***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose . To compare erectile function ( EF ) recovery of patients treated by early penile rehabilitation therapy ( PRT ) with sildenafil and with control group . Method . Forty men treated by bilateral nerve sparing radical prostatectomy ( NSRP ) and with a normal pre-operative EF were enrolled . Fourteen days after surgery , they were r and omised to a flexible-dose sildenafil group and to a control group . The International Index of Erectile Function ( IIEF ) question naire was completed before surgery and at 3 , 6 , 12 and 24 weeks after NSRP . Results . In the group treated , the mean IIEF score before surgery was 26.2 and 14.1 , 16.2 , 22.5 and 25.2 at 3 , 6 , 12 and 24 weeks after NSRP , respectively . In the control group , the respective scores were 26.5 and 12.4 , 15.8 , 15.3 and 17.4 . There was a significant difference in IIEF mean score ( 25 ± 6 vs. 17 ± 9 , p < 0.05 ) and in the potency rate ( 87 % vs. 56 % ) between the groups at 24 weeks after NSRP . The percentage of patients who were capable of having medication-unassisted intercourse was 54 % vs. 21 % ; 34 % vs. 18 % of patients had a normal EF with 72 % vs. 32 % of responders to sildenafil . Conclusions . PRT with PDE-5 inhibitors should be offered early after RP to allow the recovery of EF Background Breast cancer among women is a relatively common with a more favorable expected survival rates than other forms of cancers . This study aim ed to determine the improved quality of life for post-mastectomy women through peer education . Methods Using pre and post test follow up and control design approach , 99 women with stage I and II of breast cancer diagnosis were followed one year after modified radical mastectomy .  To measure the quality of life an instrument design ed by the European organization for research and treatment of cancer , known as the Quality of Life Question ( QLQ-30 ) and it 's breast cancer supplementary measure ( QLQ-BR23 ) at three points in time ( before , immediately and two months after intervention ) for both groups were used . The participant selection was a convenient sampling method and women were r and omly assigned into two experimental and control groups . The experimental group was r and omly assigned to five groups and peer educators conducted weekly educational programs for one month . Tabulated data were analyzed using chi square , t test , and repeated measurement multivariate to compare the quality of life differences over time . Results For the experimental group , the results showed statistically significant improvement in all performance aspects of life quality and symptom reduction ( P < 0.001 ) , while the control group had no significant differences in all aspects of life quality . Conclusion The findings of this study suggest that peer led education is a useful intervention for post-mastectomy women to improves their quality of life OBJECTIVES To determine the effect of acupuncture on hot flash frequency and intensity , quality of life , and sleep quality in patients undergoing hormonal therapy for prostate cancer . Hot flashes are a common adverse effect of hormonal therapy for prostate cancer . METHODS Men who had a hot flash score > 4 who were receiving and rogen deprivation therapy for prostate cancer underwent acupuncture with electrostimulation biweekly for 4 weeks , then weekly for 6 weeks , using a predefined treatment plan . The primary endpoint was a 50 % reduction in the hot flash score after 4 weeks of therapy , calculated from the patients ' daily hot flash diaries . The hot flash-related quality of life and sleep quality and biomarkers potentially related to hot flashes , including serotonin , calcitonin gene-related peptide , and urinary 5-hydroxyindoleacetic acid , were examined . RESULTS A total of 25 men were enrolled from September 2003 to April 2007 . Of these , 22 were eligible and evaluable . After 4 weeks , 9 ( 41 % , 95 % confidence interval 21%-64 % ) of 22 patients had had a > 50 % reduction in the hot flash score . Of the 22 patients , 12 ( 55 % , 95 % confidence interval 32%-76 % ) met this response definition at any point during the therapy course . No patient had a significant increase in hot flash score during therapy . A reduced hot flash score was associated with improvement in the hot flash-related quality of life and sleep quality . CONCLUSIONS Multiple placebo-controlled trials have demonstrated a 25 % response rate to placebo treatment for hot flashes . Of the 22 patients , 41 % had responded by