Psychological Adjustment Following Mastectomy Health And Social Care Essay

Psychological Adjustment Following Mastectomy Health And Social Care Essay Breast cancer is so common that 1 in 17 women develops breast cancer in her lifetime (Health Promotion Board, 2009). The American Cancer Society (2010) estimated 1.4 million new diagnoses of breast cancer worldwide. In Singapore, breast cancer is the leading cancer among women with an annual incidence rate of 1300 (Singapore Cancer Society, 2008). Data from the National Registry of Diseases Office (2010) shows that breast cancer contributed to a significant 29.2% of cancer in Singapore women, most prevalent at the age group 55-59. The ethnic distribution of the disease is equal and the estimated lifetime risk of breast cancer is 5% which is much lower than that of the American and European women (Singapore Cancer Society, 2010). However, the incidence rate has been rising rapidly exceeding the rate in United States (Jara-Lazaro, Thilagaratnam, Tan, 2010). Mastectomy is inevitable in patients with large breast tumors (Singapore Cancer Society, 2010). It has unique consequences because of the mutilation of an organ that represents a womans femininity and sexuality and plays an important role in sexual pleasure and stimulation. The paper reviews the literature relating to the psychosocial impact of mastectomy on a womans body image and sexuality which can affect her mental health. As survivorship of breast cancer following mastectomy becomes more common, the findings in this review are of significance to nurses caring for these women in providing interventions to address their psychological wellbeing. 2. Literature Review The review has been divided into 3 stressors for post-mastectomy women: body image, sexual functioning and marital adjustment. 2.1 Body image Ample studies had demonstrated mastectomy was associated with altered body image (Morris, 1979; Gottschalk, Hoigaard-Martin, 1984; Lasry et al., 1987). A recent study conducted by Bakhta and Najafib (2010) also found that women who had undergone mastectomy had lower body image than healthy women. However, many other recent studies proved otherwise. Moreira and Canavarro (2010) conducted a longitudinal study on breast cancer patients and found only a slight increased in body shame during the period of surgery to 6-months after the treatments ending. Esmaili, Saiidi, Majd and Esmaieli (2010) conducted a survey on 90 women during the period of 1-3 months following mastectomy and found insignificant change in body image. Hopwood et al. (2000) found that 21% of the women reported no change in body image in the first 3 years following prophylactic mastectomy as they viewed the surgery as a good trade-off for better health. The type of surgery has a predictive role on body image and various researchers have explored its impact on womens adjustment. A quantitative research showed larger proportion of those who had mastectomy without immediate breast reconstruction reported problems with body image (Sackey, Sandelin, Frisell, Wickman, Brandberg, 2010). Studies on the impact of type of surgery have revealed contradictory results with Hopwood et al. (2000) demonstrating that some women disliking the look or feel of the reconstructed breast. Young women reported more body image problems (Bakhta, Najafib, 2010) while older breast cancer patients showed greater acceptance of the mastectomy consequences (Ganz et al., 2002). Salter (1997) states that patients acceptance of body changes is largely influenced by peoples reactions around her, implying that behaviour of the partners and nurses play the most important role in determining patients acceptance of their body regardless of the type of the surgery and the age of the patient. 2.2 Sexual functioning Many researchers have demonstrated the strong impact of breast cancer and mastectomy on sexual function. Reported rates for post-mastectomy sexual problems range from a low 18.6% in those with mastectomy and reconstruction to a high 30.2% in those without reconstruction (Rubino, Figus, Lorettu, Sechi, 2006). The main causes of post-mastectomy sexual problems were altered self-perceived sexual image (Yeo et al., 2004), loss of pleasurable sensation in the breasts and consequent decreased of sexual desire (Graziottin, 2007; Burwell, Case, Kaelin, Avis, 2006). This shows that sexual difficulties can be attributed to physical problems. 