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Should sexuality come into prostate cancer?

Prostate cancer poses as significant a risk to men as breast cancer does to women. But while there’s endless information about breast cancer, prostate cancer seems much more of a medical black hole.

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While it often falls under the radar, prostate cancer is a severe problem for men. In fact, 1 in 7 men will receive this diagnosis at some point. With statistics like that, prostate cancer poses as significant a risk to men as breast cancer does to women. While there’s endless information about breast cancer, prostate cancer seems much more of a medical black hole.

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Of course, things are progressing. Studies, such as the VCaP prostate tests, help develop understanding. You can head to sites like herabiolabs.com for details on this study and others, all of which help towards developing treatments. Indeed, the future looks set to get better as our knowledge grows.

But, despite these studies, there are still areas in which we need to develop understanding. As can be seen from articles like this one found at health.usnews.com, gay men who receive a diagnosis of prostate cancer find a surprising lack of information about the future they face. Most notably, healthcare practitioners fail to even ask sexual orientation. The argument is that who you’re attracted to has little standing on an illness such as cancer. But, that isn’t quite the reality.

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Of course, there’s no distinct difference in statistics between gay and straight men being diagnosed. Cancer can happen to anyone. But, gay men certainly face challenges unique to their sexual orientation. Worse, there’s no guidelines or information out there to help them through. And, with healthcare practitioners not even taking sexuality into account, the road becomes even rockier.

On top of this, many gay men who receive a diagnosis of prostate cancer report feeling isolated, even within the gay community. Unlike with a diagnosis of HIV, where everyone pulls together, a prostate diagnosis leaves you out in the cold. The gay community itself merely hasn’t considered the impact of this illness. So, gay men who do suffer are often left with no one to turn to.

But, how does this illness impact gay men? For the most part, this issue comes from the way treatment affects sexual performance. Of course, this can be an issue for anyone. But, for a gay man, the implications are that bit more damaging. For one, many treatments can result in weaker erections, which are more problematic for gay men because of harder penetration. Plus, if surgery is conducted to remove the prostate, there can be problems with ejaculation. Not to mention the obvious issues faced by those who receive during intercourse. As well as experiencing discomfort before treatment, there’s the ongoing issue of removing the primary source of pleasure.

What needs to be done differently? For the most part, we just need to open the floor for conversations like these. It seems that, though sexual orientation doesn’t immediately impact the condition, healthcare providers still need to ask about it. This way, they can talk through personal worries, and help prepare the patient adequately for what they can expect after treatment. In short; doing away with this silence will go a long way.

Health & Wellness

Young men unaware of risks of HPV infection and need for HPV vaccination

The US Food and Drug Administration has expanded the use of HPV vaccine to people between the ages of 27 to 45. Originally, it was prescribed for those between the ages of 9 to 26.

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Young sexual minority men – including those who are gay, bisexual, queer or straight-identified men who have sex with men – do not fully understand their risk for human papillomavirus (HPV) due to a lack of information from health care providers, according to Rutgers researchers.

A Rutgers study published in the Journal of Community Health, examined what young sexual minority men – a high-risk and high-need population – know about HPV and the HPV vaccine and how health care providers communicate information about the virus and vaccine.

About 79 million Americans alone are infected with HPV, with about 14 million becoming newly infected each year, according to the Centers for Disease Control and Prevention (CDC). As a sexually transmitted infection, HPV can lead to several types of cancer, including anal and penile cancer, and is particularly concerning for sexual minority men due to the high prevalence of HIV and smoking in this community and the low HPV vaccination rates overall among men.

“Particularly in light of the decades-long focus on gay men’s health care as HIV care, there is a missed opportunity for HPV prevention in the community,” said study co-author Caleb LoSchiavo, a doctoral student at the Rutgers School of Public Health.

The researchers, who are members of the Rutgers School of Public Heath’s Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), analyzed interviews with sexual minority men in their early 20s in New York City and determined they knew little about HPV infection — including transmission, signs, symptoms and cancer risk — and vaccination.

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They also found that the men did not prioritize HPV vaccination due to the incorrect perception that HPV is an issue that exclusively or primarily affected women.

