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THE RESULTS OF SEXUAL REHABILITATION OF THE PATIENTS WITH BC FULL REHABILITATION PROCESS

THE RESULTS OF SEXUAL REHABILITATION OF THE PATIENTS WITH BC FULL REHABILITATION PROCESS
Kyaburu Simona, доктор медицинских наук

Молдавский Государственный Университет Медицины и Фармации им. Н.Тестемицану, Молдова

Участник конференции

Bibliographic data proves that 70% of patients with BC manifest sexual dysfunction after the diagnosis of the disease. Problems include decreased libido and low sexual satisfaction, dut to patient’s concerns about body image and menopausal symptoms, as side effects of treatment for BC. The authors emphasize that more than 80% of patients with BC said, that they had a normal sex life before diagnosis. After 2 years of diagnosis and treatment, 70% of them reported sexual dysfunction.

Most patients with sexual problems said they are concerned about their body image.

Keywords: breast cancer, endoprosthesis, rehabilitation, sex.

 

The researchers demonstrated that radical treatment of menopause increases the risk of BC, and generates sexual dysfunction of the adjuvant endocrine. Scientists have shown that hormones that prevent cancer recurrence after surgery – can negatively influence sexual life of patients with BC.

Sexuality after the diagnosis and treatment of BC is damaged. The patients attest that breast removal inhibit feelings of both partners. Over 50% of the tested patients had sexual disorders after one year from the surgery. Scientific analysis shows that sexual frequency is different at different ages –7 times per month for couples of patients aged 30-40 years, 6 times per month for patients aged 40-50 years, and less in case of patients over 50-60 years. After 70 years sexuality is obviously diminished. Some authors developed recommendations for sexual life of patients with BC. They appeared in literature and pamphlets entitled "Sex life after BC", "Sex after breast cancer".

In the last decades has increased number of mortality caused by breast cancer with 24,92% in Moldova, with a share in the structure of oncological morbidity of 21.2%. Currently, of the patients radically treated including mastectomies, 6098 requires endoprosthesis.

Treatment of patients with BC have radical impact on the both self-images physiological and physical appearance and leads to the disappointment and loss of feminine identity, changing family relations, including sexual, change of psychological physical and occupational self-confidences, subsequent integrationand social difficulties. It causes isolation during radical treatment, anxiety induced by ideas recurrence, family and physician addiction, husband, who is put at economic risks, changing body image,absence of breast lead to serious disorders of sexual relations within the couple. This concerns both partners. During radical treatment, 86% of wives reject their partners.

Problem actuality: high frequency of sexual disorders in the patients with BC is mentioned in various works, absence of researches in this area arguments the need for this premiere investigation.

The purpose of research: Study of sexual disorders within the couples of patients suffering from BC during entire rehabilitation process.

Research Methods. We studied 20 couples in which the wife with BC was a subject of radical treatment, including mastectomy and rehabilitation surgery - breast reconstruction. There were investigated the steps which caused sexual dysfunction, sexual disorders and their correction during rehabilitation stages, sexual satisfaction in couple of women with BC and her husband.

The research was carried out at different stages of treatment – after 6 months, 1 year, 2 years of radical treatment and entire rehabilitation process. It was studied the phases of sexual response in the patients with BC.

Table 1.

The phases of sexual response by the patients with BC

 

Phases

Sexual Disorder

I.

Sexual desire

Small sexual motivation, minimal excitation, lack of sexual fantasies and desire. There are included both neuroendocrine composition as well as individual experience. The stimuli in these conditions have no strength to cause desire.

II.

Excitation

It is physical, touches, the kisses. In the absence of mammary gland by patients appears lack of sexual desire. All sexual desire factors are inhibited - sensory, tactile, and psychological.

III.

Plateau

Tensed period during sexual processes is reduced in the BC patients with no CM. Sexual feminine processes are inhibited due to anatomical defects, breast absence, which led to expectations of orgasm.

IV.

Orgasm

Involuntary orgasms at patients with BC are rare.

V.

Resolution

Returning sexual organ is faster.

 

Research had determined that the patients with BC sexual disorder can be attested in all phases of sexual response. They have studied the causes of sexual dysfunction of the patients with BC.

Present research showed sexual disorders at different stages of sexual response at the patients with breast cancer. First sexual desire or phase is minimal at this stage, motivation and arousal small, lacking sexual fantasy. Phase excitation - is diminished, lacking response to physical arousal, touch, kiss and touch of all the factors so psychologically sensors are inhibited.

