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Arab M, Poorzad N, Noghabaei G, Ghavami B, Nouri B, Jahed Bozorgan T. A survey of female sexual dysfunction in gynaecological cancer survivors: A case–control study. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2023. [DOI: 10.1016/j.gine.2022.100826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Tammary E, Manasi K. Mental and sexual health outcomes associated with FGM/C in Africa: a systematic narrative synthesis. EClinicalMedicine 2023; 56:101813. [PMID: 36880050 PMCID: PMC9985012 DOI: 10.1016/j.eclinm.2022.101813] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
UNLABELLED There are gaps in evidence regarding mental and sexual outcomes and associated interventions for women with Female Genital Mutilation/Cutting (FGM/C) living in Africa. This study employed a narrative synthesis to collate evidence on mental and sexual health outcomes. A systematic search of bibliographic databases and websites was performed using appropriate keywords and studies published in English from January 1, 2010 to March 25, 2022. 25 studies were retrieved and reported mental and sexual health complications associated with FGM/C. Most studies, n = 13 studies reported on sexual health outcomes including sexual pain, orgasm and sexual desire problems at sexual arousal and difficulties in lubrication. Mental health outcomes were reported in four studies including depression which was most prominent followed by somatisation and anxiety, Post Traumatic Stress Disorder (PTSD) and sleep disorder. Studies did not highlight combined mental and sexual health interventions. The findings of this narrative synthesis reveal the need to prioritise provision of mental and sexual health care services for women with FGM/C. The study recommends strengthening of health systems in Africa through awareness building, training and capacity building of primary health and specialist health workers in offering mental and sexual health care to women with FGM/C. FUNDING This work was self-funded.
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Affiliation(s)
- Esho Tammary
- Deputy Vice Chancellor, Academic and Student Affairs, AMREF International University, Lang'ata Road. P.O. Box 27691-00506, Nairobi, Kenya
| | - Kumar Manasi
- Senior Implementation Scientist and Mental Health Consultant, Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
- Corresponding author. Brain and Mind Institute, Aga Khan University, Nairobi, Kenya.
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Åkeflo L, Elmerstig E, Bergmark K, Dunberger G. Barriers to and strategies for dealing with vaginal dilator therapy - Female pelvic cancer survivors' experiences: A qualitative study. Eur J Oncol Nurs 2023; 62:102252. [PMID: 36603495 DOI: 10.1016/j.ejon.2022.102252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/11/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Vaginal changes, a frequently reported late effect among women treated with pelvic radiotherapy, can result in sexual dysfunction and distress. Women are recommended vaginal dilator therapy after completed radiotherapy; however, low adoption has been recognized. This study aims to provide insight into women's difficulties with carrying out vaginal dilator therapy and their experiences of information. METHODS Face-to-face, semi-structured interviews were undertaken with 12 pelvic cancer survivors in a selected sample of women with difficulties adopting the therapy. Interviews were audio-recorded, transcribed and analyzed using qualitative content analysis. RESULTS One overarching theme, Being unprepared, emerged from three identified categories relating to Experience of received information, Experience of performing the therapy, and Motivation to perform the therapy. The women experienced the information as unrealistic and insufficient, and requested clearer and earlier information. Bleeding, pain, fear of cancer recurrence, and recalling memories from treatments were experienced. Women described intestinal symptoms, fatigue, and feeling that the therapy was self-harm as barriers to performing the therapy. They described creating routines, breathing exercises, relaxation, pre-warming the dilator and performing therapy together with their partner as helpful strategies. CONCLUSIONS Careful discussion, early and clear communication, psychoeducation and supportive follow-up of vaginal changes should be integrated into cancer treatment and follow up. Healthcare professionals should be aware of potential difficulties with vaginal dilator therapy and identify women in need of extended support. Research is required to investigate interventions that suit the needs of female pelvic cancer survivors.
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Affiliation(s)
- Linda Åkeflo
- Department of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Science, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Eva Elmerstig
- Centre for Sexology and Sexuality Studies, Department of Social Work, Malmö University, Malmö, Sweden
| | - Karin Bergmark
- Department of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Science, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Sánchez S, Baquedano L, Cancelo MJ, Jurado AR, Molero F, Nohales F, Mendoza N, Palacios S. Managing vulvar and vestibular pain in postmenopausal women: recommendations from the Spanish Menopause Society, Sociedad Española de Ginecología y Obstetricia, Sociedad Española de Medicos de Atención Primaria y Federación Española de Sociedades de Sexología. Gynecol Endocrinol 2022; 38:263-266. [PMID: 34519600 DOI: 10.1080/09513590.2021.1963954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Background: Relieving vulvar pain caused by atrophy in postmenopausal women is a challenge in our clinical practice. We know more and more about the vulva, its anatomy and physiology and we are realizing that it is different from the vagina. The importance of the vulvar approach in the management of vulvar or vestibular pain (VP) due to atrophy in postmenopausal women is becoming increasingly important. A panel of experts from several Spanish scientific societies (Spanish Menopause Society, AEEM; Spanish Federation of Sexology Societies, FESS; Spanish Society of Primary Care Physicians, SEMERGEN; and the Spanish Society of Gynecology and Obstetrics) held a meeting to discuss treatment recommendations for women with vulvar and VP based on the best available evidence, creating a report to describe grades of recommendations.
