Current sexual health care has not yet succeeded to guide men and their partners sufficiently when it comes to dealing with the consequences of prostate cancer (PCa) diagnosis and treatment. The... Show moreCurrent sexual health care has not yet succeeded to guide men and their partners sufficiently when it comes to dealing with the consequences of prostate cancer (PCa) diagnosis and treatment. The majority of men need a standardized consultation with a specialized healthcare provider (HCP) to discuss sexual health issues preferably within three months after treatment. Although current written information provision coming from urology departments discusses sexual health more often than radiotherapy departments; sexual dysfunction (SD) is still not routinely addressed. Focus during consultations is mostly on men while most of the partners also experience difficulties when dealing with sexual side effects. Regarding HCPs, urology residents experience lack of knowledge and competence to treat SD after PCa treatment and an unmet need exists for additional education and training. A symposium on sexual health care in PCa led to an increase of awareness to discuss SD more often during consultations. In case HCPs feel lack of knowledge, competence, time or tools to discuss sexual health after PCa treatment, referral to a specialized HCP should occur; according to the needs and preferences of men and their partners. However, management of outpatient clinics and availability of referral options are still in need of melioration. Show less
Background: Chronic diseases are often associated with sexual dysfunction (SD). Little is known about the practice patterns of general practitioners (GPs) regarding sexual care for chronically ill... Show moreBackground: Chronic diseases are often associated with sexual dysfunction (SD). Little is known about the practice patterns of general practitioners (GPs) regarding sexual care for chronically ill patients. Therefore, the aim of this study was to examine; to what extent GPs discuss SD with chronically ill patients; the barriers that may stop them; and the factors associated with discussing SD. Methods: A cross-sectional survey using a 58-item questionnaire was sent to 604 Dutch GPs. Descriptive statistics and associations were used for analysis of the data. Results: Nearly 58% (n = 350) of all GPs approached gave a response and 204 questionnaires were analysable (33.8%). Almost 60% of respondents considered discussing SD with patients important (58.3%, n = 119). During the first consultation, 67.5% (n = 137) of the GPs reported that they never discussed SD. The most important barrier stopping them was lack of time (51.7%, n = 104). The majority (90.2%, n = 184) stated that the GP was responsible for addressing SD; 70.1% (n = 143) indicated that the GP practice somatic care nurse (GPN) was also responsible. Nearly 80% (n = 161) of respondents were unaware of agreements within the practice on accountability for discussing SD. This group discussed SD less often during first and follow-up consults (p = 0.002 and p < 0.001, respectively). Of the respondents, 61.5% (n = 116) felt that they had received insufficient education in SD and 74.6% (n = 150) stated that the subject is seldom discussed during training. Approximately 62% of the GPs (n = 123) wanted to increase their knowledge, preferably through extra training. According to 53.2% of the GPs (n = 107) it was important to improve the knowledge of the GPN. The most frequently mentioned tool that could help improve the conversation about SD was the availability of information brochures for patients (n = 123, 60.3%). Conclusions: This study indicates that Dutch GPs do not discuss SD with chronically ill patients routinely, mainly due to lack of time. An efficient tool is needed to enable GPs to address SD in a time-saving manner. Increased availability of informational materials, agreements on accountability within GP practices, and extra training for the GPs and GPNs could improve the discussion of SD. Show less
Sexuality is a significant quality-of-life concern for many cancer patients. Patients may be disadvantaged if they are not informed and not offered sexual health care. We sought to reveal... Show moreSexuality is a significant quality-of-life concern for many cancer patients. Patients may be disadvantaged if they are not informed and not offered sexual health care. We sought to reveal oncologists' current practice and opinions concerning sexual counselling. The aim of this study was to explore the knowledge, attitude and practice patterns of Dutch medical oncologists regarding treatment-related sexual dysfunction. Questionnaires were sent to 433 members of the Dutch Society of Medical Oncology. The majority (81.5%) of the 120 responding medical oncologists (response rate 30.6%) stated they discussed sexual function with fewer than half of their patients. At the same time, 75.8% of the participating oncologists agreed that addressing sexual function is their responsibility. Sexual function was discussed more often with younger patients and patients with a curative treatment intent. Barriers for avoiding discussing sexual function were lack of time (56.1%), training (49.5%) and advanced age of the patient (50.4%). More than half (64.6%) stated they had little knowledge about the subject and the majority (72.9%) wanted to acquire additional training in sexual function counselling. Medical oncologists accept that sexual function counselling falls within their profession, yet they admit to not counselling patients routinely concerning sexual function. Only in a minority of cases do medical oncologists inform their patients about sexual side effects of treatment. Whether they counsel patients is related to how they view patient's prognosis, patient's age, and self-reported knowledge. Findings indicate there is a role for developing education and practical training. Show less