week 4 and 55 % overall in the present pilot study , providing evidence of a potentially meaningful benefit . Additional studies of acupuncture for hot flashes in this population are warranted PURPOSE The purpose of our study was to evaluate the effect of cognitive behavioral therapy ( CBT ) , physical exercise ( PE ) , and of these two interventions combined ( CBT/PE ) on menopausal symptoms ( primary outcome ) , body image , sexual functioning , psychological well-being , and health-related quality of life ( secondary outcomes ) in patients with breast cancer experiencing treatment-induced menopause . PATIENTS AND METHODS Patients with breast cancer reporting treatment-induced menopausal symptoms ( N=422 ) were r and omly assigned to CBT ( n=109 ) , PE ( n=104 ) , CBT/PE ( n=106 ) , or to a waiting list control group ( n=103 ) . Self-report question naires were completed at baseline , 12 weeks , and 6 months . Multilevel procedures were used to compare the intervention groups with the control group over time . RESULTS Compared with the control group , the intervention groups had a significant decrease in levels of endocrine symptoms ( Functional Assessment of Cancer Therapy-Endocrine Symptoms ; P<.001 ; effect size , 0.31 - 0.52 ) and urinary symptoms ( Bristol Female Lower Urinary Tract Symptoms Question naire ; P=.002 ; effect size , 0.29 - 0.33 ) , and they showed an improvement in physical functioning ( 36-Item Short Form Health Survey physical functioning subscale ; P=.002 ; effect size , 0.37 - 0.46 ) . The groups that included CBT also showed a significant decrease in the perceived burden of hot flashes and night sweats ( problem rating scale of the Hot Flush Rating Scale ; P<.001 ; effect size , 0.39 - 0.56 ) and an increase in sexual activity ( Sexual Activity Question naire habit subscale ; P=.027 ; effect size , 0.65 ) . Most of these effects were observed at both the 12-week and 6-month follow-ups . CONCLUSION CBT and PE can have salutary effects on endocrine symptoms and , to a lesser degree , on sexuality and physical functioning of patients with breast cancer experiencing treatment-induced menopause . Future work is needed to improve the design and the planning of these interventions to improve program adherence Purpose We recently reported that a partner-assisted emotional disclosure intervention for gastrointestinal cancer led to improvements in relationship quality and intimacy for couples in which the patient initially reported higher levels of holding back from discussing cancer-related concerns . The purpose s of the present study were to examine outcomes at 8-week follow-up and process variables that may influence treatment effects . Methods One hundred thirty couples were r and omly assigned to either partner-assisted emotional disclosure or an education/support control condition .  Participants completed measures of relationship quality , intimacy , and psychological distress before r and omization , post-treatment , and 8 weeks later . Patients in the disclosure intervention completed measures of negative affect immediately following each treatment session , and their level of expressiveness during the sessions was rated by trained observers . Data were analyzed using multilevel modeling . Results Among couples in which the patient initially reported higher levels of holding back , the disclosure intervention led to improvements in relationship quality and intimacy that were maintained at 8-weeks follow-up . High levels of patient expressiveness during the disclosure sessions were associated with improvements in relationship quality and intimacy , and high levels of patient negative affect immediately following the sessions were associated with reductions in psychological distress at the post-test assessment . Conclusions For couples in which the patient tends to hold back from discussing concerns , partner-assisted emotional disclosure is a beneficial intervention leading to improvements in relationship functioning that maintain over time . Future research is needed to examine methods of enhancing intervention effects , including encouraging patient expressiveness and negative affect during the sessions BACKGROUND AND PURPOSE Vaginal stenosis ( VS ) after pelvic radiotherapy ( RT ) can impair long-term quality of life . We prospect ively assessed adherence and efficacy of vaginal dilator ( VD ) use in women after pelvic RT . MATERIAL AND METHODS Women with gastrointestinal ( n=63 ) and gynecologic ( n=46 ) cancers self-reported use and VD size in monthly diaries for 12months after radiotherapy .  