Plateau - phase which is equally reduced in patients with breast cancer is caused both by lack of breast aesthetic - appearance, aesthetic discomfort. Orgasmic phase - involuntary sexual climax, is rare. Phase resolution - the fastest return the sexual organ.

Table 2.

The causes of sexual dysfunction by the patients with BC

Causes

Specified Risk Factors

Common symptoms

Patients

 

c.a.

%

Psychological

Stress after mastectomy

Libido decrease, sexual dysfunction in sexual excitation phase, orgasm absence  

10

50

Neurological and cardiac

Pathology of SNC and peripheral nervous system  arterial hypertension

Orgasm absence  

5

25

Endocrine and metabolic

Hormonal dysfunction, hormonal therapy and diabetic consequences.

Libido decrease

3

15

Other causes

Muscular, vascular, other causes

Decrease vaginal lubrication,Dyspareunia.

2

10

Total

-

-

20

100

      

 

Our research has established that sexual dysfunction at the patients with breast cancer have different causes, namely – psychological symptoms leading to frequent decrease in libido, sexual arousal dysfunction. Phase I, lack of orgasm, and makes up 50% - the vast majority, cause neurological and cardiac symptoms such as lack of orgasm with which make up 25% of sick endocrine metabolic causes symptoms that decrease libido with15% of sick and other causes of sexual dysfunction with symptoms such as reducing vaginal lubrication, dyspareunia 10% .

Table 3.

Sexual disorders in the patients with BC

Sexual disorders

Patients

The integral rehabilitation steps

c.a.

%

Diagnostic step

Treatment step

Rehabilitation step (phase)

c.a.

%

c.a.

%

c.a.

%

c.a.

%

The decrease of libido

44

44

44

44

44

44

28

28

18

18

Arousal deregulation

22

22

22

22

19

19

15

15

12

12

Orgasmic dysfunction

21

21

21

21

18

18

15

15

11

11

Dyspareunia

10

10

10

10

8

8

6

6

5

5

Vaginismus

3

3

3

3

3

3

3

3

3

3

Total

100

100

100

20

100

20

67

13,4

49

9,8

             
 

 Research has determined that the patients with BC during rehabilitation process at different stages have different sexual disorders. In the diagnostic phase libido disorders were common in 44% cases, in the treatment step it increase to 52%, in the step after her breast resection decreased to 18% cases, another trend had arousal disorders phase - 22% at the stage of diagnosis, which later decreased to 15% and 12% consecutive. The same trend was observed in organ dysfunction and dyspareunia- 15% and 5% sequentially. Vaginismus did not change.

Table 4.

Sexual satisfaction in couples received radical program of treatment and integral rehabilitation

 

Treatment and rehabilitation

 

The length of time after

treatment

 

Radical treatment without RM

Radical treatment, and rehabilitation integral RM

Patents number

Couple life satisfaction

Couple life satisfaction

 

 

Women with BC

The man, the patient husband

Women with BC

The man, the patient husband

 

No

Yes

No

Yes

No

Yes

No

Yes

c.a.

%

c.a.

%

c.a

%

c.a

%

c.a

%

c.a

%

c.a.

%

C.a.

%

c.a

%

The

radical treatment period

 

20

100

0

0

20

100

0

0

20

0

0

0

20

100

0

0

20

100

6 months after treatment

10

50

10

50

8

40

12

60

5

25

15

75

6

30

14

70

20

100

1 year after treatment

9

45

11

55

10

50

10

50

10

50

10

50

9

45

11

55

20

100

2 years after treatment

8

40

12

60

10

50

10

50

10

50

8

40

12

60

10

50

20

100

                     

(p> 0.05)

Conclusion

Our investigation had determined that during the radical treatment stage sexual relation are missing and life dissatisfaction in this compartment is absolute. Its length is 6.0 ± 1 weeks (p> 0.05). At 6 months after radical treatment, sexual relation in couple are restored, but 50% women with BC, and 40% of  their husbands are not satisfied within couple relationships, that restore 10-15% during entire rehabilitation period. Both, after 1 and  2 years after radical treatment, showed an improvement of the status of the couple sexual life, satisfaction reached 55% (p> 0.05).

The results of our research aimed to study sexual rehabilitation of patients with breast cancer at various stages of rehabilitation. Our study showed the following significant results: the phases of sexual response in all affected manifestly meant the steps - sexual disorder, and the causes and risk factors of sexual dysfunction are more affected psychologically 50% level and cardiac, neurologic - 25 %, endocrine and metabolic 15%, and other causes - 10%. 