“Everyone who is sexually active – regardless of gender, sexual orientation, partners’ genders, relationship or marital status – should talk to their doctor about receiving the HPV vaccine to prevent a future generation who may develop HPV-related cancers, such as cervical, oral and anal cancer, as we have seen emerging in Baby Boomers and Gen-Xer s,” said Perry N. Halkitis, Rutgers School of Public Health dean, CHIBPS director, and PI of the study.

The US Food and Drug Administration has expanded the use of HPV vaccine to people between the ages of 27 to 45. Originally, it was prescribed for those between the ages of 9 to 26.

In the study, researchers found that health care providers rarely discuss HPV and the HPV vaccine with patients who are young sexual minority men, and when they do, their communication is often inadequate in conveying potential risks of HPV and benefits of vaccination.

“Clinicians have a direct role in expanding the availability of LGBTQ-competent healthcare,” said lead author Jessica Jaiswal, an assistant professor at the University of Alabama, and CHIBPS affiliate. “By learning about sexual minority men’s diverse health needs and routinely offering the HPV vaccine, we can move toward a health promotion model and not only a disease prevention model.”

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Health & Wellness

Gay and bisexual men have higher rate of skin cancer

Rates of skin cancer were higher among gay and bisexual men compared to heterosexual men, but lower among bisexual women than heterosexual women.

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In the largest study of skin cancer rates among gay, lesbian or bisexual individuals, investigators from Brigham and Women’s Hospital report important differences in skin cancer prevalence among sexual minorities. Rates of skin cancer were higher among gay and bisexual men compared to heterosexual men, but lower among bisexual women than heterosexual women.

These findings, which were possible because of the sexual orientation and gender identity (SOGI) module built into a national system of surveys, have implications for patient education and community outreach initiatives focused on reducing skin cancer risk. They also have implications for the design of future nationwide surveys. Results are published in JAMA Dermatology.

“It’s absolutely critical that we ask about sexual orientation and gender identity in national health surveys; if we never ask the question, we’d never know that these differences exist,” said corresponding author Arash Mostaghimi, MD, MPA, MPH, director of the Dermatology Inpatient Service at the Brigham. “This information helps inform the nation about how to allocate health resources and how to train providers and leaders. When we look at disparities, it may be uncomfortable, but we need to continue to ask these questions to see if we’re getting better or worse at addressing them. Historically, this kind of health variation was hidden, but we now recognize that it’s clinically meaningful.”

Mostaghimi and colleagues leveraged data from the Behavioral Risk Factor Surveillance System (BRFSS), using data collected from annual questionnaires from 2014 to 2018. The Centers for Disease Control (CDC) uses the BRFSS to collect information about risk factors and behaviors among adults. About 450,000 adults are interviewed by telephone by the BRFSS each year. Beginning in 2014, the BRFSS began using the SOGI module to include questions about sexual orientation and gender identity. This module was administered in 37 states.

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Mostaghimi and colleagues compared skin cancer rates among heterosexual men to rates in gay or bisexual men and compared rates among heterosexual women to lesbian or bisexual women. Rates of skin cancer were 8.1 percent among gay men and 8.4 percent among bisexual men, statistically higher than the rate of 6.7 percent among heterosexual men. Skin cancer rates were 5.9 percent among lesbian women and 6.6 percent among heterosexual women, which was not a statistically significant difference. However, the rate of 4.7 percent among bisexual women was statistically significantly lower than heterosexual women.

The authors note that the data are based on self-reported skin cancer diagnoses, which have not been confirmed by a physician. The SOGI module was also only implemented in 37 states, so may not be generalizable to all states.

The BRFSS survey did not collect information about risk factors for skin cancer, such as UV exposure, Fitzpatrick skin type (a measure of skin color and susceptibility to sun burn), HIV status and more. However, smaller studies have reported higher usage of indoor tanning beds among sexual minority men, a known risk factor for skin cancer.

The CDC recently considered stopping implementation of the SOGI module for future BRFSS surveys, a move Mostaghimi feels would hinder efforts to support this population.