Adherence was measured as actual VD use out of recommended times over 12months ( 3 × /week × 52weeks=156 ) . RESULTS Among 109 participants , aged 28 - 81years ( median , 58years ) , mean percent adherence over 12months was 42 % ( 95 % confidence interval [ CI ] , 36 - 48 % ) . Adherence was highest in the first quarter ( 56 % ) , but fell to 25 % by the fourth . Disease type , treatment sequence , and chemotherapy were predictors of adherence ( all P<.05 ) . Eighty-two percent maintained pre-RT VD size at 12months ; of 49 % with a decrease in VD size at 1month post-RT , 71 % returned to pre-RT VD size at 12months . Disease type , younger age , and increased adherence at 6months were associated with maintaining or returning to pre-RT size at 12months ( all P⩽.05 ) . CONCLUSION VD use is effective in minimizing VS , but adherence at 12months was poor . Studies evaluating methods of improving adherence and determining the optimal frequency and duration of use are needed PURPOSE Controversy exists about whether vaginal estrogens interfere with the efficacy of aromatase inhibitors ( AIs ) in breast cancer patients . With the greater incidence of vaginal atrophy in patients on AIs , a safe and effective nonestrogen therapy is necessary . We hypothesized that vaginal testosterone cream could safely treat vaginal atrophy in women on AIs . METHODS Twenty-one postmenopausal breast cancer patients on AIs with symptoms of vaginal atrophy were treated with testosterone cream applied to the vaginal epithelium daily for 28 days . Ten women received a dose of 300 μg , 10 received 150 μg , and one was not evaluable . Estradiol levels , testosterone levels , symptoms of vaginal atrophy , and gynecologic examinations with pH and vaginal cytology were compared before and after therapy . RESULTS Estradiol levels remained suppressed after treatment to < 8 pg/mL. Mean total symptom scores improved from 2.0 to 0.7 after treatment ( p < .001 ) and remained improved 1 month thereafter ( p = .003 ) . Dyspareunia ( p = .0014 ) and vaginal dryness ( p < .001 ) improved . The median vaginal pH decreased from 5.5 to 5.0 ( p = .028 ) . The median maturation index rose from 20 % to 40 % ( p < .001 ) . Although improvement in total symptom score was similar for both doses ( -1.3 for 300 μg , -0.8 for 150 μg ; p = .37 ) , only the 300-μg dose was associated with improved pH and maturation values . CONCLUSIONS A 4-week course of vaginal testosterone was associated with improved signs and symptoms of vaginal atrophy related to AI therapy without increasing estradiol or testosterone levels . Longer-term trials are warranted OBJECTIVES To assess the effectiveness of combining sildenafil citrate with a vacuum constriction device ( VCD ) in men ( after radical prostatectomy ) unsatisfied with the results of the VCD alone . METHODS A total of 31 patients unsatisfied with the early use of VCD alone after radical prostatectomy ( mean follow-up of 4.5 months ) were instructed to take 100 mg of sildenafil 1 to 2 hours before VCD use for sexual intercourse . Patients used combination therapy for a minimum of five attempts before assessment with the abridged International Index of Erectile Function ( IIEF ) question naire and a visual analogue scale to gauge rigidity . The effect of combination therapy on the total IIEF-5 score and penile rigidity score were assessed . RESULTS Of the 31 patients , 7 ( 22 % ) had no improvement with the addition of sildenafil with VCD and discontinued the drug , and 24 ( 77 % ) reported improved penile rigidity and sexual satisfaction . The IIEF-5 score revealed statistically significant improvement in each domain , and patients reported that sildenafil enhanced their erections 100 % of the time . The penile rigidity scores on a scale of 0 to 100 with the VCD alone averaged 55 % ( range 23 % to 85 % ) for the men and 59 % ( range 26 % to 90 % ) for their partners . With the addition of sildenafil , 
    Output:
    
The present guideline provides one overarching recommendation concerning the discussion of sexual health and dysfunction , which is aim ed at all people with cancer .
Eleven additional recommendations made separately for men and women deal with issues such as sexual response , body image , intimacy and relationships , overall sexual functioning and satisfaction , and vasomotor and genital symptoms .
CONCLUSIONS To our knowledge this clinical practice guideline is the first to comprehensively evaluate interventions for the improvement of sexual problems in people with cancer .