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Sexual activity and function after surgical treatment in patients with (pre)invasive vulvar lesions

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Abstract

Purpose

Sexual activity (SA) and sexual function (SF) are central outcome measures in women affected by preinvasive (vulvar intraepithelial neoplasia, VIN) and invasive (vulvar cancer, VC) vulvar lesions. Data on sexuality after treatment are scarce.

Methods

Validated questionnaires including the female sexual function index (FSFI-d) were provided to 166 women with a history of VIN and VC who attended the colposcopy units of the University Medical Center Hamburg-Eppendorf and Asklepios Medical Clinic Altona for follow-up between March 2011 and June 2012. Additional patients (n = 14) assessed the questionnaires online through the website of the German Vulvar Cancer Support Group (VulvaKarzinom SHG e.V.) during the same time period.

Results

Twenty-four patients with VIN and 34 with VC were evaluable. Median age was 51.5 years, with 34 (58.6 %) of the patients being postmenopausal. Median time since completion of treatment was 17 months. All women had undergone vulvar surgery (laser/cold knife/combination). Overall, 14 (24.1 %) women reported no SA during the last 4 weeks. SF was clearly impaired compared with previously described normal cohorts. SA and SF of active patients did not differ significantly between those with VIN and VC. Analyses contrasting surgical treatment methods yielded no significant associations; likewise, time since diagnosis did not affect SA and SF significantly. Increasing age was negatively associated with most dimensions of the FSFI-d [desire (p = 0.011), arousal (p = 0.004), lubrication (p = 0.003), orgasm (p = 0.013), satisfaction (p = 0.345), pain (p < 0.001)].

Conclusion

Women with VIN and VC after surgical treatment are at high risk to suffer from persistent sexual dysfunction especially at higher age.

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References

  1. Beller U, Quinn MA, Benedet JL, Creasman WT, Ngan HY, Maisonneuve P, Pecorelli S, Odicino F, Heintz AP (2006) Carcinoma of the vulva. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet 95(Suppl 1):S7–27

    Article  PubMed  Google Scholar 

  2. Woelber L, Trillsch F, Kock L, Grimm D, Petersen C, Choschzick M, Jaenicke F, Mahner S (2013) Management of patients with vulvar cancer: a perspective review according to tumour stage. Ther Adv Med Oncol 5:183–192

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Judson PL, Habermann EB, Baxter NN, Durham SB, Virnig BA (2006) Trends in the incidence of invasive and in situ vulvar carcinoma. Obstet Gynecol 107:1018–1022

    Article  PubMed  Google Scholar 

  4. Farias-Eisner R, Cirisano FD, Grouse D, Leuchter RS, Karlan BY, Lagasse LD, Berek JS (1994) Conservative and individualized surgery for early squamous carcinoma of the vulva: the treatment of choice for stage I and II (T1-2N0-1M0) disease. Gynecol Oncol 53:55–58

    Article  CAS  PubMed  Google Scholar 

  5. Burke TW, Levenback C, Coleman RL, Morris M, Silva EG, Gershenson DM (1995) Surgical therapy of T1 and T2 vulvar carcinoma: further experience with radical wide excision and selective inguinal lymphadenectomy. Gynecol Oncol 57:215–220

    Article  CAS  PubMed  Google Scholar 

  6. Madeleine MM, Daling JR, Carter JJ, Wipf GC, Schwartz SM, McKnight B, Kurman RJ, Beckmann AM, Hagensee ME, Galloway DA (1997) Cofactors with human papillomavirus in a population-based study of vulvar cancer. J Natl Cancer Inst 89:1516–1523

    Article  CAS  PubMed  Google Scholar 

  7. Joura EA, Losch A, Haider-Angeler MG, Breitenecker G, Leodolter S (2000) Trends in vulvar neoplasia. Increasing incidence of vulvar intraepithelial neoplasia and squamous cell carcinoma of the vulva in young women. J Reprod Med 45:613–615

    CAS  PubMed  Google Scholar 

  8. Hillemanns P, Wang X, Staehle S, Michels W, Dannecker C (2006) Evaluation of different treatment modalities for vulvar intraepithelial neoplasia (VIN): CO(2) laser vaporization, photodynamic therapy, excision and vulvectomy. Gynecol Oncol 100:271–275

    Article  PubMed  Google Scholar 

  9. Tristram A, Hurt CN, Madden T, Powell N, Man S, Hibbitts S, Dutton P, Jones S, Nordin AJ, Naik R, Fiander A, Griffiths G (2014) Activity, safety, and feasibility of cidofovir and imiquimod for treatment of vulval intraepithelial neoplasia (RT(3)VIN): a multicentre, open-label, randomised, phase 2 trial. Lancet Oncol 15:1361–1368

    Article  CAS  PubMed  Google Scholar 

  10. Abbott-Anderson K, Kwekkeboom KL (2012) A systematic review of sexual concerns reported by gynecological cancer survivors. Gynecol Oncol 124:477–489

    Article  PubMed  Google Scholar 

  11. Hazewinkel MH, Laan ET, Sprangers MA, Fons G, Burger MP, Roovers JP (2012) Long-term sexual function in survivors of vulvar cancer: a cross-sectional study. Gynecol Oncol 126:87–92

    Article  PubMed  Google Scholar 

  12. Chedraui P, Perez-Lopez FR, San Miguel G, Avila C (2009) Assessment of sexuality among middle-aged women using the female sexual function index. Climacteric 12:213–221

    Article  CAS  PubMed  Google Scholar 

  13. Likes WM, Stegbauer C, Tillmanns T, Pruett J (2007) Correlates of sexual function following vulvar excision. Gynecol Oncol 105:600–603

