Journal of Cancer Research and Clinical Oncology

, Volume 145, Issue 2, pp 495–502 | Cite as

Gynecologic radiation oncology patients report unmet needs regarding sexual health communication with providers

  • Christina Hunter Chapman
  • Gerard Heath
  • Pamela Fairchild
  • Mitchell B. Berger
  • Daniela Wittmann
  • Shitanshu Uppal
  • Anagha Tolpadi
  • Katherine Maturen
  • Shruti JollyEmail author
Original Article – Clinical Oncology



Following radiation therapy (RT), women with gynecologic malignancies report high rates of sexual dysfunction, but little is known regarding sexual health communication between these patients and health-care providers. This study assessed these patients’ beliefs/attitudes toward providers’ sexual history taking.


Surveys were administered to women who presented for follow-up care for gynecologic cancers in an academic radiation oncology department. The surveys assessed patient sexual health beliefs and inquiry preferences. Sexual functioning was assessed using the Female Sexual Function Index (FSFI). Ordered logistic regressions were performed to assess for correlations between survey responses, FSFI, and demographic characteristics.


Seventy-five subjects participated. Most (89.8%) had FSFI scores indicating sexual dysfunction. Most patients agreed that sexual function is an important component of overall health (78.7%) and that providers should inquire regularly (62.8%). Few (12.0%) reported embarrassment around provider discussions. Most (62.7%) preferred discussion with female providers, especially married patients (p = 0.03). Half (53.4%) agreed that sexual problems are an unavoidable part of aging, a view that was more common as education level decreased (p = 0.01). Most (62.7%) patients agreed that providers should regularly ask about their sexual history, with patients having significant differences in education level. Patients with low FSFI scores were less likely to report inquiry from their OB/Gyn (p = 0.03).


Gynecologic cancer radiotherapy patients want to discuss sexual health, but report suboptimal provider inquiry. Patient views and experiences varied based on marital status, education level, and FSFI score. This work highlights the need for improved sexual health communication between cancer patients and providers.


Sexual dysfunction Sexual history taking Radiation therapy Gynecological cancer 



Investigator support for MBB was provided by Eunice Kennedy Shriver National Institute of Child Health and Human Development BIRCWH Career Development Award # K12 HD001438. Institutional support for use of the REDCap application was provided through CTSA, National Center for Advancing Translational Sciences Grant UL1TR000433.

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no conflict of interest.


