Penile carcinoma : from first symptom to sexual function and life satisfaction following organ-sparing laser treatment

• 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.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Cancer och onkologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cancer and Oncology (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Urologi och njurmedicin (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Urology and Nephrology (hsv//eng)

Nyckelord

Penile carcinoma

sexuality

life satisfaction

treatment-seeking

sexual function

Sexual dysfunction

delay

organ-sparing

Surgery

Kirurgi

Publikations- och innehållstyp

vet (ämneskategori)

dok (ämneskategori)