Cervical Cancer Survivors Have High Scores for Sexual Distress

Higher levels of distress were linked to increased vaginal sexual symptoms, worry about dyspareunia, dissatisfaction with a relationship, and concerns about body image in a study looking at sexual well-being among cervical cancer survivors published in Psycho-Oncology,Prior to this publication, biopsychosocial aspects of sexual distress among cancer survivors had rarely been studied, although it is well known that psychological factors may impact sexual function as significantly as physical factors.

The cross-sectional study used a self-administered questionnaire to gather information and enrolled 252 women in partner relationships from a pool of 764 patients who had undergone surgery between 2000 and 2011 at Leiden University Medical Center or the Center for Gynecological Oncology Amsterdam in The Netherlands. Eighteen percent of the women (n=46) had received pelvic external beam radiation therapy (EBRT) with vaginal brachytherapy (BT) as their primary therapy. The other 82% (n=206) had undergone radical hysterectomy with pelvic lymphadenectomy (RHL), and of these, 82% or 157 women received RHL alone. The rest had RHL plus EBRT or RHL plus EBRT/BT. Most of the women had cancers that were stage IIB-IA, according to the International Federation of Gynecology and Obstetrics (FIGO) staging system.

Among the 252 cancer survivors in partner relationships who were enrolled, 194 were sexually active and studied in this analysis. The women were between 25 and 69 years old, with an average age of 46.2 years. Average duration of their relationships was 17 years.

A variety of instruments to measure sexual distress, vaginal sexual symptoms, sexual pain worries, anxiety and depression, body image concerns, and relationship dissatisfaction were incorporated into the questionnaire. For instance, the 12-item Female Sexual Distress Scale (FSDS) was used to measure sexual distress. Information was also gathered about age, duration of relationships and sexual activity.

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A Third of Women Reported Distress

Thirty-eight percent (n=95) of the sexually active women surveyed reported sexual distress (measured as a score of > 15 on the FSDS). Higher levels of sexual distress were linked to increased levels of vaginal sexual symptoms, worry about dyspareunia, relationship dissatisfaction, and concerns about body image.

Reported severity of vaginal sexual symptoms varied significantly by treatment type, with subjects who underwent EBRT/BT experiencing the highest level of symptoms. Women who had RHL alone had comparable vaginal sexual symptoms to women who underwent RHL/EBRT or RHL/EBRT/BT.

On univariate analysis, sexual distress was significantly linked to vaginal sexual symptoms, worry about sexual pain, anxiety, depression, concerns about body image, and relationship dissatisfaction. Age, duration of relationships, and time since surgery were not associated with sexual distress and there were no differences between RHL alone, RHL/EBRT, RHL/EBRT/BT, and EBRT/BT in regard to these parameters. On multivariate analysis, only worry about dyspareunia, relationship dissatisfaction, vaginal sexual symptoms, and body image issues remained significantly associated with sexual distress. The authors noted that in the multivariate analysis, anxiety and depression were no longer linked with sexual distress as they have been in population studies, perhaps because cervical cancer survivors were more concerned about physical sexual symptoms.

The most telling finding, according to the authors, was the way in which worries about experiencing dyspareunia correlated with both vaginal sexual symptoms and sexual distress. They suggested this was due to a phenomenon whereby women who are worried about experiencing pain may become less aroused and lubricated, which may cause pain during intercourse, thus raising distress.

Clinicians caring for cervical cancer survivors “should be well mindful of sexual distress,” suggested the authors, allocating adequate time and privacy to explore these issues with patients and counsel them about common sexual issues after cervical cancer surgery. Healthcare providers might also consider referring patients who are distressed for psychological therapy.