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Affiliation(s)
- Sonia Sánchez
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia -AEEM), Barcelona, Spain
- Sociedad Española de Ginecología y Obstetricia (SEGO), Zaragoza, Spain
| | - Laura Baquedano
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia -AEEM), Barcelona, Spain
- Sociedad Española de Ginecología y Obstetricia (SEGO), Zaragoza, Spain
| | - Ma Jesús Cancelo
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia -AEEM), Barcelona, Spain
- Sociedad Española de Ginecología y Obstetricia (SEGO), Zaragoza, Spain
| | - Ana Rosa Jurado
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia -AEEM), Barcelona, Spain
- Sociedad Española de Ginecología y Obstetricia (SEGO), Zaragoza, Spain
| | - Francisca Molero
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia -AEEM), Barcelona, Spain
- Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Madrid, Spain
- Federación Española de Sociedades de Sexología (FESS), Madrid, Spain
| | - Francisco Nohales
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia -AEEM), Barcelona, Spain
- Sociedad Española de Ginecología y Obstetricia (SEGO), Zaragoza, Spain
| | - Nicolás Mendoza
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia -AEEM), Barcelona, Spain
- Sociedad Española de Ginecología y Obstetricia (SEGO), Zaragoza, Spain
| | - Santiago Palacios
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia -AEEM), Barcelona, Spain
- Sociedad Española de Ginecología y Obstetricia (SEGO), Zaragoza, Spain
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5
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Sexual health and wellbeing among female pelvic cancer survivors following individualized interventions in a nurse-led clinic. Support Care Cancer 2022; 30:8981-8996. [PMID: 35931832 PMCID: PMC9633476 DOI: 10.1007/s00520-022-07294-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/21/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Treatment-induced sexual and intestinal dysfunctions coexist among women after pelvic radiotherapy. We aimed to explore if sexual health and wellbeing may be improved after radiotherapy following nurse-led interventions and if an association exists between improved intestinal health and sexual health. METHODS A population-based cohort of women treated with pelvic radiotherapy underwent interventions at a nurse-led clinic at Sahlgrenska University Hospital, Sweden, from 2011 to 2017. Self-reported questionnaires were used, pre- and post-intervention, to compare self-reported changes in sexual health and wellbeing. A regression model was performed to explore the association between intestinal and wellbeing variables. RESULTS Among the 260 female pelvic cancer survivors included in the study, more women reported increased than decreased satisfaction with overall sexual health post-intervention (26.0% vs. 15.3%, p = 0.035). They also reported significantly reduced superficial genital pain (25.8% vs. 13.1%, p ≤ 0.025), reduced deep genital pain (23.1% vs. 8.0%, p ≤ 0.001), increased QoL (42.7% vs. 22.4%, p < 0.001), and reduced levels of depression (43.1% vs. 28.0%, p = 0.003) or anxiety (45.9% vs. 24.4%, p < 0.001) post-intervention. We found a significant association between reduced urgency to defecate and improved satisfaction with overall sexual health (RR 3.12, CI 1.27-7.68, p = 0.004) and between reduced urgency to defecate with fecal leakage and reduced anxious mode (RR 1.56, CI 1.04-2.33, p = 0.021). CONCLUSION Sexual health and wellbeing can be improved by interventions provided in a nurse-led clinic focusing on physical treatment-induced late effects. Further research to optimize treatment strategies in female pelvic cancer survivors is needed.
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Lubián-López DM, Moya-Bejarano D, Butrón-Hinojo CA, Marín-Sánchez P, Blasco-Alonso M, Jiménez-López JS, Villegas-Muñoz E, González-Mesa E. Measuring Resilience in Women with Endometriosis. J Clin Med 2021; 10:jcm10245942. [PMID: 34945238 PMCID: PMC8708759 DOI: 10.3390/jcm10245942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/06/2021] [Accepted: 12/14/2021] [Indexed: 12/15/2022] Open
Abstract
Endometriosis is a multifactorial disease with pathophysiological factors not yet well known; it also presents a wide symptomatic range that makes us think about the need for multidisciplinary management. It is a chronic disease in which there is no definitive treatment, and is associated in a large majority of cases with psychological pathology. Connecting comorbidities and multimorbidities on a neurobiological, neuropsychological, and pathophysiological level could significantly contribute to their more successful prevention and treatment. In our study, resilience is analyzed as an adjunctive measure in the management of endometriosis. Methods: A multi-centre, cross-sectional study was performed to analyse resilience levels in a sample of Spanish women suffering from endometriosis. CDRIS-25, CDRIS-10, BDI, the STAI, and the SF-36 Health Questionnaire were used for assessments. A representative group of 202 women with endometriosis was recruited by consecutive sampling. Exploratory and confirmatory factor analyses were performed for both resilience scales. Results: Mean CDRIS-25 and CDRIS-10 scores were 69.58 (SD 15.1) and 29.37 (SD 7.2), respectively. Women with adenomyosis and without signs of deep endometriosis showed the lowest scores. The best predictive model included women’s age, years of endometriosis evolution, number of pregnancies, and history of fertility problems as the best predictive factors. Conclusions: Women build resilience as the number of years of evolution of the disease increases. Symptoms such as dyspareunia and continued abdominal pain were more prevalent among less resilient women.
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Affiliation(s)
- Daniel María Lubián-López
- Department of Obstetrics and Gynecology, University Hospital of Jerez de la Frontera, 11407 Cádiz, Spain;
- Department of Obstetrics and Gynecology, School of Medicine, University of Cádiz, 11003 Cádiz, Spain
| | - Davinia Moya-Bejarano
- Department of Obstetrics and Gynecology, Regional University Hospital of Málaga, 29001 Málaga, Spain; (M.B.-A.); (E.V.-M.); (E.G.-M.)
- Correspondence: (D.M.-B.); (J.S.J.-L.)
| | | | - Pilar Marín-Sánchez
- Department of Obstetrics and Gynecology, University Hospital Virgen de la Arrixaca, 30120 Murcia, Spain;
| | - Marta Blasco-Alonso
- Department of Obstetrics and Gynecology, Regional University Hospital of Málaga, 29001 Málaga, Spain; (M.B.-A.); (E.V.-M.); (E.G.-M.)
| | - Jesús Salvador Jiménez-López
- Department of Obstetrics and Gynecology, Regional University Hospital of Málaga, 29001 Málaga, Spain; (M.B.-A.); (E.V.-M.); (E.G.-M.)
- Correspondence: (D.M.-B.); (J.S.J.-L.)
| | - Emilia Villegas-Muñoz
- Department of Obstetrics and Gynecology, Regional University Hospital of Málaga, 29001 Málaga, Spain; (M.B.-A.); (E.V.-M.); (E.G.-M.)
| | - Ernesto González-Mesa
- Department of Obstetrics and Gynecology, Regional University Hospital of Málaga, 29001 Málaga, Spain; (M.B.-A.); (E.V.-M.); (E.G.-M.)
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7
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Abstract
Sexual dysfunction is extremely common in cancer survivors. Cancer survivors are living longer, and survivorship issues like sexual functioning are now a part of routine cancer care. Oncology providers need to be as comfortable assessing and addressing these issues as they would any other aspect relating to cancer care. Providers should know how to perform an evaluation for sexual dysfunction, understand basic treatment options, and have appropriate referrals available to ensure that the patient's needs are met. This review provides an overview of sexual dysfunction pertaining to women who are survivors of cancer and articulates areas needing further research.
