Our latest interviewee in the Pieces of the Continent series is with Cobi Reisman, Medical Director of Flare-Health in the Netherlands.
Please introduce yourself and tell us a bit about your work
I’m Yacov Reisman, but everyone calls me Cobi. I’m the medical director of Flare-Health in the Netherlands. For years I worked as a urologist and sexologist treating patients with urological cancers and patients suffering from the sexual consequences of cancer and its treatments. Among my other activities, I developed the European educational and certification program of sexual medicine recognized by the European Union of Medical Specialists. I’m senior lecturer of Sexology in Amsterdam and honorary and visiting Professor of urology of the Russian Federal Institute of Urology, Moscow, and of the Shanghai Institute of Andrology of the Medical School of Shanghai Jiao Tong University in China. I’m co-editor of the ESSM Manual of sexual medicine, the ESSM-EFS syllabus of clinical sexology and Cancer, Intimacy, and Sexuality.
What led you to specialise in urology and sexology?
I started my training in general surgery but after a few years I missed long-term contact with the patients, making my diagnostic puzzle, and a long follow-up and therefore I switched to urology. In urology, I could combine medical, surgical, and endoscopic treatments and also have contact with other disciplines like endocrinology, nephrology, physical therapy, oncology and radiotherapy.
As a urologist, I realized that medical treatment of sexual dysfunction was not always sufficient for satisfactory sexuality. Many of my patients, mainly after oncological surgery of the pelvic organs, suffer from the sexual consequences of oncological treatments. I decided to gain more skills in this subject and followed educational programs in sexology as well. In this way, I become more competent in treating my patients with a more holistic approach.
What impact have you had as president of the ESSM?
My major aim was to increase the multidisciplinary character of the society. I believe that diseases and certainly sexual dysfunctions should be approached with a biological-psychological and a social approach. Patients bring to the physician’s office not only their body but also their past, feelings, relationships, fears, and beliefs.
Another important aspect was education. Knowledge, skills, and attitude are the fundamentals of high quality healthcare. From 2011 I was active in the building of a multidisciplinary educational program in sexual medicine. In the last 9 years, we published textbooks, built the ESSM School of Sexual Medicine, and gained European-recognized certification as fellows of the European Committee of Sexual Medicine (FECSM) and European Committee of Clinical Sexologists (ECPS).
What are the main responses you have seen to the HPV vaccine?
In the Netherlands and many other European countries, the HPV vaccine was relatively highly accepted as a vaccine for girls, associated with cervical cancer. However, the majority of the population is not aware of the need to vaccinate boys, too or about the relationship between HPV and other cancers such as anal, penile and oropharyngeal. So, some awareness is there but there is a large shortage of knowledge among both the general population and healthcare professionals. The HPV vaccine may be available, but if the population does not understand what it is and why it benefits them, they will not automatically demand it. Worse, they may begin believing misinformation about it.
What are the obstacles faced by the HPV vaccine and how can we overcome them?
There is a tremendous shortage of knowledge about HPV. HPV is a sexually transmitted infection (STI) but it can also be transmitted by close skin contact. STIs are not a comfortable subject to discuss, as there is a large taboo about the subject. There is a general social embarrassment that adults feel when talking about sex with adolescents and children. Some people believe that “sex education” is wrong and may lead to more sex, which has been scientifically proven to be not the case. Last but not least, there has been a feminization of HPV vaccine because of the identification with cervical cancer. HPV is seen as female-specific disease with women bearing the burden of infection and responsibility for prevention.
How can we better educate people on cancers caused by HPV, especially the lesser known ones like penile and anal cancers?
The success of the prevention strategies also requires adequate information and acceptance by the population, therefore intensive and positively approached public awareness programs and widespread knowledge of HPV are crucial. Health care professionals (HCPs) are among the most trusted sources of immunization information. They are a core tool to address low or declining public confidence in vaccination. Patients trust HCPs, so HCPs should be knowledgeable and confident in their recommendations.
The HPV vaccine should be a long-term ongoing strategy to help prevent cancer and communities should demand it as a social norm. HPV vaccination is cancer prevention.
Health authorities should use advocacy, social mobilization including patients’ groups, and social and behavioral change activities to empower individuals and communities to take action and improve their lives. They should address boys and girls, parents and HCPs with the right information about the different cancers caused by HPV, vaccine safety, and the responsibility of all of us.
The information should be clear that HPV causes different cancers in men and women, HPV is very common, and HPV related cancers can develop decades after first contract an HPV infection - being infected does not mean that someone has been unfaithful to their partner.
Do you have any final comments or anything you would like to add?
We know that knowledge and education are the best ways to break through a taboo. In this way, we can reduce stigma, shame, and anxiety. The people who know the facts need to keep spreading the information and educate the population around them.
I’m a father of 3 children and I can reassure everyone that all three of them are vaccinated for HPV.
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