  1. Alazri MH, Neal RD (2003) The association between satisfaction with services provided in primary care and outcomes in type 2 diabetes mellitus. Diabet Med 20:486–490CrossRefGoogle Scholar
  2. Anastasiadis AG, Davis AR, Ghafar MA, Burchardt M, Shabsigh R (2002) The epidemiology and definition of female sexual disorders. World J Urol 20:74–78. CrossRefGoogle Scholar
  3. Araujo AB, Durante R, Feldman HA, Goldstein I, McKinlay JB (1998) The relationship between depressive symptoms and male erectile dysfunction: cross-sectional results from the Massachusetts Male Aging. Study Psychosom Med 60:458–465CrossRefGoogle Scholar
  4. Arora NK (2003) Interacting with cancer patients: the significance of physicians’ communication behavior. Soc Sci Med 57:791–806CrossRefGoogle Scholar
  5. Association of Reproductive Health Professionals (2010) Sexual health fundamentals: talking with patients about sexuality and sexual health. Accessed 10 Sept 2018
  6. Baser RE, Li Y, Carter J (2012) Psychometric validation of the Female Sexual Function Index (FSFI) in. cancer survivors Cancer 118:4606–4618. Google Scholar
  7. Bertakis KD, Azari R (2012) Patient-centered care: the influence of patient and resident physician gender and gender concordance in primary care. J Womens Health (Larchmt) 21:326–333. CrossRefGoogle Scholar
  8. Castelo-Branco C, Palacios S, Ferrer-Barriendos J, Alberich X, Group CS (2010) Do patients lie? An open interview vs. a blind questionnaire on sexuality. J Sex Med 7:873–880. CrossRefGoogle Scholar
  9. Chen WT et al (2007) Chinese HIV-positive patients and their healthcare providers: contrasting Confucian versus Western notions of secrecy and support ANS. Adv Nurs Sci 30:329–342. CrossRefGoogle Scholar
  10. Damast S et al (2012) Sexual functioning among endometrial cancer patients treated with adjuvant high-dose-rate intra-vaginal radiation therapy. Int J Radiat Oncol Biol Phys 84:e187–e193. CrossRefGoogle Scholar
  11. DeSimone M, Spriggs E, Gass JS, Carson SA, Krychman ML, Dizon DS (2014) Sexual dysfunction in female cancer survivors. Am J Clin Oncol 37:101–106. CrossRefGoogle Scholar
  12. Donovan JL et al (2016) Patient-reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med 375:1425–1437. CrossRefGoogle Scholar
  13. Ekwall E, Ternestedt BM, Sorbe B (2003) Important aspects of health care for women with gynecologic cancer. Oncol Nurs Forum 30:313–319. CrossRefGoogle Scholar
  14. Fisher LL, Anderson G, Chapagain M, Montenegro X, Smoot J, Takalkar A (2010) Sex, romance, and relationships: AARP survey of midlife and older adults. AARP, Washington, DCCrossRefGoogle Scholar
  15. Geiss IM, Umek WH, Dungl A, Sam C, Riss P, Hanzal E (2003) Prevalence of female sexual dysfunction in gynecologic and urogynecologic patients according to the international consensus classification. Urology 62:514–518CrossRefGoogle Scholar
  16. Goldstein I, Lines C, Pyke R, Scheld JS (2009) National differences in patient-clinician communication regarding hypoactive sexual desire disorder. J Sex Med 6:1349–1357. CrossRefGoogle Scholar
  17. Greenfield S, Kaplan S, Ware JE (1985) Expanding patient involvement in care. Effects on patient outcomes. Ann Intern Med 102:520–528CrossRefGoogle Scholar
  18. Hall JA, Roter DL, Rand CS (1981) Communication of affect between patient and physician. J Health Soc Behav 22:18–30CrossRefGoogle Scholar
  19. Harmon G, Lefante J, Krousel-Wood M (2006) Overcoming barriers: the role of providers in improving patient adherence to antihypertensive medications. Curr Opin Cardiol 21:310–315. CrossRefGoogle Scholar
  20. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381. CrossRefGoogle Scholar
  21. Hendren SK et al (2005) Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann Surg 242:212–223CrossRefGoogle Scholar
  22. Herndon JH, Pollick KJ (2002) Continuing concerns, new challenges, and next steps in physician–patient communication. J Bone Jt Surg Am 84-A:309–315CrossRefGoogle Scholar
  23. Hinchliff S, Gott M (2011) Seeking medical help for sexual concerns in mid- and later life: a review of the literature. J Sex Res 48:106–117. CrossRefGoogle Scholar
  24. Hordern A (2000) Intimacy and sexuality for the woman with breast cancer. Cancer Nurs 23:230–236CrossRefGoogle Scholar
  25. Hordern AJ, Street AF (2007) Let’s talk about sex: risky business for cancer and palliative care clinicians. Contemp Nurse 27:49–60. CrossRefGoogle Scholar
  26. Incrocci L (2011) Talking about sex to oncologists and cancer to sexologists. J Sex Med 8:3251–3253. CrossRefGoogle Scholar
  27. Incrocci L, Jensen PT (2013) Pelvic radiotherapy and sexual function in men and women J Sex Med 10(Suppl 1):53–64 CrossRefGoogle Scholar
  28. Juraskova I, Butow P, Robertson R, Sharpe L, McLeod C, Hacker N (2003) Post-treatment sexual adjustment following cervical and endometrial cancer: a qualitative insight. Psychooncology 12:267–279. CrossRefGoogle Scholar
  29. Kaplan SH, Greenfield S, Ware JE (1989) Assessing the effects of physician–patient interactions on the outcomes of chronic disease. Med Care 27:S110–S127CrossRefGoogle Scholar
  30. Kindler CH, Szirt L, Sommer D, Häusler R, Langewitz W (2005) A quantitative analysis of anaesthetist–patient communication during the pre-operative visit. Anaesthesia 60:53–59. CrossRefGoogle Scholar
  31. 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. CrossRefGoogle Scholar
  32. Moreira ED, Kim SC, Glasser D, Gingell C (2006) Sexual activity, prevalence of sexual problems, and associated help-seeking patterns in men and women aged 40–80 years in Korea: data from the Global Study of Sexual Attitudes and Behaviors (GSSAB). J Sex Med 3:201–211. CrossRefGoogle Scholar
  33. Nicolosi A, Moreira ED, Villa M, Glasser DB (2004) A population study of the association between sexual function, sexual satisfaction and depressive symptoms in men. J Affect Disord 82:235–243. CrossRefGoogle Scholar
  34. O’Keefe M (2001) Should parents assess the interpersonal skills of doctors who treat their children? A literature review. J Paediatr Child Health 37:531–538CrossRefGoogle Scholar
  35. Roos AM, Sultan AH, Thakar R (2012) Sexual problems in the gynecology clinic: are we making a mountain out of a molehill? Int Urogynecol J 23:145–152. CrossRefGoogle Scholar
  36. Rosen R et al (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. CrossRefGoogle Scholar
  37. Roter DL (1983) Physician/patient communication: transmission of information and patient effects Md. State Med J 32:260–265Google Scholar
  38. Sadovsky R, Basson R, Krychman M, Morales AM, Schover L, Wang R, Incrocci L (2010) Cancer and sexual problems. J Sex Med 7:349–373. CrossRefGoogle Scholar
  39. Sobecki JN, Curlin FA, Rasinski KA, Lindau ST (2012) What we don’t talk about when we don’t talk about sex: results of a national survey of US obstetrician/gynecologists. J Sex Med 9:1285–1294. CrossRefGoogle Scholar
  40. Song T, Choi CH, Lee YY, Kim TJ, Lee JW, Kim BG, Bae DS (2012) Sexual function after surgery for early-stage cervical cancer: is there a difference in it according to the extent of surgical radicality? J Sex Med 9:1697–1704. CrossRefGoogle Scholar
  41. Stead ML (2003) Sexual dysfunction after treatment for gynaecologic and breast malignancies. Curr Opin Obstet Gynecol 15:57–61. CrossRefGoogle Scholar
  42. Wei JT, Dunn RL, Litwin MS, Sandler HM, Sanda MG (2000) Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer. Urology 56:899–905CrossRefGoogle Scholar
  43. 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. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Radiation OncologyUniversity of MichiganAnn ArborUSA
  2. 2.Center for Clinical Management ResearchVeterans Affairs Ann Arbor Healthcare SystemAnn ArborUSA
  3. 3.Pelvic Floor Research Group, Department of Obstetrics and GynecologyUniversity of MichiganAnn ArborUSA
  4. 4.Department of UrologyUniversity of MichiganAnn ArborUSA
  5. 5.Department of Obstetrics and GynecologyUniversity of MichiganAnn ArborUSA
  6. 6.Department of BiostatisticsUniversity of MichiganAnn ArborUSA
  7. 7.Department of RadiologyUniversity of MichiganAnn ArborUSA

Personalised recommendations