrology
Research subject
Surgery esp. Urology Specific
Identifiers
urn:nbn:se:oru:diva-25774 (URN)10.3109/00365599.2012.677473 (DOI)000308951000001 ()22989150 (PubMedID)2-s2.0-84866540090 (Scopus ID)
Available from: 2012-09-10 Created: 2012-09-10 Last updated: 2017-12-07Bibliographically approved
2. Sexual function and satisfaction in men after laser treatment for penile carcinoma
Open this publication in new window or tab >>Sexual function and satisfaction in men after laser treatment for penile carcinoma
2004 (English)In: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 172, no 2, p. 648-651Article in journal (Refereed) Published
Abstract [en]

Purpose:

We evaluate sexual function, sexual satisfaction and cosmetic results after laser treatment of penile carcinoma.

Materials and Methods:

A total of 67 patients were treated at our clinic for penile cancer using combined carbon dioxide and neodymium:YAG lasers from 1986 to 2000. At the time of this study 58 men, with a mean age of 64 years were alive, of whom 46 (79%) agreed to participate in a structured face-to-face interview addressing sexual function, sexual satisfaction and cosmetic results. The length of time that had elapsed since treatment ranged from 6 months to 15 years (median 3 years).

Results:

Of 40 patients (87%) who had been sexually active before treatment 30 (75%) had resumed activities at the time of the interview. Unaltered erectile function after treatment was reported by 33 patients (72%), 10 patients (22%) reported decreased function and 3 (6%) reported improved function. Of the 46 patients 23 (50%) were satisfied/very satisfied with their sexual life. After treatment only 3 of 30 (10%) of the evaluable men had dyspareunia. The cosmetic results were considered satisfying/very satisfying by 36 (78%) men.

Conclusions:

Laser treatment of localized penile carcinoma preserves the penis and generally provides satisfactory sexual function and cosmetic results.

National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-3151 (URN)10.1097/01.ju.0000132891.68094.87 (DOI)
Available from: 2004-05-19 Created: 2004-05-19 Last updated: 2017-12-14Bibliographically approved
3. Treatment-seeking, aspects of sexual activity and life satisfaction in men with laser-treated penile carcinoma
Open this publication in new window or tab >>Treatment-seeking, aspects of sexual activity and life satisfaction in men with laser-treated penile carcinoma
2008 (English)In: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 54, no 3, p. 631-639Article in journal (Refereed) Published
Abstract [en]

ObjectivesThe aims were to assess the initial symptoms of penile carcinoma and patients’ time frame in treatment seeking, and to describe the effect of laser treatment on sexual activity and life satisfaction.Patients and methodsA retrospective face-to-face structured interview study of patients laser treated for localised penile carcinoma at the department of Urology in Örebro, Sweden, during 1986 to 2000. Sixty-seven was treated and 58 of them (mean age, 63 yr; range, 34–90) were alive at the time of this study. Forty-six (79%) agreed to participate.ResultsNinety-six percent of the patients recalled their first symptom of penile carcinoma. Superficial ulceration and fissures were the most common symptoms (39%). Thirty-seven percent delayed seeking treatment for more than 6 mo.The patients had a greater lifetime number of sexual partners and a greater lifetime prevalence of STIs than a Swedish representative comparator population.Some aspects of sexual life, such as manual stimulation/caressing and fellatio, decreased markedly after laser treatment.Patient satisfaction with life as a whole was approximately the same as that of the general population.ConclusionsPatients delayed seeking treatment for a considerable period, despite awareness of the first local symptoms. Men with laser-treated localised penile carcinoma resume their sexual activities to a large extent after the treatment. Except for satisfaction with somatic health, similar—or even higher—proportions of patients than comparators are satisfied with life as a whole and with other domains of life including satisfaction with sexual life.Take Home MessageIn this study of 46 men who received laser treatment for localised penile carcinoma, we found that they resumed their sexual activities to a great extent and coped well with nearly all aspects of life after the treatment.

Place, publisher, year, edition, pages
Amsterdam: Elsevier, 2008
National Category
Medical and Health Sciences Urology and Nephrology
Research subject
Medicine; Surgery esp. Urology Specific
Identifiers
urn:nbn:se:oru:diva-3664 (URN)10.1016/j.eururo.2007.10.028 (DOI)18788122 (PubMedID)
Available from: 2008-12-17 Created: 2008-12-17 Last updated: 2017-12-14Bibliographically approved
4. Dyadic aspects of sexual well-being and penile carcinoma: a prospective study
Open this publication in new window or tab >>Dyadic aspects of sexual well-being and penile carcinoma: a prospective study
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Introduction. Coping with a diagnosis of cancer and, its treatment and recovery is a dyadic process within a relationship. Sexual dysfunctions and problems of penile cancer may add to the demands of coping. There are clinical reasons to view a couple’s sexuality, alone and together, as dependent factors for successful treatment.

Aim. The prospective study aimed to describe the dyadic aspects of sexual well-being and life satisfaction before and one year after organ-sparing laser treatment of penile carcinoma.

Methods. A consecutive series of 29 patients with penile carcinoma suitable for laser treatment were included together with their partners; median age was 60 (37-73) years and 57 (30-72) years, respectively. Length of partner relationship ranged between 1 and 54 years; median 29 years. The participants completed structured interviews before treatment, and at 6 months’ and 12 months’ follow-up. The interview addressed sexual activities, sexual functions, verbal (sexual) communication skills, and life satisfaction.

Main outcome measures. The interviews contained almost the same questions for patients and partners at all three measuring points. Moreover, three well-validated instruments were included: HADS, IIEF-5, and LiSat-11. Most of the questions were extracted from a national representative study of Swedish men and women and from this sample an ad hoc comparator population of 935 men and 809 women was selected.

Results. There were no significant differences between interview data at 6 and 12 months’ follow-up. Eight out of 29 couples had not been sexually active for several years before diagnosis and did not resume activity; further 4 couples had ceased having penetrative intercourse at follow-up. Sexual dysfunctions were common among men, especially decreased sexual interest and dyspareunia and about a fourth of the women had decreased vaginal lubrication before treatment. At follow-up increased sexual function was found, with the exception of erectile function and partners’ orgasm. The couples showed within-couple agreement concerning sexual activities, erectile dysfunction, retarded ejaculation, and lubrication dysfunction. Relatively few (41%) had an ongoing verbal mutual communication about their sexuality. Overall life satisfaction was found to be at par with the general population as most of domains of closeness, health, leisure and provision. Exceptions were patients somatic health and, at follow-up, sexual satisfaction. Couples with an active partner-related sexual life at follow-up showed coherence in high satisfaction with life as a whole. Sexually inactive couples showed coherence in being dissatisfied with their sexual life at baseline as well as after 12 months.

Keywords
penile carcinoma; laser treatment; prospective; organ-sparing; sexual function; sexual dysfunction; sexual satisfaction; life satisfaction
National Category
Surgery
Research subject
Surgery esp. Urology Specific
Identifiers
urn:nbn:se:oru:diva-26544 (URN)
Available from: 2012-11-29 Created: 2012-11-29 Last updated: 2017-10-17Bibliographically approved

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Skeppner, Elisabet [Elisabeth]

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