The most common symptoms are related to decreased libido, arousal dysfunction, lack of orgasm, decreased vaginal lubrication, dyspareunia. Sexual disorders are also modifying the rehabilitation phase full at all stages of diagnosis, inpatient and rehabilitation. 

Partial restores of sexual disorders, but not 100%, so the sexual partner of the patient as well. Thus we conclude importance of rehabilitation patients with all stages of breast cancer treatment and how important sexual rehabilitation, whole affected breast endoprosthesis importance, important aesthetic and anatomical, psychological rehabilitation, psychological and financial support, rehabilitation and job seeking.

References:

  • 1. Agarwal S, Liu JH, Crisera CA, Buys S, Agarwal JP. Survival in breast cancer patients undergoing immediate breast reconstruction. Breast J. 2010 Sep-Oct;16(5):503-9. doi: 10.1111/j.1524-4741.2010.00958.x. Epub 2010 Jun 29.
  • 2. Agha-Mohammadi S.  De La Cruz C.  Hurwitz D.J. Breast reconstruction with alloplastic implants. J Surg Oncol. 2006 Nov 1;94(6):471-8.
  • 3. Arroyo, J.M.G., López, M.L.D. Psychological Problems Derived from Mastectomy: A Qualitative Study. InternationalJ ournalofSurgicalOncology, 2011, 132461. doi: 10.1155/2011/132461.
  • 4. Bellino S,. Fenocchio M., Zizza M,. Rocca G., Bogetti P., Bogetto F. Quality of life of patients who undergo breast reconstruction after mastectomy: effects of personality characteristics. PlastReconstrSurg. 2011 Jan;127(1):10-7. doi: 10.1097/PRS.0b013e3181f956c0.
  • 5. Butow P.N. Psychosocial predictors of survival: metastatic breast cancer / P.N. Butow, A.S. Coates, S.M. Dunn // Ann. Oncol. 2000. - Vol. 11. - P. 469-474.
  • 6. Carpenter P. J., Norrow G. R., Schmale A. H. The psychosocial status of cancer patients after cessation of treatment // J. Psyphosoc. Oncol. - 1989. - Vol. 7, N 1-2. - P. 95 -103.
  • 7. Copper C.L. Psychosocial stress and breast cancer: the interrelationship between stress events, coping strategies and personality / C.L. Copper, E.B. Faragher // Psychol. Med. 1993. - Vol. 23. - P. 653-662.
  • 8. Coryell W.H., Zimmerman M. Personality disorder in the families of depressed, schizophrenic and never-ill probands// Ibid. — 1989. — Vol. 146. — P. 496-502.
  • 9.  deHses I. C. I. ML, Welvart K. Quality of life after breast cancer surgery // J. Surg. Oncol. - 1985. - Vol. 28. - P. 123.
  • 10. Ferrel B.R., Grant M., Funk B., Scaffner M.L. Quality of Life in breast cancer // Cancer Pract. 1996. - Vol. 4, № 6. - P. 331 - 340.
  • 11. Holmberg L., Omne-Ponten M., Burns T et. al. Psychosocial adjustment after mastectomy and breast-conserving treatment // Cancer. - 1989. - Vol. 64, N 4. - P. 969 - 974.
Комментарии: 1

Григоренко Любовь Викторовна

Dear professor Kyaburu Simona! Your report is very actually among such trouble patients. Should your scientific experiment help such couple with BC full rehabilitation process? If psychological level taken 50% , why psychological care couldn't be provide at the early period after mastectomy. Does the rehabilitation process correlated with financial support of medical establishment. Why shouldnt your use experience of USA countries where psychologist usually works with families or social programmeof rrehabilitation. King regards and I wish you professional success in your scientific experiment. Hryhorenko Luibov
Комментарии: 1

Григоренко Любовь Викторовна

Dear professor Kyaburu Simona! Your report is very actually among such trouble patients. Should your scientific experiment help such couple with BC full rehabilitation process? If psychological level taken 50% , why psychological care couldn't be provide at the early period after mastectomy. Does the rehabilitation process correlated with financial support of medical establishment. Why shouldnt your use experience of USA countries where psychologist usually works with families or social programmeof rrehabilitation. King regards and I wish you professional success in your scientific experiment. Hryhorenko Luibov
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