Erectile dysfunction, masculinity, and psychosocial outcomes: a review of the experiences of men after prostate cancer treatment.
Erectile dysfunction, masculinity, and psychosocial outcomes: a review of the experiences of men after prostate cancer treatment.
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DOI：
10.21037/tau.2016.08.12
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发表时间：
2017-02
影响因子：
2
通讯作者：
Hyde MK
中科院分区：
文献类型：
--
作者：
Chambers SK;Chung E;Wittert G;Hyde MK
前列腺癌（PC）治疗的副作用，如勃起功能障碍（艾德），可能会影响男性的生活质量（QoL），心理社会和心理性调整。男性气质（即，男性的身份或他们作为男性的感觉）也可能与男性对PC治疗和艾德的反应有关，但这种联系的确切性质尚不清楚。本综述旨在提供一个关于PC治疗后艾德、男性气质和心理社会影响的证据现状的快照。检索了1980年1月1日至2016年1月31日的三个数据库（Medline/PsycINFO、CINHAL和EMBASE）。研究入选标准为：接受PC治疗的患者;测量艾德或性功能;在定量研究中测量男性气概或在定性研究中作为主题出现;包括心理社会或QoL结局;以英语发表的同行评审期刊文章。52篇文章（14篇定量，38篇定性）符合审查标准。研究主要是横截面，北美，异性恋男性，与局部PC，并接受根治性前列腺切除术的样本。结果表明，男子气概框男性的反应，并受到他们的经验与PC治疗后，艾德。在定性研究中，患有艾德的男性一直报告失去（不再是一个男人）或减少（少了一个男人）的男子气概，这与抑郁，尴尬，自我价值下降和害怕被污名化有关。艾德和男性气质之间的相关性在定量研究中也得到了类似的支持。在两项研究中，男性气质也是一个主持人较差的生活质量和心理健康结果的PC患者ED。在定性研究中，男性气质的基础如何解释和调整他们的经验。男性使用传统的（霸权的）应对反应，包括情绪克制、坚忍、接受、乐观和幽默，或者将他们的经历与他们的年龄（艾德不可避免）、延长寿命（艾德付出的代价很小）、性定义（不仅仅是勃起和插入）、其他男子气概的证据（已经有了孩子）或性能力（播种了很多野燕麦）合理化。所审查的研究的局限性包括：理论和特定背景的测量方法发展不足;定量实证或前瞻性研究很少;很少评估调节或中介因素;很少考虑异质性（人口统计学，性取向，治疗类型）。临床医生和健康从业者可以帮助PC患者与艾德，以扩大他们的性关系的看法，并协助他们使意义出他们的经验，减少威胁的方式，他们的男子气概。未来的挑战是更好地解开PC患者的艾德和阳刚之气之间的关系，通过解决所概述的方法学限制，以便可以开发以整体方式纳入阳刚之气的艾德干预措施。
Prostate cancer (PC) treatment side-effects such as erectile dysfunction (ED) can impact men’s quality of life (QoL), psychosocial and psycho-sexual adjustment. Masculinity (i.e., men’s identity or sense of themselves as being a man) may also be linked to how men respond to PC treatment and ED however the exact nature of this link is unclear. This review aims to provide a snapshot of the current state of evidence regarding ED, masculinity and psychosocial impacts after PC treatment. Three databases (Medline/PsycINFO, CINHAL, and EMBASE) were searched January 1st 1980 to January 31st 2016. Study inclusion criteria were: patients treated for PC; ED or sexual function measured; masculinity measured in quantitative studies or emerged as a theme in qualitative studies; included psychosocial or QoL outcome(s); published in English language, peer-reviewed journal articles. Fifty two articles (14 quantitative, 38 qualitative) met review criteria. Studies were predominantly cross-sectional, North American, samples of heterosexual men, with localised PC, and treated with radical prostatectomy. Results show that masculinity framed men’s responses to, and was harmed by their experience with, ED after PC treatment. In qualitative studies, men with ED consistently reported lost (no longer a man) or diminished (less of a man) masculinity, and this was linked to depression, embarrassment, decreased self-worth, and fear of being stigmatised. The correlation between ED and masculinity was similarly supported in quantitative studies. In two studies, masculinity was also a moderator of poorer QoL and mental health outcomes for PC patients with ED. In qualitative studies, masculinity underpinned how men interpreted and adjusted to their experience. Men used traditional (hegemonic) coping responses including emotional restraint, stoicism, acceptance, optimism, and humour or rationalised their experience relative to their age (ED inevitable), prolonged life (ED small price to pay), definition of sex (more than erection and penetration), other evidence of virility (already had children) or sexual prowess (sown a lot of wild oats). Limitations of studies reviewed included: poorly developed theoretical and context-specific measurement approaches; few quantitative empirical or prospective studies; moderating or mediating factors rarely assessed; heterogeneity (demographics, sexual orientation, treatment type) rarely considered. Clinicians and health practitioners can help PC patients with ED to broaden their perceptions of sexual relationships and assist them to make meaning out of their experience in ways that decrease the threat to their masculinity. The challenge going forward is to better unpack the relationship between ED and masculinity for PC patients by addressing the methodological limitations outlined so that interventions for ED that incorporate masculinity in a holistic way can be developed.