Abstract
Treatment of early-stage cervical and endometrial cancer has been associated with significant sexual difficulties in at least half of women following hysterectomy. Despite the fact that women report such sexual side effects to be the most distressing aspect of their cancer treatment, evidence-based treatments for Female Sexual Arousal Disorder (FSAD), the most common sexual symptom in this group, do not exist. We developed and pilot tested a brief, three session psychoeducational intervention (PED) targeting FSAD in 22 women with early-stage gynecologic cancer. The PED consisted of three, 1-h sessions that combined elements of cognitive and behavioral therapy with education and mindfulness training. Women completed questionnaires and had a physiological measurement of genital arousal at pre- and post-PED (sessions 1 and 4) and participated in a semi-structured interview (session 4) during which their feedback on the PED was elicited. There was a significant positive effect of the PED on sexual desire, arousal, orgasm, satisfaction, sexual distress, depression, and overall well-being, and a trend towards significantly improved physiological genital arousal and perceived genital arousal. Qualitative feedback indicated that the PED materials were very user-friendly, clear, and helpful. In particular, women reported the mindfulness component to be most helpful. These findings suggest that a brief 3-session PED can significantly improve aspects of sexual response, mood, and quality of life in gynecologic cancer patients, and has implications for establishing the components of a psychological treatment program for FSAD.
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Notes
The treatment manual is available from the corresponding author upon request.
References
Adams, S. G., Dubbert, P. M., Chupurdia, K. M., Jones, A., Lofland, K. R., & Leermakers, E. (1996). Assessment of sexual beliefs and information in aging couples with sexual dysfunction. Archives of Sexual Behavior, 25, 249–260.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
Andersen, B. L., & Wolf, F. M. (1986). Chronic physical illness and sexual behavior: Psychological issues. Journal of Consulting and Clinical Psychology, 54, 168–175.
Andersen, B. L., Woods, X. A., & Copeland, L. J. (1997). Sexual self-schema and sexual morbidity among gynecologic cancer survivors. Journal of Consulting and Clinical Psychology, 65, 221–229.
Anderson-Darling, C., & McKoy-Smith, Y. (1993). Understanding hysterectomies: Sexual satisfaction and quality of life. Journal of Sex Research, 30, 324–335.
Basson, R. (2002). A model of women’s sexual arousal. Journal of Sex and Marital Therapy, 28, 1–10.
Basson, R. (2004). Pharmacotherapy for sexual dysfunction in women. Expert Opinion in Pharmacotherapy, 5, 1045–1059.
Basson, R., & Brotto, L. A. (2001). Detailed interview assessment of real-life sexual arousal. Unpublished interview.
Basson, R., & Brotto, L. A. (2003). Sexual psychophysiology and effects of sildenafil citrate in oestrogenized women with acquired genital arousal disorder and impaired orgasm. British Journal of Obstetrics and Gynaecology, 110, 1014–1024.
Beck, A. T., & Beamesderfer, A. (1974). Assessment of depression: The Depression Inventory. In P. Pichot (Ed.), Modern problems in pharmacopsychiatry: Psychological measurements in psychopharmacology (pp. 151–169). New York: Karger, Basel.
Bergmark, K., Avall-Lundqvist, E., Dickman, P. W., Henningsohn, L., & Steineck, G. (1999). Vaginal changes and sexuality in women with a history of cervical cancer. New England Journal of Medicine, 340, 1383–1389.
Bergmark, K., Avall-Lundqvist, E., Dickman, P. W., Henningsohn, L., & Steineck, G. (2002). Patient-rating of distressful symptoms after treatment for early cervical cancer. Acta Obstetrics Gynecology Scandinavia, 81, 443–450.
Brotto, L. A., & Heiman, J. R. (2003). Sexual arousal and cervical cancer: Psychoeducation treatment manual. Unpublished document.
Brotto, L. A., & Heiman, J. R. (2007). Mindfulness in sex therapy: Applications for women with sexual difficulties following gynaecologic cancer. Sexual and Relationship Therapy, 22, 3–11.
Butler, L., Banfield, V., Sveinson, T., & Allen, K. (1998). Conceptualizing sexual health in cancer care. Western Journal of Nursing Research, 20, 683–705.
Butler-Manuel, S. A., Buttery, L. D., A’Hern, R. P., Polak, J. M., & Barton, D. P. (2000). Pelvic nerve plexus trauma at radical hysterectomy and simple hysterectomy: The nerve content of the uterine supporting ligaments. Cancer, 89, 834–841.