2.3 Marital Adjustment Mastectomy affects not only the patient but also her relationship with her partner. In the study of Avci, Okanli, Karabulutlu and Bilgili (2009), it was found that the patients had a moderate level of marital adjustment. Research has shown that quality of a womans relationship is a stronger predictor of sexual functioning than the alteration of the body after mastectomy (Alder et al., 2008; Zee et al., 2008). Whilst each of these factors has been considered separately, it is important to acknowledge that they are interconnected. Women who have a poor body image following mastectomy have lower sexual satisfaction and are more dissatisfied with their relationship with their partners. Future research is needed to acknowledge this inter-relationship, in order to manage the multi-faceted consequences of mastectomy. 3. Discussion 3.1 Relevance to nursing practice This review has demonstrated that there is a compelling evidence that mastectomy can have a significant impact on a womans psychological adjustment in terms of body image, sexual functioning and relationship with their partners, especially in young women. Schultz and Van de Wiel (2003) found that psychological well-being and sexual intimacy help in the recovery process. This suggests that nurses should be particularly sensitive to the consequences of mastectomy for womens sexuality and body image, as well as the consequences for their partners. In view of Salters study in 1997, it is suggested that nurses consider educating the patients husbands about the facial expressions, tone, touch, and behaviour that can enhance their wives body image. The nurses should also understand that their own body language can affect their patients acceptance of the changes in their body. The findings of this review regarding marital adjustment confirmed the need for a comprehensive counseling and education serving the purpose of mental health management for women and partners following mastectomy to facilitate marital adjustment. Patients who reported greater perceived support in a study reported fewer adjustment problems and lower psychological distress (Baidera, Ever-Hadanib, Goldzweigc, Wygodaa, Peretz, 2003). As such, a good relationship with the husband is important, especially as post-mastectomy outpatient care becomes more common, more men will be involved in providing care and emotional support for their wives at home. 3.2 Recommendations for future research On the basis of gaps in the current literature, further research is required to find out about the impact of mastectomy on Singaporean womens body image and sexual functioning. In the local study, it is found that body image and sexuality is often not discussed with patients following mastectomy as most breast cancer patients felt uneasy talking about their concerns, especially among the Indians, Malays and the elderly Chinese (Saraswathi, Suzanna, Ho, 2005). One notable gap in the current literature is an understanding of cultural differences in psychological adjustment which is important to Singapores multicultural society. In exploring post-mastectomy body image and sexuality, a nurse should know about customs of different religious groups so she can be culturally sensitive to the women under their care. However, this important area has received limited attention in the published literature. In the recent years, increasing focus has been given to study the body image among patients following mastectomy (Bakhta, Najafib, 2010; Moreira, Canavarro, 2010; Esmaili, Saiidi, Majd, Esmaieli, 2010). The findings of insignificant changes in body image could be attributed to patients more preoccupied with their survival rather than the physical changes due to loss of the breast in the earlier stages following mastectomy. As such, further study is required to find out the impact on body image after a long period of time when survival is obtained. Similarly, identification of interventions to respond to women with psychological concerns following mastectomy is yet to be explored. As such, further research is needed to ensure the psychological needs of women are met during treatment. 4. CONCLUSION This literature review details the likelihood of altered body image, the nature of sexual difficulties and the implications of marital adjustment associated with mastectomy. Based on the findings of the review, it is suggested that nurses caring for women who had undergone mastectomy to be particularly sensitive to their sexuality, body image and relationship with their partners to promote better recovery. She may consider teaching the husbands of the women how to help their wives accept their body image changes. In view of the importance of family support, a nurse may want to offer counseling to both the patient and the husband so as to facilitate in the marital adjustment following mastectomy. Several literature gaps are identified, including limited attention to local womens psychological concerns following mastectomy, customs of different religious groups that may affect the psychological adjustment and effective nursing intervention for women with concerns regarding body image, sexual functioning and marital adjustment following mastectomy.

