Being confronted with cancer is a life-changing event, with major impact to well-being, quality of life and relationships. Cancer treatments and outcomes have improved, but possess the potential to... Show moreBeing confronted with cancer is a life-changing event, with major impact to well-being, quality of life and relationships. Cancer treatments and outcomes have improved, but possess the potential to impair reproductive and sexual function. International guidelines highlight the importance of timely discussion of sexual function and fertility deterioration resulting from treatments. In spite of these developments, practice behaviour and attitudes of health professionals have been reported to vary.The first part of this thesis demonstrates barriers among oncology professionals in the Netherlands in discussing sexual function during daily practice. In general, consensus exists regarding responsibility for addressing sexual dysfunction. Despite, the implementation of discussing sexual function as a standard of care is not carried out structural.Part two describes practice routines concerning the counselling on impaired fertility and fertility preservation for cancer patients of reproductive age. Medical oncologists and oncology nurses both reported discussing the impact of treatment on fertility. However, it was not performed in all cases and depending on factors like educational level, experience, type of hospital, prognosis and chances of fertility recovery.Furthermore, testicular cancer patients were evaluated on specific items concerning the discussion, referral and process of semen cryopreservation. Long term reproductive concerns were identified among survivors. Show less
Based on ethnographic research among Burundian refugee boys and young men in Nakivale refugee settlement in Uganda, we explore how boys and young men in the camp, guided by the longing for a better... Show moreBased on ethnographic research among Burundian refugee boys and young men in Nakivale refugee settlement in Uganda, we explore how boys and young men in the camp, guided by the longing for a better life, aspire for onward migration and develop strategies based on their knowledge of relevant legal frameworks. Given that onward migration under the UNHCR framework is possible for onlythe most ‘vulnerable’, we highlight the negotiation strategies adopted by some boys and youngmen to support their ‘process’ ,based on sexual vulnerability related to being in same-sex relationships. Notwithstanding the deprivation and bleak prospects, we thus propose to look at the refugee settlement also as a space opening chance for vital transformation. At the same time, we point out that the restricting frameworks seeking to foster protection of refugees, may, in an environment hostile to same-sex relations, unintentionally render refugee boys and young men more vulnerable to gendered exploitation. Show less
Background Anti-cancer drugs commonly adversely affect fertility and sexual function. Despite this, patients report a lack of counselling of these potential adverse effects. The aim was to... Show moreBackground Anti-cancer drugs commonly adversely affect fertility and sexual function. Despite this, patients report a lack of counselling of these potential adverse effects. The aim was to determine Dutch oncologists' knowledge about the adverse effects of various cancer drugs on fertility and sexual function. Methods A cross-sectional survey was sent to members of the Dutch Society for Medical Oncology (n = 433). The survey questions included various cancer drugs' adverse effects on fertility, ovulation, spermatogenesis, and sexual function. Results One hundred and five of 392 oncologists responded (26.8%). Oncologists were more aware of the adverse effects on fertility compared to sexual function. Drugs that were mostly believed to negatively affect fertility were cisplatin (n = 81, 80.2%), epirubicin (n = 78, 78.0%) and cyclophosphamide (n = 80, 77.7%). Regarding sexual function, most mentioned drugs were tamoxifen (n = 67, 65.7%), GnRH-agonists (n = 64, 63.4%) and cisplatin (n = 58, 57.4%). Oncologists with expertise in urology possessed more awareness regarding sexuality-related adverse effects (cisplatin p = 0.038, etoposide p = 0.025, ifosfamide p = 0.06, vinblastine p = 0.000). Conclusion Results revealed that oncologists have different beliefs about possible sexual and fertility-related adverse effects concerning medication resources and literature. Based on our results, oncologists do not possess sufficient knowledge to inform patients about sexual and fertility-related adverse effects. Show less
Wilschut, V.F.C.; Pianosi, B.; Os-Medendorp, H. van; Elzevier, H.W.; Jukema, J.S.; Ouden, M.E.M. den 2021
Background: Although older adults are sexual, sexuality is infrequently discussed with them by health care professionals. Nursing students, as future professionals, can make an important... Show moreBackground: Although older adults are sexual, sexuality is infrequently discussed with them by health care professionals. Nursing students, as future professionals, can make an important contribution by developing competences in discussing intimacy and sexuality with older adults to increase quality of life and to prevent sexual problems. In order to improve these competences, current levels of knowledge and attitude need to be explored.Objectives: To investigate i) knowledge and attitudes of nursing students regarding intimacy and sexuality of older adults, ii) the difference in knowledge and attitudes of nursing students in different years of study and iii) frequency of discussing intimacy and sexuality with older adults. Design: Cross-sectional.Settings: A University of Applied Sciences in the Netherlands.Participants: Nursing students, >= 16 years who were able to read and write in Dutch.Methods: The Ageing Sexual Knowledge and Attitudes Scale was used among nursing students. Furthermore, demographic information and frequencies were collected. Data was analyzed using SPSS.Results: In total, 732 students participated. The mean knowledge-score was 43.9 (SD = 8.9), the mean attitudescore 64.3 (SD = 16.0). Unlike attitude, the level of knowledge differed significantly per year of study: first year students had the lowest and third year students the highest knowledge. Most students stated they 'never' (54.1%) or 'once' (13.2%) discussed intimacy and sexuality with older adults. Reasons to avoid talking about intimacy and sexuality were feelings of 'not being the right person' (17.3%) and 'incompetence' (14.0%).Conclusions: Nursing students had moderate knowledge and positive attitudes toward older adults' intimacy and sexuality. The knowledge-level differed per year of study, the attitude level did not. Only a minority discussed intimacy and sexuality with older adults. Moderate knowledge and positive attitudes do not mean that intimacy and sexuality is discussed. To ensure students feel responsible and competent, interventions should focus on continuous knowledge dissemination, role clarification and role modelling. Show less