Butler-Manuel, S. A., Buttery, L. D., A’Hern, R. P., Polak, J. M., & Barton, D. P. (2002). Pelvic nerve plexus trauma at radical and simple hysterectomy: A quantitative study of nerve types in the uterine supporting ligaments. Journal of the Society of Gynecology Investigation, 9, 47–56.
Capone, M. A., Good, R. S., Westie, K. S., & Jacobson, A. F. (1980). Psychosocial rehabilitation of gynecologic oncology patients. Archives of Physiological Medicine and Rehabilitation, 61, 128–132.
Centers for Disease Control and Prevention. (2001). 2001 Cancer data by site and race. Retrieved November 30, 2004, from http://apps.nccd.cdc.gov/uscs/.
Clarke, A., Black, N., Rowe, P., Mott, S., & Howle, K. (1995). Indications for and outcome of total abdominal hysterectomy for benign disease: A prospective cohort study. British Journal of Obstetrics and Gynaecology, 102, 611–620.
Denton, A. S., & Maher, E. J. (2003). Interventions for the physical aspects of sexual dysfunction in women following pelvic radiotherapy (Cochrane Review). In: The Cochrane Library. Oxford: Update Software.
Derogatis, L. R., Rosen, R., Leiblum, S., Burnett, A., & Heiman, J. (2002). The Female Sexual Distress Scale (FSDS): Initial validation of a standardized scale for assessment of sexually related personal distress in women. Journal of Sex and Marital Therapy, 28, 317–330.
Ewert, B., Slangen, T., & van Herendael, B. (1995). Sexuality after laparoscopic-assisted vaginal hysterectomy. Journal of the American Association of Gynecologic Laparoscopy, 3, 27–32.
Gottman, J. M., & Silver, N. (1999). The seven principles for making marriage work. New York: Three Rivers Press.
Grumann, M., Robertson, R., Hacker, N. F., & Sommer, G. (2001). Sexual functioning in patients following radical hysterectomy for stage IB cancer of the cervix. International Journal of Gynecologic Cancer, 11, 372–380.
Hahn, T. N. (1976). The miracle of mindfulness: A manual on meditation. Boston: Beacon Press.
Hayes, S. C., Follette, V. M., & Linehan, M. M. (Eds.). (2004). Mindfulness and acceptance: Expanding the cognitive behavioral tradition. New York: Guilford Press.
Heiman, J. R., & LoPiccolo, J. (1988). Becoming orgasmic: A sexual and personal growth program for women. New York: Simon & Schuster.
Heiman, J. R., & Rowland, D. L. (1983). Affective and physiological sexual response patterns: The effects of instructions on sexually functional and dysfunctional men. Journal of Psychosomatic Research, 27, 105–116.
Helstrom, L., Weiner, E., Sorbrom, D., & Backstrom, T. (1994). Predictive value of psychiatric history, genital pain and menstrual symptoms for sexuality after hysterectomy. Acta Obstetrics Gynecology Scandinavia, 73, 575–580.
Jacobson, E. (1938). Progressive relaxation. Chicago: University of Chicago Press.
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.
Kuppermann, M., Summitt, R. L., Varner, R. E., McNeeley, S. G., Goodman-Gruen, D., Learman, L. A., et al. (2005). Sexual functioning after total compared with supracervical hysterectomy: A randomized trial. Obstetrics and Gynecology, 105, 1309–1318.
Kylstra, W. A., Leenhouts, G. H. M. W., Everaerd, W., Panneman, M. J. M., Hahn, D. E. E., Weijmar Schultz, W. C. M., et al. (1999). Sexual outcomes following treatment for early stage gynecological cancer: A prospective multicenter study. International Journal of Gynecologic Cancer, 9, 387–395.
Leenhouts, G. H. M. W., Kylstra, W. A., Everaerd, W., Hahn, D. E. E., Weijmar Schultz, W. C. M., van de Wiel, H. B. M., et al. (2002). Sexual outcomes following treatment for early-stage gynecological cancer: A prospective and cross-sectional multi-center study. Journal of Psychosomatic Obstetrics and Gynaecology, 23, 123–132.
Lemieux, L., Kaiser, S., Pereira, J., & Meadows, L. M. (2004). Sexuality in palliative care: Patient perspectives. Palliative Medicine, 18, 630–637.
Lieberman, M. A., Golant, M., Giese-Davis, J., Winzlenberg, A., Benjamin, H., Humphreys, K., et al. (2003). Electronic support groups for breast carcinoma: A clinical trial of effectiveness. Cancer, 97, 920–925.
Maas, C. P., ter Kuile, M., Tuynman, C., Laan, E., Weyenborg, P., Trimbos, J. B., et al. (2002). Disturbance of sexual response after radical hysterectomy: A psychophysiologic study. International Journal of Gynecologic Cancer, 12, 613–614.