    Article  PubMed  Google Scholar 

  14. Ekwall E, Ternestedt BM, Sorbe B (2003) Important aspects of health care for women with gynecologic cancer. Oncol Nurs Forum 30:313–319

    Article  PubMed  Google Scholar 

  15. Likes WM, Stegbauer C, Tillmanns T, Pruett J (2007) Pilot study of sexual function and quality of life after excision for vulvar intraepithelial neoplasia. J Reprod Med 52:23–27

    PubMed  Google Scholar 

  16. Stellman RE, Goodwin JM, Robinson J, Dansak D, Hilgers RD (1984) Psychological effects of vulvectomy. Psychosomatics 25:779–783

    Article  CAS  PubMed  Google Scholar 

  17. Green MS, Naumann RW, Elliot M, Hall JB, Higgins RV, Grigsby JH (2000) Sexual dysfunction following vulvectomy. Gynecol Oncol 77:73–77

    Article  CAS  PubMed  Google Scholar 

  18. Aerts L, Enzlin P, Vergote I, Verhaeghe J, Poppe W, Amant F (2012) Sexual, psychological, and relational functioning in women after surgical treatment for vulvar malignancy: a literature review. J Sex Med 9:361–371

    Article  PubMed  Google Scholar 

  19. Alder J, Bitzer J (2011) Gynecological cancer and sexuality. Ther Umsch 68:581–586

    Article  PubMed  Google Scholar 

  20. Gunther V, Malchow B, Schubert M, Andresen L, Jochens A, Jonat W, Mundhenke C, Alkatout I (2014) Impact of radical operative treatment on the quality of life in women with vulvar cancer—a retrospective study. Eur J Surg Oncol 40:875–882

    Article  CAS  PubMed  Google Scholar 

  21. Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, Ferguson D, D’Agostino Jr R (2000) The female sexual function index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 26:191–208

  22. Wiegel M, Meston C, Rosen R (2005) The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther 31:1–20

    Article  PubMed  Google Scholar 

  23. Ribeiro MC, Nakamura MU, Torloni MR, Scanavino Mde T, Scomparini FB, Mattar R (2014) Female sexual function of overweight women with gestational diabetes mellitus—a cross-sectional study. PLoS One 9:e95094

    Article  PubMed Central  PubMed  Google Scholar 

  24. Farmer MA, Meston CM (2007) Predictors of genital pain in young women. Arch Sex Behav 36:831–843

    Article  PubMed Central  PubMed  Google Scholar 

  25. StataCorpLP (2014) Stata/SE 13.1 for Windows. StataCorp LP, College Station

    Google Scholar 

  26. Lindau ST, Schumm LP, Laumann EO, Levinson W, O’Muircheartaigh CA, Waite LJ (2007) A study of sexuality and health among older adults in the United States. N Engl J Med 357:762–774

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  27. Andersen BL, Turnquist D, LaPolla J, Turner D (1988) Sexual functioning after treatment of in situ vulvar cancer: preliminary report. Obstet Gynecol 71:15–19

    PubMed Central  CAS  PubMed  Google Scholar 

  28. Laumann EO, Nicolosi A, Glasser DB, Paik A, Gingell C, Moreira E, Wang T (2005) Sexual problems among women and men aged 40–80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Int J Impot Res 17:39–57

    Article  CAS  PubMed  Google Scholar 

  29. Laumann EO, Paik A, Rosen RC (1999) Sexual dysfunction in the United States: prevalence and predictors. JAMA 281:537–544

    Article  CAS  PubMed  Google Scholar 

  30. Camacho ME, Reyes-Ortiz CA (2005) Sexual dysfunction in the elderly: age or disease? Int J Impot Res 17(Suppl 1):S52–S56

    Article  PubMed  Google Scholar 

  31. Verschuren JE, Enzlin P, Dijkstra PU, Geertzen JH, Dekker R (2010) Chronic disease and sexuality: a generic conceptual framework. J Sex Res 47:153–170

    Article  PubMed  Google Scholar 

  32. Schick V, Herbenick D, Reece M, Sanders SA, Dodge B, Middlestadt SE, Fortenberry JD (2010) Sexual behaviors, condom use, and sexual health of Americans over 50: implications for sexual health promotion for older adults. J Sex Med 7(Suppl 5):315–329

    Article  PubMed  Google Scholar 

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Conflict of interest

All authors declare that there are no conflicts of interest involved with the presented data. This study was funded by internal departmental sources.

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Authors and Affiliations

  1. Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Donata Grimm, Anna-Katharina Schliedermann, Fabian Trillsch, Katharina Prieske, Friederike Gieseking, Sven Mahner & Linn Woelber

  2. Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Christine Eulenburg

  3. Department of Gynecology and Gynecologic Oncology, Medical Center Asklepios Altona, Hamburg, Germany

    Oliver Brummer

  4. Vulvar Cancer Support Group (VulvaKarzinom SHG e.V.), Wilhelmshaven, Germany

    Enzia Selka

Authors
  1. Donata Grimm
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  2. Christine Eulenburg
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  3. Oliver Brummer
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  4. Anna-Katharina Schliedermann
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  5. Fabian Trillsch
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  6. Katharina Prieske
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  7. Friederike Gieseking
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  8. Enzia Selka
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  9. Sven Mahner
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  10. Linn Woelber
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Corresponding author

Correspondence to Linn Woelber.

Additional information

Donata Grimm and Christine Eulenburg contributed equally to this work.

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Grimm, D., Eulenburg, C., Brummer, O. et al. Sexual activity and function after surgical treatment in patients with (pre)invasive vulvar lesions. Support Care Cancer 24, 419–428 (2016). https://doi.org/10.1007/s00520-015-2812-8

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  • DOI: https://doi.org/10.1007/s00520-015-2812-8

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