Albers, L.F.; Belzen, M.A. van; Batenburg, C. van; Engelen, V.; Putter, H.; Pelger, R.C.M.; Elzevier, H.W. 2020
Introduction The needs of cancer patients and survivors regarding discussing sexuality are frequently unmet, with many not receiving adequate information. To optimize information about sexuality... Show moreIntroduction The needs of cancer patients and survivors regarding discussing sexuality are frequently unmet, with many not receiving adequate information. To optimize information about sexuality and cancer, patients' perspective is needed. The goals of this study were to investigate what kind of information Dutch cancer patients need, their ideas on how to improve communication, and to identify patients who are more in need of information regarding sexuality. Methods The Dutch Federation of Cancer Patient Organizations developed and conducted a nationwide 28-item online survey. The survey was distributed among cancer patients and survivors. Results In total, 2657 (ex) cancer patients participated, with a median age of 61 years, and half were male (45.2%). Of the respondents, 65% were in need of information about sexuality. Patients <= 61 years (p < 0.001), patients with a self-reported negative effect of cancer on sexuality (p < 0.001) and patients who were diagnosed less than 2 years ago (p < 0.04) reported a higher need for information. Regardless of type of cancer, patients were most in need of practical tips and practical information regarding sexuality. To enhance communication about sexuality, 64% of the respondents suggested that it would be of help if care providers give information as standard care. Conclusions (Ex) cancer patient prefer to receive standard information about sexuality by their care providers. According to patients' preferences, information must include practical tips. Age, self-reported negative effect on sexuality status and time from diagnoses influenced the need for information. Show less
Dikmans, R.E.; Krouwel, E.M.; Ghasemi, M.; Grift, T.C. van de; Bouman, M.B.; Ritt, M.J.P.F.; ... ; Mullender, M.G. 2018
Stress urinary incontinence (SUI) is the most observed type of urinary incontinence and is defined as the loss of urine following a rise in abdominal pressure. The TVT (Tension-free Vaginal Tape),... Show moreStress urinary incontinence (SUI) is the most observed type of urinary incontinence and is defined as the loss of urine following a rise in abdominal pressure. The TVT (Tension-free Vaginal Tape), a mid-urethral sling (MUS), was introduced in 1996 and soon became the gold standard in the surgical treatment of SUI. Over the last decade, numerous MUS devices have been introduced but only some were able to achieve similar results in comparison to the original TVT. The main question of this thesis is whether slings, old and new, for either male and female, can live up to the expectations of both patients and physicians by being both safe and effective in curing urinary incontinence. Secondly, the question is raised whether sling surgery is anatomically safe with regard to those nervous systems which are essential for the sexual function or may actually be responsible for iatrogenic neurological damage during placement. In this thesis we conclude that many slings were, or still are, freely available on the market without any proper pre-market research. Moreover sling surgery can have serious negative side-effects on sexual function that should be a standard part of the informed consent provided when opting for surgery. Show less
Dewinter, J.; Vermeiren, R.; Vanwesenbeeck, I.; Nieuwenhuizen, C. van 2016
In this thesis the psychological impact of two types of breast reconstruction after prophylactic or therapeutic mastectomy for breast cancer was investigated with a prospective study including 202... Show moreIn this thesis the psychological impact of two types of breast reconstruction after prophylactic or therapeutic mastectomy for breast cancer was investigated with a prospective study including 202 patients from different hospitals in the South-West of the Netherlands between 2007-2012. With semi-structured interviews the motives to opt for breast reconstruction were qualitatively investigated. The impact of breast reconstruction was further investigated with psychological questionnaires from baseline to the end of the breast reconstruction procedure (mean follow-up of 21 months). The psychological outcomes after breast reconstruction that were investigated were: body image, satisfaction with the partner relationship and the sexual relationship, general anxiety and depression, cancer distress, and general mental and physical health. In general, the psychological outcomes after breast reconstruction were acceptable, however a subgroup of women experienced psychological adjustment problems. A percentage of 20-30% remained having problems with changes in their body image and the impact on the intimate partner relationship. Women at risk for psychological adjustment problems were younger women, those with significant cancer distress, women who experienced complications after surgery, particularly if the breast reconstruction failed, and women who underwent bilateral prophylactic mastectomy because of an increased hereditary risk to develop breast cancer. Show less
“Xbalanque’s Marriage” examines the Sun and Moon myth of the Q’eqchi’ Mayas from the perspective of marriage alliance and hunting ideology. On the negative side, the relationship between a tapir... Show more“Xbalanque’s Marriage” examines the Sun and Moon myth of the Q’eqchi’ Mayas from the perspective of marriage alliance and hunting ideology. On the negative side, the relationship between a tapir and the old adoptive mother of Xbalanque and his older brother can be read as the denial of alliance, with the tapir symbolizing antisocial behavior and the old woman incestuous reproduction and paedophiliac cannibalism. The older brother’s abjuration of women has the effect of substituting the transient male brotherhood of hunting bands for a lasting marriage alliance. By contrast, the narrative’s core consists of a tale in which the war chief Xbalanque becomes a hummingbird lover to abduct and marry the daughter of the paramount mountain deity. A central concern of this ‘Hummingbird tale’, and of its many versions elsewhere in Guatemala and Belize, is the ritual alliance to the earth and the acquisition of its products, as personified by the mountain’s daughter. The Q’eqchi’ narrative shows how the dissolution of this alliance sets free the forces of destruction, whereas its reestablishment asserts alliance as a life-giving, cosmic force. Show less
