Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands.
Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Departments of Pediatrics and Psychology, The Ohio State University, Columbus, OH, USA.
J Sex Med. 2022 Nov;19(11):1644-1654. doi: 10.1016/j.jsxm.2022.07.014. Epub 2022 Sep 8.
Childhood cancer and its treatment can impair survivors' development throughout life, particularly psychosexual development, which can be affected in complex ways and is crucial for survivors' well-being. Yet, research is scarce.
This study assessed psychosexual development (milestone attainment, age at attainment, perceived timing) in young adult survivors of childhood cancer. It further examined sexual satisfaction and sexual functioning, and whether survivors' perceived timing of sexual debut was related to satisfaction or functioning.
A registry-based nationwide survey was completed by N = 492 German survivors of childhood cancer (age 21-26 years, 6-26 years postdiagnosis). They completed standardized measures of psychosexual milestones (eg, first kiss, sexual debut), sexual satisfaction, and sexual functioning. Psychosexual development was compared to normative data (N = 1,533).
Psychosexual development, sexual satisfaction, and sexual functioning were the primary outcome measures. Psychosexual development was characterized in three ways: milestone attainment (yes/no), age at attainment, perceived timing ("right" time, too early/late).
Milestone attainment was comparable to normative data, except for sexual debut: Survivors were less often experienced (82.5% vs 88%; P = .002) and older at sexual debut (17.4 vs 16.2 years; g = 0.55), but most survivors (58.3%) perceived their timing as "right." Survivors of brain tumors were least likely to have had their sexual debut, but if experienced age at sexual debut was similar to other survivors. Female survivors were somewhat more experienced than males (eg, first kiss, first relationship; <10% difference), but they were somewhat older when they first kissed (g = 0.26). Age at diagnosis was unrelated to milestone attainment. Perceived early/late sexual debut was related to lower satisfaction in female survivors (P = .026), but unrelated to sexual dysfunction. Instead, partnered men reported particularly low dysfunction whereas women reported similar levels of sexual dysfunction irrespective of their relationship status (P = .049). Overall, sexual functioning was favorable (60.2%: not/barely problematic).
Most survivors reported favorable sexual satisfaction and functioning, but a minority of survivors may need supportive services.
STRENGTHS & LIMITATIONS: This project represents one of few large-scale studies on psychosexual development in childhood cancer survivors relative to normative data, and is the first to link development to sexual satisfaction/functioning. Assessing satisfaction/functioning with validated, but brief measures limits detailed insights, but was inclusive of any sexual orientation. Medical background information based on registry data was limited.
Results showed normative psychosexual development (except for sexual debut) in most survivors. A self-determined attitude toward sexuality (ie, engaging in sexual activities at the "right" time) may generally determine positive sexual experiences. Lehmann V, Gerhardt CA, Baust K, et al. Psychosexual Development and Sexual Functioning in Young Adult Survivors of Childhood Cancer. J Sex Med 2022;19:1645-1654.
儿童癌症及其治疗会影响幸存者一生的发展，尤其是性心理发展，其可能受到复杂因素的影响，对幸存者的幸福感至关重要。然而，目前相关研究还很少。
本研究评估了儿童癌症青年幸存者的性心理发展（里程碑的实现、实现年龄、感知时机）。进一步探讨了性满意度和性功能，以及幸存者感知的性初体验时间是否与满意度或功能有关。
通过一项基于登记的全国性调查，共纳入 492 名德国儿童癌症幸存者（年龄 21-26 岁，诊断后 6-26 年）。他们完成了标准化的性心理里程碑（如初吻、性初体验）、性满意度和性功能的评估。性心理发展与正态数据进行了比较（N=1533）。
性心理发展、性满意度和性功能是主要的结局指标。性心理发展以三种方式进行描述：里程碑的实现（是/否）、实现年龄、感知时机（“合适”的时机、过早/过晚）。
除了性初体验，其他里程碑的实现与正态数据相当：幸存者较少经历过（82.5%对 88%；P=0.002），且性初体验年龄较大（17.4 对 16.2 岁；g=0.55），但大多数幸存者（58.3%）认为他们的时机“合适”。脑肿瘤幸存者最不可能有性初体验，但如果有，他们的性初体验年龄与其他幸存者相似。女性幸存者的性经验比男性略多（例如，初吻、初恋；差异<10%），但她们初吻的年龄较大（g=0.26）。诊断年龄与里程碑的实现无关。感知的性初体验过早/过晚与女性幸存者的满意度较低有关（P=0.026），但与性功能障碍无关。相反，有伴侣的男性报告的性功能障碍尤其低，而女性无论其关系状况如何，报告的性功能障碍相似（P=0.049）。总体而言，性功能良好（60.2%：无/仅有轻微问题）。
大多数幸存者报告了良好的性满意度和性功能，但少数幸存者可能需要支持性服务。
本研究是为数不多的相对于正态数据评估儿童癌症幸存者性心理发展的大型研究之一，也是第一个将发展与性满意度/功能联系起来的研究。使用经过验证的但简短的测量方法评估满意度/功能限制了详细的见解，但包含了任何性取向。基于登记数据的医学背景信息有限。
结果表明，大多数幸存者的性心理发展正常（除了性初体验）。对性的自我决定态度（即在“合适”的时机参与性活动）可能普遍决定了积极的性体验。