“This is the first time we’ve been able to look nationally at data about skin cancer rates among sexual minorities. Eliminating SOGI would prevent us from better studying this vulnerable population over time to see how rates may change from year to year,” said Mostaghimi. “As a next step, we want to connect with sexual minority communities to help identify the cause of these differences in skin cancer rates. This is work that will need to be done thoughtfully but may help not just sexual minorities but everyone.”

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Health & Wellness

10+ lifetime sexual partners linked to heightened cancer risk

Those who reported a higher tally of sexual partners were also more likely to smoke, drink frequently, and do more vigorous physical activity on a weekly basis.

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A history of 10 or more lifetime sexual partners is linked to a heightened risk of being diagnosed with cancer, reveals research published online in the journal BMJ Sexual & Reproductive Health.

And among women, a higher number of sexual partners is also linked to heightened odds of reporting a limiting long term condition, the findings indicate.

Few studies have looked at the potential impact of the number of sexual partners on wider health outcomes.

To try and plug this knowledge gap, the researchers drew on information gathered for the English Longitudinal Study of Ageing (ELSA), a nationally representative tracking study of older adults (50+) living in England.

In 2012-13, participants were asked how many sexual partners they had had. Complete data were provided by 5722 of the 7079 people who responded to this question: 2537 men and 3185 women. Responses were categorised as 0-1; 2-4; 5-9; and 10 or more sexual partners.

Participants were also asked to rate their own health and report any long standing condition or infirmity which impinged on routine activity in any way.

Other relevant information obtained included: age; ethnicity; marital status; household income other than a pension; lifestyle (smoking, drinking, physical activity); and presence of depressive symptoms.

The average age of participants was 64, and almost three out of four were married. Some 28.5% of men said they had had 0-1 sexual partners to date; 29% said they had had 2-4; one in five (20%) reported 5-9; while 22% reported 10 or more.

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The equivalent figures for women were: just under 41%; 35.5%; just under 16%; and just under 8%.

In both sexes, a higher number of sexual partners was associated with younger age, single status, and being in the highest or lowest brackets of household wealth.

Those who reported a higher tally of sexual partners were also more likely to smoke, drink frequently, and do more vigorous physical activity on a weekly basis.

When all the data were analysed, a statistically significant association emerged between the number of lifetime sexual partners and risk of a cancer diagnosis among both sexes.

Compared with women who reported 0-1 sexual partners, those who said they had had 10 or more, were 91% more likely to have been diagnosed with cancer.

Among the men, those who reported 2-4 lifetime sexual partners were 57% more likely to have been diagnosed with cancer than were those who reported 0-1. And those who reported 10 or more, were 69% more likely to have been diagnosed with the disease.

While the number of sexual partners was not associated with reported long standing conditions among the men, it was among the women.

Women who reported 5-9 or 10+ lifetime sexual partners were 64% more likely to have a limiting chronic condition than those who said they had had 0-1.

This is an observational study, and as such, can’t establish cause. Nevertheless, the findings chime with those of previous studies, implicating sexually transmitted infections in the development of several types of cancer and hepatitis, suggest the researchers.

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They didn’t obtain information on the specific types of cancer participants reported, but speculate: “…the heightened risk of cancer might be driven by those types known to be associated with [sexually transmitted infections].”

And they suggest that enquiring about the number of sexual partners might complement existing cancer screening programmes by helping to identify those at risk, if further research can establish a causal association between the number of sexual partners and subsequent ill health.

But an explanation for the gender difference in long term condition risk remains “elusive,” they write, especially given that men tend to have more lifetime sexual partners than women, while women are more likely than men to see a doctor when they feel ill, so potentially limiting the associated consequences for their long term health.

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Health & Wellness

Visual disturbances in Viagra users

In a new study, Viagra patients suffered numerous visual disturbances, including abnormally dilated pupils, blurred vision, light sensitivity, and color vision disturbances, which included intensely blue colored vision with red/green color blindness.

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Sildenafil is commonly used to treat erectile dysfunction and is generally regarded as safe with limited side effects. However, a recent study in Frontiers in Neurology has highlighted the risk of persistent visual side-effects, such as light sensitivity and color vision impairment, in men who have taken the highest recommended dose of Viagra. While these effects appear to be rare, the research suggests that first-time Viagra users should start with a lower dose before increasing it, if necessary.

