Pleasurable and problematic receptive anal intercourse and diseases of the colon, rectum and anus

被引:5
|
作者
Dickstein, Daniel R. [1 ]
Edwards, Collin R. [2 ]
Rowan, Catherine R. [3 ]
Avanessian, Bella [4 ,5 ]
Chubak, Barbara M. [6 ]
Wheldon, Christopher W. [7 ]
Simoes, Priya K. [8 ]
Buckstein, Michael H. [1 ]
Keefer, Laurie A. [8 ]
Safer, Joshua D. [4 ,9 ]
Sigel, Keith [10 ]
Goodman, Karyn A. [1 ]
Rosser, B. R. Simon [11 ]
Goldstone, Stephen E. [12 ]
Wong, Serre-Yu [8 ]
Marshall, Deborah C. [1 ,13 ]
机构
[1] Icahn Sch Med Mt Sinai, Dept Radiat Oncol, New York, NY 10029 USA
[2] Columbia Univ, Vagelos Coll Phys & Surg, Dept Radiol, New York, NY USA
[3] Univ Calgary, Div Gastroenterol & Hepatol, Inflammatory Bowel Dis Unit, Calgary, AB, Canada
[4] Icahn Sch Med Mt Sinai, Ctr Transgender Med & Surg, New York, NY USA
[5] Icahn Sch Med Mt Sinai, Div Plast & Reconstruct Surg, New York, NY USA
[6] Icahn Sch Med Mt Sinai, Dept Urol, New York, NY USA
[7] Temple Univ, Dept Social & Behav Sci, Coll Publ Hlth, Philadelphia, PA USA
[8] Icahn Sch Med Mt Sinai, Dept Med, Dr Henry D Janowitz Div Gastroenterol, New York, NY USA
[9] Icahn Sch Med Mt Sinai, Dept Med, Div Endocrinol, New York, NY USA
[10] Icahn Sch Med Mt Sinai, Dept Med, Div Infect Dis, New York, NY USA
[11] Univ Minnesota, Sch Publ Hlth, Div Epidemiol & Community Hlth, Minneapolis, MN USA
[12] Icahn Sch Med Mt Sinai, Dept Surg, New York, NY USA
[13] Icahn Sch Med Mt Sinai, Dept Populat Hlth Sci & Policy, New York, NY USA
基金
美国国家卫生研究院;
关键词
QUALITY-OF-LIFE; INFLAMMATORY-BOWEL-DISEASE; SEXUALLY-TRANSMITTED INFECTIONS; INTIMATE PARTNER VIOLENCE; TOTAL MESORECTAL EXCISION; RECENT HETEROSEXUAL ENCOUNTERS; TENOFOVIR DISOPROXIL FUMARATE; LOW ANTERIOR RESECTION; PELVIC FLOOR; RISK-FACTORS;
D O I
10.1038/s41575-024-00932-1
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
The ability to experience pleasurable sexual activity is important for human health. Receptive anal intercourse (RAI) is a common, though frequently stigmatized, pleasurable sexual activity. Little is known about how diseases of the colon, rectum, and anus and their treatments affect RAI. Engaging in RAI with gastrointestinal disease can be difficult due to the unpredictability of symptoms and treatment-related toxic effects. Patients might experience sphincter hypertonicity, gastrointestinal symptom-specific anxiety, altered pelvic blood flow from structural disorders, decreased sensation from cancer-directed therapies or body image issues from stoma creation. These can result in problematic RAI - encompassing anodyspareunia (painful RAI), arousal dysfunction, orgasm dysfunction and decreased sexual desire. Therapeutic strategies for problematic RAI in patients living with gastrointestinal diseases and/or treatment-related dysfunction include pelvic floor muscle strengthening and stretching, psychological interventions, and restorative devices. Providing health-care professionals with a framework to discuss pleasurable RAI and diagnose problematic RAI can help improve patient outcomes. Normalizing RAI, affirming pleasure from RAI and acknowledging that the gastrointestinal system is involved in sexual pleasure, sexual function and sexual health will help transform the scientific paradigm of sexual health to one that is more just and equitable. Receptive anal intercourse (RAI) is an important consideration in gastrointestinal disorders and cancers. This Review discusses the anorectum as a sexual organ, providing an overview of pleasurable and problematic RAI and how gastrointestinal disease itself and associated treatments (such as surgery) can affect RAI. Strategies to manage problematic RAI to improve sexual health are also described. Receptive anal intercourse (RAI) is common worldwide.Pleasurable RAI occurs through stimulation of the perianal or anal nerves and prostate or paraurethral glands, inducing vasodilation, erectile tissue engorgement, anopelvic tissue sensitization, and anal sphincter and pelvic muscular contractions.Patients with a stoma and anorectal stump should be counselled on hygiene and dilator use to minimize infections, maintain anorectal patency, and prevent a permanent stoma, promoting RAI restoration.Antidiarrhoeals, anti-flatulence medications, fibre supplements, lower residue diet to control regularity, avoiding spicy foods, timing meals, and defecation prior to RAI can help control symptoms and relieve distress.Survivors of anal, rectal, and colon cancer and patients with gastrointestinal disease should be counselled on problematic RAI due to anal sphincter, neurovasculature, and prostate or paraurethral gland damage resulting in arousal dysfunction, anodyspareunia or orgasm dysfunctions.Management strategies, including anal dilators for anodyspareunia, anal vibrators for arousal disorders, pelvic floor strengthening for anorgasmia and psychological interventions for decreased desire, should be discussed with patients.
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页码:377 / 405
页数:29