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Affiliation(s)
- Mindy Goldman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 2356 Sutter Street, San Francisco, CA 94143, USA.
| | - Mary Kathryn Abel
- University of California, San Francisco School of Medicine, 2356 Sutter Street, San Francisco, CA 94143, USA
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Svanström Röjvall A, Buchli C, Flöter Rådestad A, Martling A, Segelman J. Impact of Androgens on Sexual Function in Women With Rectal Cancer - A Prospective Cohort Study. J Sex Med 2021; 18:1374-1382. [PMID: 37057455 DOI: 10.1016/j.jsxm.2021.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/29/2021] [Accepted: 05/29/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Women treated for rectal cancer are at risk of sexual dysfunction and impaired ovarian androgen production. AIM To investigate a possible association between serum levels of endogenous androgens and sexual function in women with rectal cancer. METHODS Women diagnosed with stage I-III rectal cancer were consecutively included and prospectively followed with the Female Sexual Function Index (FSFI) questionnaire from baseline to 2 years postoperatively and blood samples for hormone analyses, baseline to 1 year. Androgens were measured with liquid chromatography-mass spectrometry and electrochemiluminescence. The associations between the 4 measured androgens (testosterone, free testosterone, androstenedione, and dehydroepiandrosterone sulphate) and sexual function were assessed with generalized least squares random effects regression analysis in sexually active women. OUTCOMES The primary outcome measure was the mean change observed in the FSFI total score when the serum androgen levels changed with one unit. Secondary outcomes were the corresponding mean changes in the FSFI domain scores: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain/discomfort. RESULTS In the 99 participants, the median FSFI total score decreased from 21.9 (range 2.0 - 36.0) to 16.4 (3.5 - 34.5) and 11.5 (2.0 to 34.8) at 1 and 2-years follow-up. After adjustment for age, partner, psychological well-being, preoperative (chemo)radiotherapy, and surgery, total testosterone and androstenedione were significantly associated with FSFI total score (β-coefficients 3.45 (95% CI 0.92 - 5.97) and 1.39 (0.46 - 2.33) respectively). Testosterone was significantly associated with the FSFI-domains lubrication and orgasm, free testosterone with lubrication, androstenedione with all domains except desire and satisfaction, and dehydroepiandrosterone sulphate with none of the domains. STRENGTHS AND LIMITATIONS This is the first study investigating whether androgen levels are of importance for the impaired sexual function seen in women following rectal cancer treatment. The prospective design allows for repeated measures and the use of the FSFI for comparisons across studies. No laboratory data were collected at the 2-year follow-up, and the missing data could have further clarified the studied associations. CONCLUSION AND CLINICAL IMPLICATION Testosterone and androstenedione were associated with sexual function in female rectal cancer patients. The results are of interest for future intervention studies and contribute to the understanding of sexual problems, which is an essential component of the rehabilitation process in pelvic cancer survivors. Svanström Röjvall A, Buchli C, Flöter Rådestad A, et al. Impact of Androgens on Sexual Function in Women With Rectal Cancer - A Prospective Cohort Study. J Sex Med 2021;18:1374-1382.
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Affiliation(s)
- Annika Svanström Röjvall
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Surgery, GI Oncology Unit, St Göran's Hospital, Stockholm, Sweden.
| | - Christian Buchli
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Pelvic Cancer, GI Oncology and Colorectal Surgery Unit, Stockholm, Sweden
| | - Angelique Flöter Rådestad
- Department of Hereditary Cancer, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Anna Martling
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Pelvic Cancer, GI Oncology and Colorectal Surgery Unit, Stockholm, Sweden
| | - Josefin Segelman
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Surgery, Ersta Hospital, Stockholm, Sweden
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9
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Abstract
A critique of the literature that androgen deficit underlies women's sexual dysfunctions is provided. Although there is scant evidence that androgens are responsible, many aspects of androgen activity remain to be investigated. Research does link serum levels of dehydroepiandrosterone (DHEA) to women's sexual desire but apparently not via DHEA's androgenic activity. Current assessment and management of women's sexual dysfunction are summarized.
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Affiliation(s)
- Rosemary Basson
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
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Gürtler MA, Brunner P, Dürsteler-MacFarland KM, Wiesbeck GA. [Sexual Dysfunction in Primary Health Care]. PRAXIS 2019; 108:23-30. [PMID: 30621544 DOI: 10.1024/1661-8157/a003172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
UNLABELLED Sexual Dysfunction in Primary Health Care Abstract. In primary health care, sexual dysfunctions are usually only insufficiently recorded. At the same time, these disorders are relatively common and often remain untreated. This study investigated sexual dysfunction and how it is influenced by lifestyle in patients in a general practitioner's practice (HP). METHODS A sample of HP patients was asked about their sexuality, psychosocial situation and lifestyle, using validated questionnaires. RESULTS The sample consisted of 30 women and 37 men. Of these, about two thirds have never spoken to a physician about their sex life and more than four fifths have never been asked about it by a phyisican. In 75 % of the sample there was no evidence of sexual dysfunction. Men with questionnaire values indicating sexual dysfunction showed significantly higher psychological stress than those with inconspicuous values. CONCLUSION Despite an inconspicuous anamnesis regarding risk factors of sexual dysfunction, about a quarter of the sample found evidence of sexual dysfunction. An inconspicuous anamnesis in the areas of alcohol/tobacco consumption and depression does not make a targeted questioning about sexual dysfunction superfluous. Particularly for men, acute psychological stress should be a sufficient reason to address the topic of sexuality and to deepen it if necessary.
