Preservation of function in genitourinary cancers: psychosexual and psychosocial issues

GU cancers are commonly associated with treatment-related sexual dysfunction, varying from mild to severe. For the clinical oncologist, it is important to be aware that sexual problems or sexual dysfunction may occur as a result of any aspect of cancer and cancer treatment. Sexual function is sensitive to the effects of trauma, both physical and emotional. This is particularly the case for patients whose cancer affects their genitals. Despite some commonalities of psychosocial and psychosexual issues in GU patients across diagnostic categories, GU patients do not present as one distinct, homogeneous group. GU neoplasms, with the exception of bladder cancer, affect mostly men. Men and women tend to differ in their ways of dealing with emotional distress and physical illness. While the man may typically do well using denial as a defense and may not want to discuss his feelings about his diagnosis and treatment, his partner may suffer if her way of coping is oriented toward communicating thoughts and feelings about the situation. Another important difference in this population is related to age and developmental differences. Testicular cancer typically is diagnosed in young men between the ages of 15 and 34 (46). The patients often still live with their parents or have just formed families of their own. In contrast, prostate cancer is diagnosed in older men, who are at a completely different stage in their lives when they have to deal with this challenge. Developmental stage at the time of diagnosis and treatment is an important variable in adaptation to cancer (47). Since GU malignancies and their treatments directly or indirectly affect sexual organs and sexual functioning, issues of sexual body image and identity as men or women are frequent concerns for GU patients. This is most obviously the case for men facing penectomy or orchiectomy. Similarly, women undergoing cystectomy with its simultaneous removal of uterus, ovaries, and parts of the vaginal wall face issues regarding their femininity as well as doubts about future sexual functioning. However, body image concerns are not limited to these two groups but may affect any cancer patient. The experience of having lost all hair due to chemotherapy, bearing of surgical scars, lost or altered functioning, and just the realization of having had cancer may change the way a patient feels about his/her body permanently.(ABSTRACT TRUNCATED AT 250 WORDS)