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Psychological Factors of Testicular Cancer
editAlthough testicular cancer has a low mortality rate and better prognosis outcomes, psychological factors still affect cancer patients struggling with a diagnosis. [1] This means that the absence of testicles can influence perceptions of masculinity, sexual identity, and body image.[2] Castration or partial removal is associated with fantasies, beliefs, myths, and cultural norms surrounding the testes, which can lead to severe psychological trauma and consequences for the individual.[2] Consequently, worries regarding sexual and reproductive capabilities may induce feelings of despair, inadequacy, and emotional turmoil.[2] Factors that are associated with a decrease in psychological outcomes are early adulthood, partnership status, work status, sexual dysfunction, diminished masculinity, and adaptive mechanisms. [1]
Masculinity and Sexual Identity
editBiological ideas about masculinity say that our bodies confirm our gender, so changes or damage to our reproductive system can affect how men feel about being men.[3] Since testicles have long been seen as symbols of strength, bravery, and masculinity, having surgery to remove them can change how men with testicular cancer view themselves and what it means to be a man.[3]
Social stigma related to Masculinity and Sexual Identity
editYouthful males aged 18-24 encounter distinct gender-specific social factors that are linked to a decrease in mental health outcomes.[3] These social factors include limited access to health services and engagement, stigma related to masculinity, and cultural expectations.[3] Single or unemployed men are at a higher risk of poorer psychological outcomes that are correlated with an impairment of sexual functions and masculinity.[1] Another factor that is related to experiencing negative effects related to masculinity is not having children, due to not being able to meet traditional expectations of being a protector or provider.[3] Men who felt that losing a testicle made them less masculine also felt negative psychological effects.[3]
New research shows that testicular cancer survivors who have low testosterone levels feel less masculine than those with normal testosterone levels.[4] These concerns are important for teenage boys going through puberty or recently experiencing physical changes, which can shape their developing understanding of their sexual identity.[4] For example, gynecomastia, which is when males develop enlarged breasts during puberty, is a common and normal part of growing up.[4] However, only up to 11% of patients diagnosed with testicular cancer have gynecomastia when they first seek medical attention, and about 4% of males checked for gynecomastia turn out to have testicular cancer.[4] After testicular cancer, some men feel less masculine, but how much cancer affects masculinity varies from person to person. [3]
Body Image
editNew studies show that 16% of survivors have serious concerns about how they look after the removal of a testicle.[4] These survivors worry about feeling awkward and anxious because of their missing testicles, and they feel different from other people.[4] Even though 52% of survivors felt that their bodies had changed a lot because of cancer and treatment, 88% of the spouses didn't think their partners were any less attractive.[4]
How survivors feel about their bodies is a big factor in deciding whether to get a testicular prosthesis.[4] Many worry about losing their masculinity, and how they see themselves, and just want to look and feel normal again.[4] Looking back at how testicular prostheses were used, especially with many teenagers, there were noticeable improvements in how people felt about their bodies and themselves overall one year after getting an implant.[4] They also felt more comfortable during sexual activities.[4]
Anxiety and Depression
edit
After having the testicles removed through orchiectomy, testicular cancer survivors may experience long-lasting feelings of sadness or embarrassment.[2] Research has shown that these emotions are more prevalent among younger and unmarried men compared to older and partnered individuals. [2]The most common psychological problem faced by men diagnosed with testicular cancer is anxiety.[1] New research suggested that there was no direct comparison between people who have been diagnosed with testicular cancer and the general population.[1] Studies show that anxiety is more frequent among testicular cancer survivors of similar gender and age compared to the general population, affecting about 1 in 5 survivors.[1][5] Depression doesn't seem to burden testicular cancer patients as much as anxiety.[1]
Fear of Recurrence
editAround one out of every three testicular cancer survivors experience significant fear of the cancer coming back, and this fear is considered the most troubling issue for them.[5] Unmarried men reported they felt less fear of cancer recurrence than men who were in a relationship.[1] Survivors who have a fear of recurrence of their cancer tend to have more:
- Intrusive thoughts
- Feel more depressed
- Stressed
- Experience poorer physical well-being [5]