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Affiliation(s)
| | - Patrick Brunner
- 2 Zentrum für Psychiatrie und Psychotherapie, Psychiatrische Klinik Zugersee
| | | | - Gerhard A Wiesbeck
- 3 Zentrum für Abhängigkeitserkrankungen, Universitäre Psychiatrische Kliniken Basel
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Yong PJ. Deep Dyspareunia in Endometriosis: A Proposed Framework Based on Pain Mechanisms and Genito-Pelvic Pain Penetration Disorder. Sex Med Rev 2017; 5:495-507. [DOI: 10.1016/j.sxmr.2017.06.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/19/2017] [Accepted: 06/24/2017] [Indexed: 12/30/2022]
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The Problematization of Sexuality among Women Living with HIV and a New Feminist Approach for Understanding and Enhancing Women’s Sexual Lives. SEX ROLES 2017. [DOI: 10.1007/s11199-017-0826-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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13
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Evaluating the efficacy of vaginal dehydroepiandosterone for vaginal symptoms in postmenopausal cancer survivors: NCCTG N10C1 (Alliance). Support Care Cancer 2017; 26:643-650. [PMID: 28921241 DOI: 10.1007/s00520-017-3878-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 09/10/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Women with estrogen deficiencies can suffer from vaginal symptoms that negatively impact sexual health. This study evaluated vaginal dehydroepiandrosterone (DHEA) for alleviation of vaginal symptoms. METHODS This three-arm randomized, controlled trial evaluated DHEA 3.25 mg and DHEA 6.5 mg, each compared to a plain moisturizer (PM) over 12 weeks, to improve the severity of vaginal dryness or dyspareunia, measured with an ordinal scale, and overall sexual health using the Female Sexual Function Index (FSFI). Postmenopausal women with a history of breast or gynecologic cancer who had completed primary treatment, had no evidence of disease, and reported at least moderate vaginal symptoms were eligible. The mean change from baseline to week 12 in the severity of vaginal dryness or dyspareunia for each DHEA dose was compared to PM and analyzed by two independent t tests using a Bonferroni correction. RESULTS Four hundred sixty-four women were randomized. All arms reported improvement in either dryness or dyspareunia. Neither DHEA dose was statistically significantly different from PM at 12 weeks (6.25 mg, p = .08; 3.25 mg, p = 0.48), although a significant difference at 8 weeks for 6.5 mg DHEA was observed (p = 0.005). Women on the 6.5 mg arm of DHEA reported significantly better sexual health on the FSFI (p < 0.001). There were no significant differences in provider-graded toxicities and few significant differences in self-reported side effects. CONCLUSION PM and DHEA improved vaginal symptoms at 12 weeks. However, vaginal DHEA, 6.5 mg, significantly improved sexual health. Vaginal DHEA warrants further investigation in women with a history of cancer.
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Yong PJ, Williams C, Yosef A, Wong F, Bedaiwy MA, Lisonkova S, Allaire C. Anatomic Sites and Associated Clinical Factors for Deep Dyspareunia. Sex Med 2017; 5:e184-e195. [PMID: 28778678 PMCID: PMC5562494 DOI: 10.1016/j.esxm.2017.07.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 07/07/2017] [Accepted: 07/10/2017] [Indexed: 12/26/2022] Open
Abstract
Introduction Deep dyspareunia negatively affects women’s sexual function. There is a known association between deep dyspareunia and endometriosis of the cul-de-sac or uterosacral ligaments in reproductive-age women; however, other factors are less clear in this population. Aim To identify anatomic sites and associated clinical factors for deep dyspareunia in reproductive-age women at a referral center. Methods This study involved the analysis of cross-sectional baseline data from a prospective database of 548 women (87% consent rate) recruited from December 2013 through April 2015 at a tertiary referral center for endometriosis and/or pelvic pain. Exclusion criteria included menopausal status, age at least 50 years, previous hysterectomy or oophorectomy, and not sexually active. We performed a standardized endovaginal ultrasound-assisted pelvic examination to palpate anatomic structures for tenderness and reproduce deep dyspareunia. Multivariable regression was used to determine which tender anatomic structures were independently associated with deep dyspareunia severity and to identify clinical factors independently associated with each tender anatomic site. Main Outcome Measure Severity of deep dyspareunia on a numeric pain rating scale of 0 to 10. Results Severity of deep dyspareunia (scale = 0–10) was independently associated with tenderness of the bladder (b = 0.88, P = .018), pelvic floor (levator ani) (b = 0.66, P = .038), cervix and uterus (b = 0.88, P = .008), and cul-de-sac or uterosacral ligaments (b = 1.39, P < .001), but not with the adnexa (b = −0.16, P = 0.87). The number of tender anatomic sites was significantly correlated with more severe deep dyspareunia (Spearman r = 0.34, P < .001). For associated clinical factors, greater depression symptom severity was specifically associated with tenderness of the bladder (b = 1.05, P = .008) and pelvic floor (b = 1.07, P < .001). A history of miscarriage was specifically associated with tenderness of the cervix and uterus (b = 2.24, P = .001). Endometriosis was specifically associated with tenderness of the cul-de-sac or uterosacral ligaments (b = 3.54, P < .001). Conclusions In reproductive-age women at a tertiary referral center, deep dyspareunia was independently associated not only with tenderness of the cul-de-sac and uterosacral ligaments but also with tenderness of the bladder, pelvic floor, and cervix and uterus. Yong PJ, Williams C, Yosef A, et al. Anatomic Sites and Associated Clinical Factors for Deep Dyspareunia. Sex Med 2017;5:e184–e195.
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Affiliation(s)
- Paul J Yong
- Department of Obstetrics and Gynecology, University of British Columbia; BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, BC, Canada.
| | - Christina Williams
- Department of Obstetrics and Gynecology, University of British Columbia; BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, BC, Canada
| | - Ali Yosef
- Department of Obstetrics and Gynecology, University of British Columbia; BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, BC, Canada
| | - Fontayne Wong
- Department of Obstetrics and Gynecology, University of British Columbia; BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, BC, Canada
| | - Mohamed A Bedaiwy
- Department of Obstetrics and Gynecology, University of British Columbia; BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, BC, Canada
| | - Sarka Lisonkova
- Department of Obstetrics and Gynecology, University of British Columbia; BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, BC, Canada
| | - Catherine Allaire
- Department of Obstetrics and Gynecology, University of British Columbia; BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, BC, Canada
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15
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Abstract
BACKGROUND As cancer survival rates increase, so does the imperative for a satisfying quality of life, including a fulfilling sexual life. OBJECTIVE The feasibility and effectiveness of a newly formed Sexual Health Clinic were determined using a nurse-led format, which provided support to survivors in a cancer care setting. METHODS Twenty-one cancer survivors received assessment, education, and tailored sexual health support by an oncology nurse with specialized skills in sexual health. Two months later, semistructured interviews focused on patients' personal experiences. Questionnaires were also administered to healthcare providers involved in providing the follow-up care. RESULTS Participants presented with sexual concerns that were psychological, physical, and/or relational. Scores on validated measures of sexual functioning were in the range comparable to those with a sexual dysfunction. Participants were open to being asked about sexual health and wanted professionals available who were skilled in dealing with sexual health services. Most participants experienced an improvement in their well-being and/or sexual life following participation. Some noted more confidence when speaking with their partner about sexual concerns. CONCLUSION Our pilot Sexual Health Clinic was feasible, and evidence for its effectiveness was based on qualitative feedback. Participants and providers identified a strong need for the inclusion of sexual health services in cancer care. IMPLICATIONS FOR PRACTICE Oncology nurses are in a key position to initiate discussions surrounding sexual health issues related to cancer treatment. Self-awareness, sensitivity, and a nonjudgmental approach are required to address this dimension of holistic cancer care.
