By clicking register, I agree to your terms. Among women surviving after gynecological malignancies sexual dysfunction is a morbidity unexplored in Indian context because of cultural barriers.
With the increasing proportion of women surviving carcinoma of the cervix, quality of life has become an important clinical issue. Despite the immense distress it causes in patients, sexual dysfunction is neither screened nor treated in Indian scenario.
Despite this recognition, the area is not well researched and there is a paucity of information on the impact of cancer treatment on sexual health in Indian Context.
This article aims to review the phases of sexual response and how each may be affected by the
G n balasubramaniam wife sexual dysfunction and emotional stress of cancer diagnosis and treatment. We will then discuss existing tools for assessment of sexual function and approaches to their treatment. Finally, we will conclude with advice to health care professionals based on current research and suggest questions for future study.
Sexual dysfunction- female- cancer treatment Asian Pac J Cancer Prev, 18 5Introduction The incidence of breast cancer has increased globally over the last decades Hortobagy et al. Although traditionally less common, the greatest increase has occurred in Asian countries Green and Raina Level of knowledge of breast cancer risk factors, symptoms and screening methods was high as compared to cervical cancer in teachers in different parts in India Shankar "G n balasubramaniam wife sexual dysfunction" al, To reduce this increasing load of mortality due to breast cancer, emphasis on early detection and increased use of systemic therapy is required and that can only happen if we have a better understanding of the trend, age group involved and other risk factors Chauhan et al.
In a study of Kowalczyk et al. The presences of a sexual partner and the support they provide as well as the level of state anxiety are the predictors of sexual dysfunction in breast cancer survivors.
Scientists currently Hummel et al.
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They concluded that Internet-based CBT has salutary effects on sexual functioning, body image, and menopausal symptoms in BCSs with a sexual dysfunction. In India, approximately 1 million new cases
G n balasubramaniam wife sexual dysfunction detected, and G n balasubramaniam wife sexual dysfunction, deaths occurred due to cancer in Ferlay et al.
Among cancers of the female genital tract, the incidence of ovarian cancer ranks below only carcinoma of the cervix and the endometrium. With the advent of synergistic surgical, radiotherapy and chemotherapy based management, the mortality rates in cancer patients have declined. This has lead to increase in morbidities associated with malignancy survivors. Assessment of overall sexual health To determine the etiology of female sexual dysfunction different facets of emotionalphysical and other comorbid diseases and drugs intake has to be taken into consideration.
Hypertension, diabetesmetabolic syndrome, thyroid disorders are well known diseases associated with sexual dysfunction Manolis and Doumas, ; Enzlin et al. Antihypertensives like beta-blockers as well as diuretics are well known for sexual side effects Ko et al. Emotional disorders such as anxiety and depression are associated with reductions in sexual desire, sexual arousal, and orgasm Krychman et al.
Additionally, women may suffer unnecessarily if they are self-blaming or feel some past behavior or transgression was a contributing factor to the development of their cancer. Relationship discord may also be exacerbated during cancer care and treatment. How does cancer treatment affect sexual health?
Surgery, radiotherapy and chemotherapy all have an impact on sexual health in several ways.
Sexual Dysfunction in Females after...
Oophorectomy either surgical or after radiotherapy or chemotherapy leads to acute decrease in levels of estrogen, progesterone and testosterone in women leading to irreversible menopause. With the change in this endocrine axis there is emergence of menopausal symptoms such as vulvovaginal and clitoral atrophic changes coupled with vaginal thinning, decreased elasticity with resulting dryness and onset of dyspareunia Johansen et al.
In patients undergoing hysterectomy there are both long term as well as short term sexual morbidity. Long-term effects for as long as 2years tend to include a negative impact on libido and vaginal lubrication. These morbidities are more frequent with radical hysterectomies Jensen et al. Many have researched the impact of breast surgery on sexual health. Cytotoxic chemotherapy in women not only create poor self- esteem due to alopecia and generalized weakness but also
G n balasubramaniam wife sexual dysfunction to decrease in sexual interest owning to side effects such as anemia, leucocytopenia, diarrhea and fatigue Ganz et al.
Antiestrogen therapies, of which the selective estrogen receptor modulator tamoxifen has been the most studied, are commonly used in hormone-positive cancers, most notably breast cancer. Tamoxifen has been reported to affect sexual function in some patients, leading to physiological consequences of impaired venous congestion and lack of vaginal lubrication, all of which result in both arousal and pain issues Kaplan, ; Mourits et al.
Like surgery, radiation therapy may cause scarring and nerve damage. In situations where the ovaries are irradiated, there is also risk of sterilization and early menopause. Radiation has both short-term and longterm effects. In the treatment of cervical cancer, women receiving radiation with or without surgery have similar sexual practices and satisfaction compared with women who have undergone radical hysterectomy 6 months after treatment, but by 1 year they have much higher rates of dyspareunia.