Erectile dysfunction can have significant psychological consequences for men who are affected by it, and it can make fulfilling sexual relationships more difficult to achieve. Sildenafil, more commonly known by its trade name Viagra, became available in 1998 as a treatment for erectile dysfunction. It soon became the fastest selling drug in history, demonstrating the phenomenal demand for treatments that enhance sexual performance.

Originally developed as a treatment for high blood pressure, the drug dilates blood vessels and relaxes smooth muscle in the penis, making it easier to achieve and maintain an erection. The effects of the drug normally last 3-5 hours and although side-effects such as headache and blurred vision occasionally occur, they usually disappear relatively quickly.

However, Dr. Cüneyt Karaarslan of the Dünyagöz Adana hospital in Turkey, noticed a pattern in 17 male patients who attended the hospital. In the new study, Karaarslan reports that the patients suffered numerous visual disturbances, including abnormally dilated pupils, blurred vision, light sensitivity, and color vision disturbances, which included intensely blue colored vision with red/green color blindness.

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All 17 patients had taken sildenafil for the first time, and all took the highest recommended dose of 100 mg. None of the men had been prescribed the medication. The visual side-effects began once the drug took effect, and were still present when the men arrived at the clinic 24-48 hours later.

The doctors in the clinic conducted various eye tests and monitored the patients over time to see how their symptoms developed. Fortunately, in all 17 patients the symptoms had cleared up by 21 days later, but this was doubtless a difficult experience for the men involved.

“Many men use non-prescription performance enhancing drugs to help with sexual anxiety and erectile dysfunction,” said Karaarslan. “For the vast majority of men, any side-effects will be temporary and mild. However, I wanted to highlight that persistent eye and vision problems may be encountered for a small number of users.”

So, why were these men susceptible to such long-lived side-effects? It may be possible that a small subsection of the population does not break sildenafil down and eliminate it from the body efficiently, leading to very high concentrations in the blood compared with most users.

These men also took the highest recommended dose of sildenafil on their first time taking the drug. Starting with a lower dose may have meant less severe side-effects. In addition, taking the drug under medical supervision would likely have meant that the men would not have used such a high dose on their first time.

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So, if you are struggling with erectile dysfunction, should you be worried about trying Viagra? In short, no. Such persistent side-effects appear to be very rare. However, it is always best practice to consult your physician first, it may be best not to start at the highest dose, and in case you are particularly sensitive, consider first using the drug under medical supervision.

“Although these drugs, when used under the control of physicians and at the recommended doses, provide very important sexual and mental support, uncontrolled and inappropriate doses should not be used or repeated,” said Karaarslan.

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Health & Wellness

Poor sexual health more common in women than men

Several important at-risk groups may be in danger of being overlooked by current sexual health intervention efforts, so more tailored approaches may be needed, the authors conclude.

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Poor sexual health is more common in women and affects them in more diverse ways than men, according to a UK study – “Latent class analysis of sexual health markers among men and women participating in a British probability sample survey” – published in the open access journal BMC Public Health.

Out of 12,132 men and women included in the study, 17% of men and 47.5% of women reported poor sexual health. Several important at-risk groups may be in danger of being overlooked by current sexual health intervention efforts, so more tailored approaches may be needed, the authors conclude.

To get a better idea of how sexual health varies within the UK population, a team of researchers at the University of Glasgow, UK investigated patterns of sexual health markers, such as sexually transmitted infections (STIs) or sexual function problems, in 12,132 sexually active men and women, aged 16-74 from England, Scotland and Wales, who were interviewed between 2010 and 2012. The data came from the National Survey of Sexual Attitudes and Lifestyles. The authors also examined associations of sexual health with socio-demographic, health and lifestyle characteristics, as well as with satisfaction or distress with a person’s sex life.

Alison Parkes, who led the study at the MRC/CSO Social and Public Health Sciences Unit said: “‘Sexual health’ is an umbrella term that covers several different health risks, such as STIs, unplanned pregnancy, sexual function problems and sexual coercion. A greater understanding of how these risks are patterned across the population is needed to improve the targeting and delivery of sexual health programmes.”