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Matarín Jiménez TM, Fernández-Sola C, Hernández-Padilla JM, Correa Casado M, Antequera Raynal LH, Granero-Molina J. Perceptions about the sexuality of women with fibromyalgia syndrome: a phenomenological study. J Adv Nurs 2017; 73:1646-1656. [PMID: 28122137 DOI: 10.1111/jan.13262] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2017] [Indexed: 11/28/2022]
Abstract
AIMS The aim of this study was to explore and understand the perceptions and experiences of women with fibromyalgia syndrome regarding their sexuality. BACKGROUND Fibromyalgia syndrome is a chronic pathology, which compromises a woman's physical, mental and emotional health. Although concerns related to sexuality are commonly reported, research has tended to focus on the physical symptoms. DESIGN An interpretive qualitative research methodology using Gadamer's philosophical hermeneutics was carried out. METHODS This qualitative study explores the sexuality of women with fibromyalgia syndrome. A focus group and semi-structured interviews were conducted with 13 women with fibromyalgia syndrome. Data were collected between April - June 2014. Participants were recruited until findings reached saturation. FINDINGS Three themes define the perception of sexuality for these women: (i) Physical impact: don't touch, don't look; (ii) Sexuality and identity: fighting against their loss; (iii) Impact on the relationship: sexuality as a way of connecting the couple. CONCLUSION Despite limitations, sexuality is important for the identity and quality of life of women with fibromyalgia syndrome. Together with the physical symptomology, guilt, fear and a lack of understanding compromise the coping process. Women need the support of their partner, their socio-family environment and health professionals. Nurses can aid the successful adjustment to sexual problems related to fibromyalgia syndrome.
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Affiliation(s)
| | - Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Spain.,Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco, Chile
| | | | | | | | - José Granero-Molina
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Spain.,Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco, Chile
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Parton C, Ussher JM, Perz J. Women’s constructions of heterosex and sexual embodiment after cancer. FEMINISM & PSYCHOLOGY 2016. [DOI: 10.1177/0959353516674493] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The significant impact of cancer on women’s sexual well-being has been acknowledged increasingly within research. However, the role of cultural discourse in shaping women’s construction and embodied experience of sexuality has received less attention. In this study, we examined heterosexual women’s constructions of sexual embodiment in the context of cancer. Sixteen women across a range of ages (20–71 years), cancer types and stages took part in in-depth semi-structured interviews. A thematic decomposition analysis was conducted on the interview transcripts, drawing on feminist poststructuralist theory. A main theme was identified in which the women took up subject positions of “Embodying sexuality” and “Embodying the absence of sexuality”. Accounts of “Embodying sexuality” included “Experiencing bodily ease during sex” and “Managing a dysfunctional body during sex”. The women’s positioning of “Embodying the absence of sexuality” included “Asexuality and the absence of desire” and “Unsuccessful attempts to renegotiate sex”. Women’s intrapsychic negotiation of sexual and gendered discourse, the materiality of embodied change and relationship context influenced their constructions of sexual subjectivity. These findings indicate a need for researchers and clinicians to acknowledge cultural discourses of sex and gender that shape the possibilities and constraints for women’s sexual well-being after cancer.
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Schlichthorst M, Sanci LA, Hocking JS. Health and lifestyle factors associated with sexual difficulties in men - results from a study of Australian men aged 18 to 55 years. BMC Public Health 2016; 16:1043. [PMID: 28185600 PMCID: PMC5103242 DOI: 10.1186/s12889-016-3705-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Sexual difficulties (SD) are common among men of all ages and can have considerable impact on quality of life and indications for future health. SD are associated with mental and physical wellbeing and with relationship satisfaction, yet they are rarely discussed with medical professionals who are often ill equipped to assess and manage them. This paper provides an updated overview on the status of SD in Australian men from 18 to 55 years of age and will form a baseline comparison for future analyses of SD based on Ten to Men data. Methods We used data from Ten to Men, the Australian Longitudinal Study on Male Health. SD was measured using eight items capturing specific sexual difficulties. We examined associations of a range of health and lifestyle factors (smoking, alcohol consumption, illicit drug use, obesity and new sexual partners, self-rated health status, disability, pain medication, diagnosed physical and mental health conditions) with each SD using logistic regression. The sample included 12,636 adult males who had previously been sexually active. Analysis was stratified by age (18–34 years versus 35–55 years). Results This paper shows that experiencing SD is relatively common among Australian men – overall half the sample (54 %; 95 % CI: 0.53–0.55) experienced at least one SD for more than 3 months over the past 12 months. While more common in older men aged 45 to 55 years, almost half the 18 to 24 year old men (48 %) also reported at least one SD highlighting that SD affects men of all ages. We found that SDs were associated with both lifestyle and health factors, although the strongest associations were observed for health factors in both age groups, in particular poor self-rated health, having a disability and at least one mental health condition. Lifestyle factors associated with SDs in men of all ages included smoking, harmful alcohol consumption and drug use in the past 12 months. Obesity was only associated with an increased rate of SD in men aged 35 to 55 years. Conclusion Sexual difficulties are common among men of all ages and increasingly more prevalent as men grow older. They are strongly associated with both health and lifestyle factors. With previous literature showing that SDs can be a precursor of an underlying or developing physical and mental health condition, it is imperative that sexual health and sexual functioning is discussed with a doctor as part of a standard health check and across the lifespan.