The Importance of Sex Education Essays -- Children Sex Ed Youth Educ

Children and young adults today distinguish right from wrong based on their previous knowledge. The education they receive plays a major role in the way they make decisions. Sex is a controversial topic brought up frequently throughout a child's life. Based on the way it is taught, the child makes decisions that may forever change his or her life. (Sex Education That 3) Although it is often opposed, the two most essential ways children learn about sex today is the education they receive at home and at school. The relationship and behavior between children and their parents is crucial to the ways these children shape their own sexual ideas and values A child who perceives his relationship to his parents as supportive and close, is more likely to sexually behave in a way approved by his or her parents than a child brought up in an unhealthy environment. (Single-Sex Education 1) Furthermore, communication is more effective in a loving family relationship, and a child who feels loved generally feels good about his or her general outlook on sex. (Straight Talk About 56) Along with normal education, sex education must progress and grow with the individual child. Often, there is a real communication barrier between parents and children when it comes to talking about sex. (Sex Education That 2 ) The children sometimes feel awkward asking parents personal questions. In numerous situations, kids are left with many unanswered questions. A small number of adults know for sure what their kids think about sex, or do not know their son's or daughter's sexual experiences. (Choosing Virginity 68 )Parents frequently wish to talk to their children but are sometimes too ashamed or just too ignorant. Yet, adults still do not seek wa... ...fected. (Single Sex Education 5)They also argue that a million teenage girls get pregnant each year and at least half of these girls have an abortion. (Virgin Cool 71) The government hasn't yet taken its case anywhere, but will most likely in the years to come. Ultimately, it is up to the children to decide how he or she interprets the sex education of which they receive. (Straight Talk About 45) The most effective deterrents include a strong self-esteem, the ability to make informed choices, and meaningful options that give young people futures worth protecting and healthy ways to protect their identity. (Sexual Values 29) The choices they make will forever impact their lives. The controversy of sex education will, as well, forever stay the same. Whether at home or at school, children will always be faced with many tough decisions to make. (Sex Education That 45)

How is Gender Viewed in Society? Essay

Gender is still an issue in society. Though, many parts of the world made great strides in reducing gender discrimination, a casual glance across the globe quickly reveals that the scourges of gender intolerance are far from having been eliminated. Despite intense and almost desperate efforts to eliminate ethnic intolerance and discrimination, they appear to be every bit as bad at the close of the 20th century as at the beginning of the century.   Ã¢â‚¬Å"We do not cut our own deal by ourselves, in gender–neutral institutions and arenas. The social institutions of our world–workplace, family, school, and politics–are also gendered institutions, sites where the dominant definitions are reinforced and reproduced, and where â€Å"deviants† are disciplined. We become gendered selves in a gendered society† (Kimmel, 2004, p16). We live in a society where as ‘gender’ we entail that the organizations of our society have developed in ways that reproduce both the differences between women and men and the control of men over women. Institutionally, we can see how the constitution of the workplace is organized around representing and reproducing masculinity: The temporal and spatial organization of work both depend upon the severance of spheres. However, a primary reason for our seeming incapability to eliminate the plagues of gender, ethnic, and class discrimination is the fact that we have not appropriately understood the etiology and functions of this phenomenon. Social dominance theorists suggest that these forms of social oppression, somewhat than being just products of â€Å"improper socialization,† simple ignorance, or the exigencies of capitalism, are mainly the result of inherent features of human and primate social organization. â€Å"Yet to the point to which they refuse to give up their femininity, they are seen as different, and thus gender discrimination is justifiable as the sorting of different people into different Slots† (Catharine MacKinnon, 1989, pp. 218-19). Women who succeed are punished for throwing out their femininity–rejected as potential partners, labeled as â€Å"dykes,† left off the enticement lists. The first women who entered the military, or military colleges, or even Princeton and Yale when they became coeducational in the late 1960s, were seen as being â€Å"less† feminine, as being abortive as women. Yet had they been more â€Å"successful† as women, they would have been seen as less capable soldiers or students (Michael Kimmel, Diane Diamond, and Kirby Schroeder, 1999).   . I believe that one of the major reasons why humans have made so little advancement in eliminating gender discrimination is that we do not yet adequately understand the dynamics of these phenomena. One instance of this lack of under- standing is the popularity of the double danger hypothesis, which holds that Black women, for instance, will be more discriminated against than Black males. Thus gender inequality creates a double bind for women–a double bind that is based on the postulation of gender difference and the assumption of institutional gender neutrality. Work cited Catharine MacKinnon, Towards a Feminist Theory of the State (Cambridge: Harvard University Press, 1989), pp. 218-19. Michael Kimmel, Diane Diamond, and Kirby Schroeder, â€Å"‘What’s This about a Few Good Men?’ Negotiating Sameness and Difference in Military Education from the 1970s to the Present,† in Masculinities and Education, N. Lesko, ed. (Thousand Oaks, Calif: Sage Publications, 1999). Michael S. Kimmel, The Gendered Society, Oxford University Press, 2000

Infectious Disease Essay - 2531 Words

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