Being diagnosed with testicular cancer often destroys many men's feelings of being invincible and brings up unexpected questions about life and purpose.[5] They feel a sense of being in between or on the threshold of a new identity.[5] This involves feeling disconnected from those who haven't been through a similar intense experience, questioning the purpose of their existence, and becoming more aware of life's fragility and the certainty of death.[5] New research suggests that certain testicular cancer survivors think their cancer was triggered by their stress sensitivity.[5] This may be why some survivors have a fear of recurrence more than 10 years after treatment, even though the actual risk of recurrence is around 1%.[5]
Biological and Psychological Factors of Sexual Dysfunction
editSexual dysfunction can present as a symptom in people who have been diagnosed with testicular cancer. Sexual dysfunction can stem from biological factors, psychological factors, or a blend of both.[2] Difficulties in physiological aspects such as achieving erection and ejaculation are correlated with the severity of the disease and the methods of treatment employed such as surgery, radiotherapy, or chemotherapy.[2] Conversely, psychological aspects such as libido and satisfaction remain unaffected by the type of treatment received.[2] Nonetheless, treatment approaches for testicular cancer can induce physiological alterations while simultaneously eliciting emotional responses. [2] Therefore, diminished sexual function (such as decreased libido or inhibition) may result from treatment-related physical factors like fatigue, overall discomfort, hair loss, and significant weight fluctuations, as well as emotional factors including concerns about sexual performance, fear of losing control, and ambiguity regarding what lies ahead.[2]
Stressful Experiences Caregivers of Testicular Cancer Patients May Notice
editThe stressful event of testicular cancer not only affects the patient that is diagnosed but also affects the caregiver. The psychological stress model consists of stressful experiences that a patient with testicular cancer may go through after diagnosis, that caregivers may want to look out for.[6] The stressful experiences consist of 4 main categories:
- Late side-effects
- Fear of tumor relapse
- Fertility problems
- Social and workplace issues
These side effects may need physical and emotional care which in turn can cause the caregiver an emotional burden.[6]
Post-traumatic Growth From Testicular Cancer
editNot every survivor of testicular cancer has negative outcomes of depression and some even may gain positive outcomes from their experience.[5] This means that when you look at outcomes across all testicular cancer survivors, the positives and negatives could balance each other out.[5] Many cancer survivors, both young and older adults, have reported benefits and personal growth in the months and even years following their diagnosis.[5] Furthermore, researchers have discovered that while the journey of testicular cancer initially brings physical and emotional challenges, it also leads many survivors to develop a newfound gratitude for life.[5] Besides improving mental outlook, going through testicular cancer might also motivate men to adopt healthier behaviors such as:
- More physical activity
- Reduce or stop smoking
These positive changes in lifestyle could contribute to better psychological well-being, which can offset any initial difficulties they face.[5]
References
edit- ^ a b c d e f g h Rincones, Orlando; Smith, Allan 'Ben'; Naher, Sayeda; Mercieca-Bebber, Rebecca; Stockler, Martin (May 2021). "An Updated Systematic Review of Quantitative Studies Assessing Anxiety, Depression, Fear of Cancer Recurrence or Psychological Distress in Testicular Cancer Survivors". Cancer Management and Research. 13: 3803–3816. doi:10.2147/CMAR.S198039. ISSN 1179-1322. PMC 8123967. PMID 34007213.
- ^ a b c d e f g h i j Schepisi, Giuseppe; De Padova, Silvia; De Lisi, Delia; Casadei, Chiara; Meggiolaro, Elena; Ruffilli, Federica; Rosti, Giovanni; Lolli, Cristian; Ravaglia, Giorgia; Conteduca, Vincenza; Farolfi, Alberto; Grassi, Luigi; De Giorgi, Ugo (2019-02-25). "Psychosocial Issues in Long-Term Survivors of Testicular Cancer". Frontiers in Endocrinology. 10: 113. doi:10.3389/fendo.2019.00113. ISSN 1664-2392. PMC 6397854. PMID 30858829.
- ^ a b c d e f g Cite error: The named reference
:2was invoked but never defined (see the help page). - ^ a b c d e f g h i j k Carpentier, Melissa Y.; Fortenberry, J. Dennis (2010-08-01). "Romantic and Sexual Relationships, Body Image, and Fertility in Adolescent and Young Adult Testicular Cancer Survivors: A Review of the Literature". Journal of Adolescent Health. 47 (2): 115–125. doi:10.1016/j.jadohealth.2010.04.005. ISSN 1054-139X. PMC 2907366. PMID 20638003.
- ^ a b c d e f g h i j k l m Smith, Allan “Ben”; Rutherford, Claudia; Butow, Phyllis; Olver, Ian; Luckett, Tim; Grimison, Peter; Toner, Guy; Stockler, Martin; King, Madeleine (April 2018). "A systematic review of quantitative observational studies investigating psychological distress in testicular cancer survivors". Psycho-Oncology. 27 (4): 1129–1137. doi:10.1002/pon.4596. hdl:11343/283526. ISSN 1057-9249. PMID 29171109.
- ^ a b "Testicular Cancer Awareness Month: A Focus on Implications of Mental Health Among Testicular Cancer Survivors". www.urotoday.com. Retrieved 2024-04-11.
- ^ Cite error: The named reference
:3was invoked but never defined (see the help page). - ^ Dax, Victoria; Ftanou, Maria; Tran, Ben; Lewin, Jeremy; Wallace, Rebecca; Seidler, Zac; Wiley, Joshua F. (September 2022). "The impact of testicular cancer and its treatment on masculinity: A systematic review". Psycho-Oncology. 31 (9): 1459–1473. doi:10.1002/pon.5994. ISSN 1057-9249. PMC 9542153. PMID 35789023.