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Affiliation(s)
- Marisa Schlichthorst
- Centre for Mental Health, Melbourne School of Population and Global Hralth, The University of Melbourne, Melbourne, 3010, Australia.
| | - Lena A Sanci
- Department of General Practice, The University of Melbourne, Melbourne, 3010, Australia
| | - Jane S Hocking
- Centre for Mental Health, Melbourne School of Population and Global Hralth, The University of Melbourne, Melbourne, 3010, Australia
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Ussher JM, Perz J, Gilbert E. Perceived causes and consequences of sexual changes after cancer for women and men: a mixed method study. BMC Cancer 2015; 15:268. [PMID: 25885443 PMCID: PMC4407322 DOI: 10.1186/s12885-015-1243-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 03/23/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Previous research on cancer and sexuality has focused on physical aspects of sexual dysfunction, neglecting the subjective meaning and consequences of sexual changes. This has led to calls for research on cancer and sexuality to adopt an "integrative" approach, and to examine the ways in which individuals interpret sexual changes, and the subjective consequences of sexual changes. METHOD This study examined the nature and subjective experience and consequences of changes to sexual well-being after cancer, using a combination of quantitative and qualitative analysis. Six hundred and fifty seven people with cancer (535 women, 122 men), across a range of reproductive and non-reproductive cancer types completed a survey and 44 (23 women, 21 men) took part in an in-depth interview. RESULTS Sexual frequency, sexual satisfaction and engagement in a range of penetrative and non-penetrative sexual activities were reported to have reduced after cancer, for both women and men, across reproductive and non-reproductive cancer types. Perceived causes of such changes were physical consequences of cancer treatment, psychological factors, body image concerns and relationship factors. Sex specific difficulties (vaginal dryness and erectile dysfunction) were the most commonly reported explanation for both women and men, followed by tiredness and feeling unattractive for women, and surgery and getting older for men. Psychological and relationship factors were also identified as consequence of changes to sexuality. This included disappointment at loss of sexual intimacy, frustration and anger, sadness, feelings of inadequacy and changes to sense of masculinity of femininity, as well as increased confidence and self-comfort; and relationship strain, relationship ending and difficulties forming a new relationship. Conversely, a number of participants reported increased confidence, re-prioritisation of sex, sexual re-negotiation, as well as a strengthened relationship, after cancer. CONCLUSION The findings of this study confirm the importance of health professionals and support workers acknowledging sexual changes when providing health information and developing supportive interventions, across the whole spectrum of cancer care. Psychological interventions aimed at reducing distress and improving quality of life after cancer should include a component on sexual well-being, and sexual interventions should incorporate components on psychological and relational functioning.
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Affiliation(s)
- Jane M Ussher
- Centre for Health Research, University of Western Sydney, Locked Bag 1797, Penrith South, 2751, Australia.
| | - Janette Perz
- Centre for Health Research, University of Western Sydney, Locked Bag 1797, Penrith South, 2751, Australia.
| | - Emilee Gilbert
- School of Social Sciences and Psychology, University of Western Sydney, Locked Bag 1797, Penrith South, 2751, Australia.
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20
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Kim SI, Lee Y, Lim MC, Joo J, Park K, Lee DO, Park SY. Quality of life and sexuality comparison between sexually active ovarian cancer survivors and healthy women. J Gynecol Oncol 2015; 26:148-54. [PMID: 25686396 PMCID: PMC4397231 DOI: 10.3802/jgo.2015.26.2.148] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 12/27/2014] [Accepted: 01/07/2015] [Indexed: 11/30/2022] Open
Abstract
Objective compare quality of life (QoL) and sexual functioning between sexually active ovarian cancer survivors and healthy women. Methods A cross-sectional study was performed in 103 successfully treated ovarian cancer survivors and 220 healthy women. All women had engaged in sexual activity within the previous 3 months, and ovarian cancer survivors were under surveillance after primary treatment without evidence of disease. QoL and sexual functioning were assessed using three questionnaires; the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), Ovarian Cancer Module (EORTC QLQ-OV28), and the Female Sexual Function Index (FSFI). Propensity score matching was used to adjust covariates between the ovarian cancer survivor and healthy women groups. In total, 73 ovarian cancer survivors and 73 healthy women were compared. Results Poorer social functioning (mean, 82.4 vs. 90.9; p=0.010) and more financial difficulties (mean, 16.4 vs. 7.8; p=0.019) were observed among ovarian cancer survivors than among healthy women. Sexuality, both in terms of desire, arousal, lubrication, orgasm, satisfaction, and pain and in terms of interest in sex, sexual activity, and enjoyment of sex (EORTC QLQ-OV28) were similar between the groups. However, vaginal dryness was more problematic in ovarian cancer survivors, with borderline statistical significance (p=0.081). Conclusion Sexuality was not impaired in ovarian cancer survivors who were without evidence of disease after primary treatment and having sexual activities, compared with healthy women, whereas social functioning and financial status did deteriorate. Prospective cohort studies are needed.
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Affiliation(s)
- Se Ik Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.; Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Yumi Lee
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Myong Cheol Lim
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.; Gynecologic Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
| | - Jungnam Joo
- Biometric Research Branch, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Kibyung Park
- Biometric Research Branch, Research Institute and Hospital, National Cancer Center, Goyang, Korea.; Jaseng Medical Foundation, Jaseng Hospital of Korean Medicine, Seoul, Korea
| | - Dong Ock Lee
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sang Yoon Park
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.; Gynecologic Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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Symptoms: Menopause, Infertility, and Sexual Health. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 862:115-41. [PMID: 26059933 DOI: 10.1007/978-3-319-16366-6_9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
By 2022, the number of survivors is expected to grow to nearly 18 million. Therefore, addressing acute and chronic negative sequelae of a cancer diagnosis and its treatments becomes a health imperative. For women with a history of breast cancer, one of the common goals of treatment and prevention of recurrence is to reduce circulating concentrations of estradiol, especially in women with hormone receptor positive breast cancer. Hormone deprivation after a diagnosis of breast cancer impacts physiological targets other than in the breast tissue and can result in unwanted side effects, all of which can negatively impact quality of life and function and cause distress. Symptoms that are most strongly linked by evidence to hormone changes after cancer diagnosis and treatment include hot flashes, night sweats, sleep changes, fatigue, mood changes, and diminishing sexual function, including vaginal atrophy (decreased arousal, dryness and dyspareunia), infertility, decreased desire and negative self-image. Weight gain and resulting body image changes are often concomitants of the abrupt onset of treatment-induced menopause. The purpose of this chapter is to briefly review what is known about the advent of premature menopause in women treated for breast cancer, menopausal symptoms that are exacerbated by endocrine treatments for breast cancer, and the associated concerns of hot flashes and related menopausal symptoms, sexual health and fertility issues. We will discuss limitations in the current research and propose strategies that address current limitations in order to move the science forward.
