Controlled prospective longitudinal study of women with cancer: I. Sexual functioning outcomes.

Abstract

The incidence and etiology of sexual difficulties for women with survivable cancer were studied. Women with early stage gynecologic cancer (n = 47) were assessed after their diagnosis but prior to treatment and then reassessed at 4, 8, and 12 months posttreatment. Sexual and medical outcomes were compared with data from members of two matched comparison groups who were also assessed longitudinally: women diagnosed and treated for benign gynecologic disease (n = 18) and gynecologically healthy women (n = 57). Global sexual behavior disruption did not occur, but the frequency of intercourse declined for women treated for disease, whether malignant or benign. In relation to the sexual response cycle, diminution of sexual excitement is pronounced for women with disease; however, this difficulty is more severe and distressing for women with cancer, possibly due to significant coital and postcoital pain, premature menopause, treatment side effects, or a combination. Changes in desire, orgasm, and resolution phases of the sexual response cycle may also occur, but they are of lesser magnitude or duration or both. Approximately 30% of the women treated for cancer were diagnosed with a sexual dysfunction. The nature, early timing, and maintenance of sexual functioning morbidity suggest the instrumental role that cancer and cancer treatments play in these deficits (particularly arousal problems) and suggest that preventive therapies are necessary.

Sexual morbidity in very long term survivors of vaginal and cervical cancer: A comparison to national norms

“…Strong evidence for the negative impact of medical illness and treatments on sexual functioning exists [7,20,[29][30][31], but concern for sexual matters remains largely on the margin of medical care, particularly for older women. This study presents an extreme case: women who have undergone extirpation, destruction, or severe compromise to their reproductive and sexual organs, many prior to coitarche and reproduction, report that physicians infrequently discussed the impact of their cancer treatment on sexual functioning.…”

“…Aging may exacerbate or ameliorate these problems; cancer survivors can feel uncertain about whether sexual problems are a consequence of cancer or aging [6]. Gynecologic and breast cancers and their treatments directly affect the sexual organs and may disrupt the physical and psychological phases of the female sexual response cycle [7,8]. Several studies of shorter-term survivors describe health [9][10][11][12], quality of life [10][11][12] and sexuality [9,10,12] after diagnosis of gynecological cancer.…”

Sexual Self Schema as a Moderator of Sexual and Psychological Outcomes for Gynecologic Cancer Survivors

“…Here, "survivor" was operationalized as a patient who was at least 6 months post any cancer therapy and diagnosed 2−10 years previously as the clinically relevant interval for the study aims. By at least 2 years, the acute stress of diagnosis has ended (Andersen, Anderson, & deProsse, 1989b), patients have returned to their pre-cancer routines (Guidozzi, 1993;Klee, Thranov, & Machin, 2000a, b), and sexual changes have stabilized (Andersen et al, 1989a). By excluding patients treated longer than 10 years previously, we hoped to decrease the likelihood of added, comorbid conditions common in older adulthood that also disrupt sexuality (Lethbridge-Cejku, Schiller, & Bernadel, 2004).…”

“…Previous research has demonstrated that this global evaluation is sensitive to pre-to post-cancer treatment effects (Andersen et al, 1989a;Andersen, Woods, & Copeland, 1997).…”

“…While many cancer patients experience some degree of sexual difficulty (Andersen, 1985), prevalence studies have demonstrated that gynecologic cancer patients, much like men treated for prostate cancer (Bertero, 2001;Jenkins et al, 2004;Schover et al, 2002a, b), undergo early reductions in sexual activity and disrupted responsiveness that can be permanent (Gershenson et al, 2007;Hawighorst-Knapstein et al, 2004;Lindau, Gavrilova, & Anderson, 2007). Studies comparing gynecologic cancer patients to healthy controls/norms have shown that women with gynecologic cancer may resume intercourse, but report diminished sexual responsiveness (Weijmar Schultz, van De Wiel, & Bouma, 1991) and lower sexual satisfaction (Gershenson et al, 2007;Lindau et al, 2007), and are found to have higher rates of sexual dysfunction than healthy women or women with benign gynecologic disease (Andersen, Anderson, & deProsse, 1989a). In sum, the prevalence of sexual difficulties among these patients is well known (Andersen, 1994b); these studies provide an estimate of the magnitude of need for support services in this population, but offer little insight into treatment or prevention of sexual problems or emotional distress.…”