前列腺癌治疗后男同性恋和双性恋男性未被识别的性功能障碍：性交疼痛的前因和影响。
Unrecognized sexual dysfunction in gay and bisexual men after prostate cancer treatment: the antecedents and impact of anodyspareunia.
机构信息
Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA United States.
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States.
出版信息
J Sex Med. 2023 Mar 31;20(4):515-524. doi: 10.1093/jsxmed/qdad009.
BACKGROUND
Anodyspareunia may be an adverse outcome of prostate cancer (PCa) treatment for gay, bisexual, and other men who have sex with men (GBM).
AIM
The aims of this study were to (1) describe the clinical symptoms of painful receptive anal intercourse (RAI) in GBM following PCa treatment, (2) estimate the prevalence of anodyspareunia, and (3) identify clinical and psychosocial correlates.
METHODS
This was a secondary analysis of baseline and 24-month follow-up data from the Restore-2 randomized clinical trial of 401 GBM treated for PCa. The analytic sample included only those participants who attempted RAI during or since their PCa treatment (N = 195).
OUTCOMES
Anodyspareunia was operationalized as moderate to severe pain during RAI for ≥6 months that resulted in mild to severe distress. Additional quality-of-life outcomes included the Expanded Prostate Cancer Index Composite (bowel function and bother subscales), the Brief Symptom Inventory-18, and the Functional Assessment of Cancer Therapy-Prostate.
RESULTS
Overall 82 (42.1%) participants reported pain during RAI since completing PCa treatment. Of these, 45.1% experienced painful RAI sometimes or frequently, and 63.0% indicated that the pain was persistent. The pain at its worst was moderate to very severe for 79.0%. The experience of pain was at least mildly distressing for 63.5%. Painful RAI worsened for a third (33.4%) of participants after completing PCa treatment. Of the 82 GBM, 15.4% were classified as meeting criteria for anodyspareunia. Antecedents of anodyspareunia included a lifelong history of painful RAI and bowel dysfunction following PCa treatment. Those reporting symptoms of anodyspareunia were more likely to avoid RAI due to pain (adjusted odds ratio, 4.37), which was negatively associated with sexual satisfaction (mean difference, -2.77) and self-esteem (mean difference, -3.33). The model explained 37.2% of the variance in overall quality of life.
CLINICAL IMPLICATIONS
Culturally responsive PCa care should include the assessment of anodyspareunia among GBM and explore treatment options.
STRENGTHS AND LIMITATIONS
This is the largest study to date focused on anodyspareunia among GBM treated for PCa. Anodyspareunia was assessed with multiple items characterizing the intensity, duration, and distress related to painful RAI. The external validity of the findings is limited by the nonprobability sample. Furthermore, the cause-and-effect relationships between the reported associations cannot be established by the research design.
CONCLUSIONS
Anodyspareunia should be considered a sexual dysfunction in GBM and investigated as an adverse outcome of PCa treatment.
背景
性快感缺失可能是前列腺癌（PCa）治疗对男同性恋、双性恋和其他与男性发生性关系的男性（GBM）的不良后果。
目的
本研究旨在（1）描述接受 PCa 治疗后的 GBM 中肛交疼痛的临床症状，（2）估计性快感缺失的患病率，以及（3）确定临床和社会心理相关性。
方法
这是对接受 PCa 治疗的 401 名 GBM 进行的 Restore-2 随机临床试验的基线和 24 个月随访数据的二次分析。分析样本仅包括在 PCa 治疗期间或之后尝试过肛交的参与者（n=195）。
结果
性快感缺失被定义为在接受 PCa 治疗后≥6 个月期间进行肛交时出现中度至重度疼痛，导致轻度至重度困扰。其他生活质量结果包括扩展前列腺癌指数综合量表（肠功能和困扰子量表）、简明症状量表-18 和癌症治疗功能评估-前列腺。
总体而言，82 名（42.1%）参与者报告在完成 PCa 治疗后出现过肛交疼痛。其中，45.1%的人偶尔或经常出现肛交疼痛，63.0%的人表示疼痛持续存在。疼痛最严重时为中度至重度疼痛。79.0%的人感到疼痛至少有轻度困扰。对于三分之一（33.4%）的参与者，肛交疼痛在完成 PCa 治疗后恶化。在 82 名 GBM 中，15.4%符合性快感缺失的标准。性快感缺失的前驱因素包括终生有肛交疼痛史和 PCa 治疗后肠功能障碍。报告有性快感缺失症状的人更有可能因疼痛而避免肛交（调整后的优势比，4.37），这与性满足度（平均差异，-2.77）和自尊（平均差异，-3.33）呈负相关。该模型解释了总体生活质量 37.2%的方差。
临床意义
应在接受 PCa 治疗的 GBM 中评估性快感缺失，并探讨治疗选择。
局限性
这是迄今为止最大的一项针对接受 PCa 治疗的 GBM 中出现性快感缺失的研究。性快感缺失通过描述与疼痛性肛交相关的强度、持续时间和痛苦的多个项目进行评估。研究设计限制了研究结果的外部有效性。此外，报告的关联之间的因果关系不能由研究设计确定。
结论
性快感缺失应被视为 GBM 的性功能障碍，并将其作为 PCa 治疗的不良后果进行调查。
Zotero 插件