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22
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Ussher JM, Perz J, Gilbert E. Women's Sexuality after Cancer: A Qualitative Analysis of Sexual Changes and Renegotiation. WOMEN & THERAPY 2014. [DOI: 10.1080/02703149.2014.897547] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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23
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Gilbert E, Perz J, Ussher JM. Talking about sex with health professionals: the experience of people with cancer and their partners. Eur J Cancer Care (Engl) 2014; 25:280-93. [PMID: 25040442 DOI: 10.1111/ecc.12216] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2014] [Indexed: 12/31/2022]
Abstract
Changes to sexuality can be one of the most difficult aspects of life following cancer. This study examines the experience of discussing sexuality post cancer with health care professionals (HCPs), from the perspective of women and men with cancer (PWC), and their partners (PPWC), across a range of cancer types. A total of 657 PWC (535 women, 122 men) and 148 PPWC (87 women, 61 men) completed a survey containing closed and open-ended items, analysed by analysis of variance and thematic analysis. Discussions about sexuality with a HCP were more likely to be reported by men (68%) compared to women PWC (43%), and by women (47%) compared to men PPWC (28%), as well as by those with a sexual or reproductive cancer. Men PWC and women PPWC were most likely to want to discuss sexuality with a HCP, with men PWC and PPWC reporting highest levels of satisfaction with such discussions. Open-ended responses revealed dissatisfaction with the unwillingness of HCPs to discuss sexuality, unhappiness with the nature of such discussion, and positive accounts of discussions about sexuality with HCPs. These findings lend support to the notion that people with cancer and their partners may have unmet sexual information and support needs.
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Affiliation(s)
- E Gilbert
- Centre for Health Research, University of Western Sydney, Sydney, New South Wales, Australia
| | - J Perz
- Centre for Health Research, University of Western Sydney, Sydney, New South Wales, Australia
| | - J M Ussher
- Centre for Health Research, University of Western Sydney, Sydney, New South Wales, Australia
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Perz J, Ussher JM, Gilbert E. Feeling well and talking about sex: psycho-social predictors of sexual functioning after cancer. BMC Cancer 2014; 14:228. [PMID: 24673768 PMCID: PMC3986691 DOI: 10.1186/1471-2407-14-228] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 03/17/2014] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Changes to sexual wellbeing are acknowledged to be a long-term negative consequence of cancer and cancer treatment. These changes can have a negative effect on psychological well-being, quality of life and couple relationships. Whilst previous conclusions are based on univariate analysis, multivariate research can facilitate examination of the complex interaction between sexual function and psycho-social variables such as psychological wellbeing, quality of life, and relationship satisfaction and communication in the context of cancer, the aim of the present study. METHOD Six hundred and fifty seven people with cancer (535 women, 122 men) and 148 partners (87 women, 61 men), across a range of sexual and non-sexual cancers, completed a survey consisting of standardized measures of sexual functioning, depression and anxiety, quality of life, relationship satisfaction, dyadic sexual communication, and self-silencing, as well as ratings of the importance of sex to life and relationships. RESULTS Men and women participants, reported reductions in sexual functioning after cancer across cancer type, for both people with cancer and partners. Multiple regression analysis examined psycho-social predictors of sexual functioning. Physical quality of life was a predictor for men and women with cancer, and for male partners. Dyadic sexual communication was a predictor for women with cancer, and for men and women partners. Mental quality of life and depression were also predictors for women with cancer, and the lower self-sacrifice subscale of self-silencing a predictor for men with cancer. CONCLUSION These results suggest that information and supportive interventions developed to alleviate sexual difficulties and facilitate sexual renegotiation should be offered to men and women with both sexual and non-sexual cancers, rather than primarily focused on individuals with sexual and reproductive cancers, as is the case currently. It is also important to include partners in supportive interventions. Interventions aimed at improving sexual functioning should include elements aimed at improving physical quality of life and sexual communication, with a focus on psychological wellbeing also being important for women with cancer.
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Affiliation(s)
- Janette Perz
- Centre for Health Research, University of Western Sydney, Locked Bag 1797, Penrith South 2751, Australia
| | - Jane M Ussher
- Centre for Health Research, University of Western Sydney, Locked Bag 1797, Penrith South 2751, Australia
| | - Emilee Gilbert
- Centre for Health Research, University of Western Sydney, Locked Bag 1797, Penrith South 2751, Australia
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Smith KB, Wang DL, Plotkin SR, Park ER. Appearance concerns among women with neurofibromatosis: examining sexual/bodily and social self-consciousness. Psychooncology 2013; 22:2711-9. [DOI: 10.1002/pon.3350] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 05/31/2013] [Accepted: 06/17/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Kelly B. Smith
- Department of Obstetrics & Gynaecology; University of British Columbia; BC Canada
| | - Daphne L. Wang
- Department of Neurology and Cancer Center; Massachusetts General Hospital/Harvard Medical School; MA USA
| | - Scott R. Plotkin
- Department of Neurology and Cancer Center; Massachusetts General Hospital/Harvard Medical School; MA USA
| | - Elyse R. Park
- Department of Psychiatry; Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital/Harvard Medical School; MA USA
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Montanari G, Di Donato N, Benfenati A, Giovanardi G, Zannoni L, Vicenzi C, Solfrini S, Mignemi G, Villa G, Mabrouk M, Schioppa C, Venturoli S, Seracchioli R. Women with deep infiltrating endometriosis: sexual satisfaction, desire, orgasm, and pelvic problem interference with sex. J Sex Med 2013; 10:1559-66. [PMID: 23551753 DOI: 10.1111/jsm.12133] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Endometriosis is a chronic and progressive condition of women of reproductive age. It is strongly associated with a significant reduction of quality of life (QOL) and sexual function. AIMS This study aims to objectively evaluate sexual function in women with deep infiltrating endometriosis (DIE) and to study the impact of endometriosis symptoms and type of lesion on patient's sexual function. METHODS This is a cross-sectional study in a tertiary care university hospital. It included 182 patients with preoperative clinical and ultrasound diagnosis of DIE who were referred to our center from 2008 to 2011. MAIN OUTCOME MEASURES A sexual activity questionnaire, the Sexual Health Outcomes in Women Questionnaire (SHOW-Q) was used to collect data pertaining to satisfaction, orgasm, desire, and pelvic problem interference with sex. Short Form 36 (SF-36) was used to evaluate QOL. Demographic and clinical characteristics were assessed: age, body mass index, parity, ethnicity, postsecondary education, employment, smoking, history of surgical treatment, and hormonal contraception. Patients were asked about pain symptoms (dysmenorrhea, dyspareunia, dyschezia, chronic pelvic pain, and dysuria) using a visual analog scale. RESULTS The mean values obtained on the different scales of the SHOW-Q showed poor sexual function (mean SHOW-Q total score 56.38 ± 22.74). Satisfaction was the dimension most affected (mean satisfaction score 55.66 ± 34.55), followed by orgasm (mean orgasm score 56.90 ± 33.77). We found a significant correlation between the SF-36 scores and the SHOW-Q scores (P < 0.0001). Sexual dysfunction and deterioration of QOL seem to be correlated. Analyzing the impact of symptoms and lesions on sexual function, we found that dyspareunia and vaginal DIE nodules significantly affect sexual activity (P < 0.05). CONCLUSION The results of this study demonstrated that women with DIE have a sexual function impairment, correlated with the overall well-being decrease. Moreover, the presence of dyspareunia and vaginal endometriotic lesions seems to be involved in sexual dysfunction.