MacElvenn-Hoehn, H., & McCorkle, R. (1985). Understanding sexuality in progressive cancer. Seminars in Oncology Nursing, 1, 56–62.
National Cancer Institute. (2005). Endometrial cancer. Retrieved September 9, 2005, from http://www.nci.nih.gov/cancertopics/pdq/prevention/endometrial/HealthProfessional.
Rhodes, J. C., Kjerulff, K. H., Langenberg, P. W., & Guzinski, G. M. (1999). Hysterectomy and sexual functioning. Journal of the American Medical Association, 282, 1934–1941.
Rice, A. M. (2000). Sexuality in cancer and palliative care 2: Exploring the issues. International Journal of Palliative Nursing, 6, 448–453.
Robinson, J. W., Faris, P. D., & Scott, C. B. (1999). Psychoeducational group increases vaginal dilation for younger women and reduces sexual fears for women of all ages with gynecological carcinoma treated with radiotherapy. International Journal of Radiation Oncology and Biological Physics, 44, 497–506.
Roovers, J. P., van der Bom, J. G., van der Vaart, C. H., & Heintz, A. P. (2003). Hysterectomy and sexual well-being: Prospective observational study of vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy. British Medical Journal, 327, 774–778.
Rosen, R., Brown, C., Heiman, J., Leiblum, S., Meston, C. M., Shabsigh, R., et al. (2000). The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. Journal of Sex and Marital Therapy, 26, 191–208.
Sintchak, G., & Geer, J. H. (1975). A vaginal plethysmograph system. Psychophysiology, 12, 113–115.
Spanier, G. B. (1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage and the Family, 38, 15–28.
Syrjala, K. L., Schroeder, T. C., Abrams, J. R., Atkins, T. Z., Brown, W. S., Saunders, J. E., et al. (2000). Sexual function measurement and outcomes in cancer survivors and matched controls. Journal of Sex Research, 37, 213–225.
Tolman, D. L., & Szalacha, L. A. (1999). Dimensions of desire: Bridging qualitative and quantitative methods in a study of female adolescent sexuality. Psychology of Women Quarterly, 23, 7–39.
van Manen, M. (1990). Researching lived experience: Human science for an action sensitive pedagogy. Albany: State University of New York Press.
Virtanen, H., Makinen, J., Tenho, T., Kiilholma, P., Pitkanen, Y., & Hirvonen, T. (1993). Effects of abdominal hysterectomy on urinary and sexual symptoms. British Journal of Urology, 72, 868–872.
Ware, J. J., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30, 473–83.
Weijmar Schultz, W. C. M., van de Wiel, H. B. M., & Bouma, J. (1991). Psychosexual functioning after treatment for cancer of the cervix: A comparative and longitudinal study. International Journal of Gynecologic Cancer, 1, 37–46.
Weijmar Schultz, W. C. M., van de Wiel, H. B. M., Hahn, D. E. E., & Bouma, J. (1992). Psychosexual functioning after treatment for gynecological cancer: An integrative model, review of determinant factors and clinical guidelines. International Journal of Gynecologic Cancer, 2, 281–290.
Wenzel, L. B., Donnelly, J. P., Fowler, J. M., Habbal, R., Taylor, T. H., Aziz, N., et al. (2002). Resilience, reflection, and residual stress in ovarian cancer survivorship: A gynecologic oncology group study. Psychooncology, 11, 142–153.
Wiegel, M., Meston, C., & Rosen, R. (2005). The Female Sexual Function Index (FSFI): Cross-validation and development of clinical cutoff scores. Journal of Sex and Marital Therapy, 31, 1–20.
Winzelberg, A. J., Classen, C., Alpers, G. W., Roberts, H., Koopman, C., Adams, R. E., et al. (2003). Evaluation of an internet support group for women with primary breast cancer. Cancer, 97, 1164–1173.
Acknowledgements
We are grateful for the feedback from Amy Wagner and Craig Sawchuk on our PED treatment and participant manuals. This research was supported by a Sexuality Research Fellowship from the Social Science Research Council and a Grant-in-Aid from the Foundation for the Scientific Study of Sexuality to Lori A. Brotto. This research was conducted during a Postdoctoral Fellowship at the University of Washington and was supervised by Julia R. Heiman.
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Brotto, L.A., Heiman, J.R., Goff, B. et al. A Psychoeducational Intervention for Sexual Dysfunction in Women with Gynecologic Cancer. Arch Sex Behav 37, 317–329 (2008). https://doi.org/10.1007/s10508-007-9196-x
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DOI: https://doi.org/10.1007/s10508-007-9196-x