To describe sexual functioning/satisfaction and relational satisfaction of patients with stroke who received sexual counselling during their rehabilitation 1-5 years thereafter. All adult patients... Show moreTo describe sexual functioning/satisfaction and relational satisfaction of patients with stroke who received sexual counselling during their rehabilitation 1-5 years thereafter. All adult patients with stroke admitted to one Dutch Rehabilitation Centre between January 2010 and January 2014 with at least two consultations with a sexologist were invited to participate in this cross-sectional survey study. Patients were asked to complete a questionnaire on sexual functioning, relational satisfaction (Maudsley Marital Questionnaire, 0-80; low-high dissatisfaction), health-related quality of life (HRQoL) short-form12 (SF-12) mental and physical component scale (MCS and PCS; 0-100, low-high HRQoL) and mood Hospital Anxiety Depression Scale (HADS, 0-21 low-high depression/anxiety). Descriptive statistics were used for sexual functioning/satisfaction and relational satisfaction. Spearmans's correlation analysis (rs) analyzed the relationships between sexual satisfaction, relational satisfaction, PCS, MCS, depression and anxiety. Of 296 eligible patients, 62 (21%) completed the questionnaires. Mean age 55.4 (SD11.0) years, time-since-stroke 3.5 (SD3.6) years, 33 (53%) were male and 18 (29%) were single. Being sexually (very) unsatisfied was reported by 31 (54%) responders, with 63% being male and 44% female. Median MMQ-score relational satisfaction was 12.0 (IQR 4.25-23.25). A moderate correlation was present between sexual and relational satisfaction (rs = 0.35, p = 0.02). In male respondents relational satisfaction was highly correlated with lower levels of anxiety (rs = 0.54, p = 0.01) and depressive symptoms (rs = 0.71, p = 0.00). Patients with stroke who received sexual counselling during their rehabilitation treatment experience high relational satisfaction in the long term after stroke, despite their problems in sexual functioning. Show less
Sexual health and fertility does not come naturally for men and women suffering chronic kidney disease (CKD); sexual dysfunction and fertility issues are common throughout all stages of disease,... Show moreSexual health and fertility does not come naturally for men and women suffering chronic kidney disease (CKD); sexual dysfunction and fertility issues are common throughout all stages of disease, including dialysis and transplantation. These issues, alongside with other side-effects of CKD, affect patients social and relation life as well. Besides, their partners often fulfill an important and supportive role during intensive treatments or a lingering sickbed. As a result, the disease and the accompanying burdens affect also their partners’ well-being on several levels.Since CKD patients and their partners face multiple challenges in the area of sexuality, fertility, and relationships one could assume awareness about these difficulties exist among their care providers. Unfortunately, this thesis shows that renal care providers do not routinely discuss sexuality with their patients, underlying reasons varied between the different renal care providers. Whereas the results imply that providing an opportunity to discuss sexuality during is preferred by patients and their partners, especially after renal transplantations.As for fertility, most nephrologists include this subject in their consultation. However nurses of the nephrology department could also play an important role in addressing this part of renal care, however, insufficient knowledge is a retaining factor for them. Show less
Rooy, F.B.B. de; Buhmann, C.; Schonwald, B.; Martinez-Martin, P.; Rodriguez-Blazquez, C.; Putter, H.; ... ; Plas, A.A. van der 2019
Dit proefschrift toont lacunes in de Nederlandse gezondheidszorg op twee deelgebieden: de cardiologie en de gastroenterologie. Hierbij is 1) zowel onder cardiologen als onder cardiologische pati... Show moreDit proefschrift toont lacunes in de Nederlandse gezondheidszorg op twee deelgebieden: de cardiologie en de gastroenterologie. Hierbij is 1) zowel onder cardiologen als onder cardiologische pati_nten onderzocht in hoeverre zorg wordt geboden op het gebied van seksualiteit en seksuele disfunctie bij hart- en vaatziekten en in hoeverre er hieraan behoefte is. In het bijzonder op het gebied van erectiele disfunctie, een veel voorkomend probleem bij mannen met hart- en vaatziekten, blijkt een fors tekort te bestaan aan zorg hiervoor binnen de cardiologie. Naar aanleiding van de vergaarde data zijn richtlijnen opgesteld en aanbevelingen gedaan voor het verbeteren van de seksuele gezondheidzorg binnen de cardiologie. 2) Onder maag-darm-leverartsen en pati_nten die een colonoscopie ondergingen werd ge_valueerd in wel mate aandacht wordt besteed aan seksueel misbruik is het verleden. De impact van colonoscopisch onderzoek bij pati_nten met seksueel misbruik in de voorgeschiedenis werd aangetoond. Seksueel misbruik is zeer prevalent en heeft een bijzonder grote impact op de gezondheid en de pijnbeleving. Aanbevelingen worden gedaan voor het verbeteren van de zorg rondom colonoscopisch onderzoek voor pati_nten met seksueel misbruik in het verleden. Show less
The current thesis describes the long-term results of rectal cancer treatment, specifically focusing on the etiology of functional morbidity. In a large prospective randomised trial long-term... Show moreThe current thesis describes the long-term results of rectal cancer treatment, specifically focusing on the etiology of functional morbidity. In a large prospective randomised trial long-term anorectal and urogenital dysfunction after rectal cancer treatment were evaluated. Poor functional outcome appears to occur commonly : about one third of patients reported urinary dysfunction, half of patients suffered from faecal incontinence and more than half of patients experienced deterioration of sexual functioning. Despite an additional effect of radiotherapy, it is concluded that pelvic organ dysfunction is mainly caused by surgical (nerve) damage. A combined anatomic and clinical study shows that the levator ani nerve, which has been neglected so far, might be involved. Furthermore, from a systematic review comparing central ligation techniques, it is concluded that neither the high tie nor the low tie strategy is evidence based and that low tie is anatomically less invasive with respect to circulation and autonomous innervation of the proximal limb of anastomosis. With respect to leukocyte depletion of red blood cell transfusion in patients with gastrointestinal cancer, a combined analysis of two randomised controlled trials shows no better long-term survival and lower cancer recurrence compared to simple buffy-coat removal. Show less