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Affiliation(s)
- Giulia Montanari
- Minimally Invasive Gynaecological Surgery Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
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Mabrouk M, Montanari G, Di Donato N, Del Forno S, Frascà C, Geraci E, Ferrini G, Vicenzi C, Raimondo D, Villa G, Zukerman Z, Alvisi S, Seracchioli R. What is the Impact on Sexual Function of Laparoscopic Treatment and Subsequent Combined Oral Contraceptive Therapy in Women with Deep Infiltrating Endometriosis? J Sex Med 2012; 9:770-8. [DOI: 10.1111/j.1743-6109.2011.02593.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Brotto LA, Erskine Y, Carey M, Ehlen T, Finlayson S, Heywood M, Kwon J, McAlpine J, Stuart G, Thomson S, Miller D. A brief mindfulness-based cognitive behavioral intervention improves sexual functioning versus wait-list control in women treated for gynecologic cancer. Gynecol Oncol 2012; 125:320-5. [PMID: 22293042 DOI: 10.1016/j.ygyno.2012.01.035] [Citation(s) in RCA: 172] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 01/16/2012] [Accepted: 01/22/2012] [Indexed: 01/23/2023]
Abstract
GOAL The goal of this study was to evaluate a mindfulness-based cognitive behavioral intervention for sexual dysfunction in gynecologic cancer survivors compared to a wait-list control group. METHODS Thirty-one survivors of endometrial or cervical cancer (mean age 54.0, range 31-64) who self-reported significant and distressing sexual desire and/or sexual arousal concerns were assigned either to three, 90-minute mindfulness-based cognitive behavior therapy sessions or two months of wait-list control prior to entering the treatment arm. Validated measures of sexual response, sexual distress, and mood, as well as laboratory-evoked physiological and subjective sexual arousal were assessed at pre-, one month post-, and 6-months following treatment. RESULTS There were no significant effects of the wait-list condition on any measure. Treatment led to significant improvements in all domains of sexual response, and a trend towards significance for reducing sexual distress. Perception of genital arousal during an erotic film was also significantly increased following the intervention despite no change in physiologically-measured sexual arousal. CONCLUSIONS A brief mindfulness-based intervention was effective for improving sexual functioning. Geographic restrictions permitted only a select sample of survivors to participate, thus, the generalizability of the findings is limited. Future studies should aim to develop online modalities for treatment administration to overcome this limitation.
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Affiliation(s)
- Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada.
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Shunmugavel A, Khan M, Chou PCT, Singh I. Spinal cord injury induced arrest in estrous cycle of rats is ameliorated by S-nitrosoglutathione: novel therapeutic agent to treat amenorrhea. J Sex Med 2011; 9:148-58. [PMID: 22024253 DOI: 10.1111/j.1743-6109.2011.02526.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Amenorrhea following spinal cord injury (SCI) has been well documented. There has been little research on the underlying molecular mechanisms and therapeutics. AIM The purpose of the present study was to investigate the effect of GSNO in ameliorating SCI-induced amenorrhea through affecting the expression of CX43, NFkB, and ERβ protein. METHODS SCI was induced in female SD rats at the T9-T10 level. Estrous stage was determined by vaginal smear. GSNO (50 µg/kg body weight) was gavage fed daily. Animals were sacrificed on day 7 and 14 post SCI. Ovaries were fixed for histological and biochemical studies. Expression levels of ERβ, CX-43, and NFkB were analyzed by Western blot and immunofluorescence. MAIN OUTCOME MEASURES GSNO hastens resumption of the estrous cycle following SCI-induced transient arrest. RESULTS Resumption of estrous cycle was hastened by GSNO. Atretic and degenerating follicles seen in the ovary of SCI rats on day 14 post-SCI were decreased in GSNO treated animals. The increased CX43 expression observed with SCI ovary was decreased by GSNO. ERβ expression decreased significantly on day 7 and 14 post-SCI and was restored with GSNO treatment. Following SCI, NFkB expression was increased in the ovarian follicles and the expression was reduced with GSNO administration. The number of terminal deoxynucleotidyl transferase-mediated biotinylated uridine triphosphate (UTP) nick end labeling positive follicular and luteal cells was increased after SCI. GSNO-treated animals had significantly fewer apoptotic cells in the ovary. CONCLUSION SCI-induced amenorrhea is accompanied by an increase in CX43 expression and a decrease in ERβ expression. SCI animals treated with GSNO resumed the estrous cycle significantly earlier. These results indicate a potential therapeutic value for GSNO in treating amenorrhea among SCI patients.
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