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Based on markers of sexual health that were most common in different groups of people, the authors identified sexual health classes, four of which were common to both men and women; Good Sexual Health (83% of men, 52% of women), Wary Risk-takers (4% of men, 2% of women), Unwary Risk-takers (4% of men, 7% of women), and Sexual Function Problems (9% of men, 7% of women). Two additional sexual health classed were identified in women only; a Low Sexual Interest class which included 29% of women and a Highly Vulnerable class, reporting a range of adverse experiences across all markers of sexual health, which included 2% of women.

Highly Vulnerable women were more likely to report an abortion than all other female sexual health classes except unwary risk takers, and most likely to report STIs. They were also the most likely to report sexual coercion. Risk of sexual coercion was found to be low in all male sexual health classes. Among men, only those in the Sexual Function Problem class were more likely to perceive low satisfaction / high distress with their sex lives than those in Good Sexual Health. By contrast, all female poor sexual health classes were more likely to perceive low satisfaction / high distress.

Parkes said: “We identified several groups who are not well served by current sexual health intervention efforts: men and women disregarding STI risks, women with a low interest in sex feeling distressed or dissatisfied with their sex lives, and women with multiple sexual health problems. These groups had distinctive socio-demographic profiles, and may benefit from new tailored programs.

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“However, we also noticed that poor sexual health groups had certain characteristics in common. They were generally more likely to have started having sex before the age of 16; and to experience depression, alcohol or drug use. Knowledge of these comorbidities may inform interventions designed to improve sexual health across different vulnerable populations.”

The authors caution that the observational nature of the study does not allow for assumptions about cause and effect. Causal mechanisms underlying associations such as between substance use and sexual health are likely to be complex and bidirectional.

Parkes said: “At a time when financial pressures are being felt by sexual health services across Britain, it may be advisable to prioritize interventions with the most widespread benefits. Our study identified widely-shared characteristics of different groups at risk of poor sexual health. Targeting these lifestyle and health factors could mitigate a broad spectrum of sexual health problems.”

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Pornography is not a ‘public health crisis’, say researchers

“The movement to declare pornography a public health crisis is rooted in an ideology that is antithetical to many core values of public health promotion and is a political stunt, not reflective of best available evidence.”

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Existing evidence suggests pornography may negatively affect some individuals, but it does not qualify as a public health crisis, and calling it one could cause harm.

Researchers from the Boston University School of Public Health (BUSPH) have written an editorial in the American Journal of Public Health special February issue arguing against the claim that pornography is a public health crisis, and explaining why such a claim actually endangers the health of the public.

“The movement to declare pornography a public health crisis is rooted in an ideology that is antithetical to many core values of public health promotion and is a political stunt, not reflective of best available evidence,” write Dr. Kimberly M. Nelson and Dr. Emily F. Rothman, both faculty in the Department of Community Health Sciences at BUSPH.

While 17 U.S. states have introduced nonbinding resolutions declaring pornography a public health crisis, the authors write that pornography does not fulfill the public health field’s definition of one. Pornography use has increased steadily over time rather than spiking or reaching a tipping point; it does not “directly or imminently” lead to death, disease, property destruction, or population displacement; and it does not overwhelm local health systems.

Instead, Nelson and Rothman write, the existing evidence suggests that there may be negative health consequences for some people who use pornography, no substantial consequences for the majority, and even positive effects for some (for example, through safer sexual behaviors such as solo masturbation). Motivating people to use less extreme pornography, and less frequently, are reasonable harm reduction goals, the authors write, instead of trying to end all use. Increasing pornography literacy would also be useful, they write; Dr. Rothman and colleagues outline their pornography literacy program for Boston area adolescents in a paper in the same journal issue.

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What is the harm of calling pornography a public health crisis? Nelson and Rothman argue that this mischaracterization can lead to unwarranted policy or funding shifts, rather than saving the power to mobilize the public health workforce for real crises. “Moreover, pathologizing any form of sexual behavior, including pornography use, has the potential to restrict sexual freedom and to stigmatize, which is antithetical to public health,” they write.

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