Sexual desire and arousal also tend to be affected to a greater degree in women receiving radiation therapy, compared with those receiving surgery alone Schover et al.
A survey of gynecologic oncologists in New England found that less than half gather sexual history of new patients Wiggins et al. The problem lies both among clinicians as well as the patients. Screening patients can be challenging and may be considered time consuming for oncologists focused on diagnosis, management, and the urgent medical complications of disease and treatment.
Moreover, to effectively address dysfunction, health care professionals may need to establish baseline sexual function in healthy patients or at least a pretreatment baseline Quirk "G n balasubramaniam wife sexual dysfunction" al.
The basic problem being lack of time and others being personal discomfort with the topic, inadequate training and understanding of safe, effective available treatments. Patients, however, have different reasons for not discussing sexual concerns. Several scales for objective assessment of sexual dysfunction have been developed over the years.
Quality-of-life questionnaires vary in
G n balasubramaniam wife sexual dysfunction content and coverage. Some are broadly relevant to any population regardless of health or disease status generic questionnairewhereas others focus on particular concerns in specific disease such as cervical cancer disease-specific questionnaire. Besides, dimension-specific questionnaires may focus on sexual dysfunction, anxiety, depression, or adverse effects after treatment.
This scale is used to assess the use of questionnaires to score treatment effects in carcinoma of uterine cervix. The questionnaire approach is a practical method for obtaining reliable and consistent data. In the scales each answer is scored depending on the severity of the symptoms, higher the score the more severe the symptom. The perception of morbidity may be quite different by the doctor and the patient, particularly if the morbidity is protracted, irreversible, uncontrollable, and painful or socially disabling Pavy et al.
This may focus attention on symptoms that can be alleviated, but which have not received sufficiently serious attention so far. Female sexual dysfunction, the therapeutic approach The pre text of management of sexual dysfunctions lies on three tier approach of open communication, medical understanding, and education Krychman, The understanding that sexual dysfunctions may arise during treatment must be clearly discussed and screened for during treatment and follow-up.
Regular and routine screening also may assist in identifying new or evolving concerns regarding dysfunction and may afford the opportunity to address and ultimately help guide prognosis for recovery. Drugs affecting the desire component of sexual dysfunction are anti-depressants often prescribed in cancer survivors. Bupropion is another worthy option Croft et al.
Endocrine causes of decreased desire, such as early menopause after oophorectomy or chemical alteration of the estrogen response with agents like tamoxifen, present a unique challenge. In many cases, hormone supplementation is strictly contraindicated on the basis of the nature of the tumor.
Testosterone supplementation has been studied for libido-enhancing effects in women and used for women under other circumstances. Given that it has not been adequately studied in female cancer survivors, it cannot be recommended for use Barton et al.
Survivors in long-term relationships have their own challenges that may impact desire. It is important that the partner be involved in the counseling, the initial setting of expectations, and in screening for dysfunction, provided the patient is comfortable with this. Whether it is from the hormonal effects of surgical or endocrine
G n balasubramaniam wife sexual dysfunction or damage done by radiation or cytotoxic chemotherapy, vaginal dryness, irritation, and vulvo vaginal atrophy are common impediments to normal sexual function in women with cancer.
A hormonal solution, particularly a systemic estrogen treatment, can be used in many cases, although contraindications exist in hormonally sensitive cancers. Fortunately, a number of alternatives exist and can easily be prescribed or recommended by physicians encountering this complaint.
For patients with lower risk, local estrogen creams, rings, or tablets are applied directly to the vaginal mucosa, have minimal systemic effects, and may provide the most effective treatment Simunic et al. There are also nonpharmacologic vaginal moisturizers.
The nonhormonal therapy was found in a placebo-controlled clinical trial to be effective in managing vaginal atrophy Nachtigall, For problems related to arousal there is a prescription device that is FDA approved as an aid for female arousal. This device has shown promising role in patients with oophorectomy,hysterectomy and in patients treated with radiotherapy who had severe dyspareunia Josefson, Patients dealing with
G n balasubramaniam wife sexual dysfunction that is the result of scarring or shortening of the vagina from surgery or radiation are explained regarding the use of vaginal dilators coupled with aggressive vaginal rehabilitation including vaginal lubricants, moisturizers, and minimally absorbed local vaginal estrogen products, may also be used to lengthen or widen the vagina.
In general, when confronting any sexual dysfunction, providers should always consider individual and couples counseling along with any biological or medical treatment plan that includes prescription.
Physicians should also be willing to refer patients to a specialist when more complex or intractable problems arise. Sexual health comprises an important dimension of human well- being.
Among the unresolved questions is the incomplete division between sexuality and fertility, which is highly relevant for pediatric cancer survivors and young women. Is it possible
G n balasubramaniam wife sexual dysfunction treat them as 2 sides of the same coin?
If so, how can we ensure proper care of fertility-challenged women? Women who choose not to have children or women who for any reason do not see their fertility and sexual wellness as quite so closely intertwined? Currently there is recognition that it is important to preserve fertility; however, is preservation of sexual function addressed satisfactorily? The American Society of Clinical Oncology recommends that fertility preservation be considered as part of cancer treatment planning as early in the process as possible Lee et al.
In addition, the cancer-related FSD is limited by a better understanding of baseline sexual function when newly diagnosed. This is likely attributed to the unspoken understanding among oncologists that there is a time and place to discuss issues, and that the newly diagnosed patient, overcome with a cancer diagnosis "G n balasubramaniam wife sexual dysfunction" grappling to make decisions on treatment, is not in an appropriate state of mind to discuss sexual health.
Further development of nonhormonal treatment regimens need to be further researched and developed. Finally, there is a lack of evidence-based data evaluating the role of integrative medical techniques on sexual function, especially in the female cancer patients. Brotto et al have done some research on the practice of mindfulness, demonstrating a positive impact on sexuality, albeit in small cohorts. In Indian scenario with cultural and ethical boundaries sex and related dysfunctions are still a taboo, but the problem exists and causes harm.
Ignorance is no cure so it must be a matter of introspection that this domain of life must be discussed and treated for all cancer survivors. This is review article, so data is taken from many original articles and review papers related to this topic. Although all authors completed the disclosure declaration, there is no conflict of interests. Hospital-based study of endometrial cancer survival in Mumbai, India. Asian Pacific J Cancer Prev, 14, J Natl Cancer
G n balasubramaniam wife sexual dysfunction, 99, —9.
Obstet Gynecol, 98, —3.
Keywords: Sexual dysfunction, female, cancer...
Gudalur Narayanaswamy Balasubramaniam (6 January – 1 May ), popularly known as GNB, was an Indian Carnatic singer. He innovated the art. B. Balasubramaniam Sexual hallucinations have been reported since the advent of anaesthesia.
A middle‐aged woman had been sedated with 10 mg midazolam for talking about a difficult domestic situation and often referred to the problems . G. Park, MEDICAL MALPRACTICE | Intensive Care, Encyclopedia of.
G.N. Balasubramaniam, Ramnad Krishnan and Palghat Mani Iyer were among the maestros who refused to let their children enter the world of.
Keywords: Sexual dysfunction, female, cancer treatment. Go to: .. References. Balasubramaniam G, Sushama S, Rasika B, et al. N Engl J Med. My friendship with late G. N. Balasubramaniam started in peculiar circumstances - with a friction. people and he was perpetually inveigled away to sing at any function in the vicinity. And the fair sex outnumbered the rest at his recitals. Cancer besides being a leading cause of mortality also creates a myriad of morbidities in survivors whether treated or untreated. Balasubramaniam, Ramnad Krishnan and Palghat Mani Iyer were among the maestros who refused to let their children enter the world of music. By clicking register, I agree to your terms. Sexual Dysfunction in Females after Cancer Treatment: an Unresolved Issue - PDF Download Free G. N. Balasubramaniam - WikiVisually
He innovated the art in every way emphasis on laya exercise power and reducing the gamakas which eventually made Carnatic music appeal to the lay and the well-informed alike. He was conjointly a Tamil film actor. Balasubramanian was born in Gudalur, a small village near Mayavaram in Tamil Nadu.
He was the son of G V Narayanaswamy Iyer, who was a keen student of music. Throughout his younger years, he observed with utmost attention the techniques of the musicians of his day.
Ariyakudi Ramanuja Iyengar became his manasika guru and inspiration. While his father dreamed of living in a villa at Luz Church access through GNB becoming a successful lawyer, the musician in GNB made at work for greater goals in life. However, he joined the diploma course in music under Madras University in the first set and Tiger Varachari was the principal.
Within 2 years, he was intelligent for concert performances.
My friendship with late G. Balasubramaniam started in peculiar circumstances - with a friction. Puttu Rao, a respected advocate of Mysore, came to my place. I was surprised and when he said "I say what bring into the world you done to GNB? But I could not meet him. It is not an foremost matter. Besides I was again a bit concerned abut the effect the review would bring into the world on the organisers of my concerts.
After all I am a professional musician. And if they hear your off pivotal concerts, they will certainly go along with giving apasruthi concerts and meat at you in case anyone criticised them. We regularly corresponded and personally discussed various aspects of music.
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He is way more experienced than me and it bothers me? Gudalur Narayanaswamy Balasubramaniam (6 January – 1 May ), popularly known as GNB, was an Indian Carnatic singer. He innovated the art. treatment for erectile dysfunction, physicians should consider the cardiovascular 10 Asia Pacific Society for Sexual Medicine (APSSM) – Balasubramaniam Srilatha .. Srilatha (Singapore) [email protected] T b. T. S. F s is. S s. E a s. E n a .. his wife, in part, because the tissues were too thin distally..
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