Elsevier

Gynecologic Oncology

Volume 124, Issue 3, March 2012, Pages 477-489
Gynecologic Oncology

Review
A systematic review of sexual concerns reported by gynecological cancer survivors

https://doi.org/10.1016/j.ygyno.2011.11.030Get rights and content

Abstract

Objective

To identify physical, psychological and social sexual concerns reported by gynecological (GYN) cancer survivors.

Methods

A systematic review of the literature was conducted using CINAHL, PubMed and PsycInfo databases. Reference lists from articles provided additional relevant literature. Only research articles from peer-reviewed journals were included. A total of 37 articles were located; 34 explored women's sexual concerns following gynecological cancer diagnosis and treatment and 3 tested interventions for sexual concerns in women with gynecological cancer.

Results

Sexual concerns were identified across all dimensions of sexuality. Common concerns in the physical dimension were dyspareunia, changes in the vagina, and decreased sexual activity. In the psychological dimension, common concerns were decreased libido, alterations in body image, and anxiety related to sexual performance. And in the social dimension, common concerns were difficulty maintaining previous sexual roles, emotional distancing from the partner, and perceived change in the partner's level of sexual interest. Of the three psychoeducational intervention studies, two reported improvements in physical aspects of sexual function, and one reported improved knowledge, but without resolution of sexual concerns.

Conclusion

Gynecological cancer survivors experience a broad range of sexual concerns after diagnosis and treatment, but the majority of studies emphasized physical aspects of sexuality, and may not adequately represent women's psychological and social sexual concerns. Health care providers should remain mindful of psychological and social sexual concerns when caring for gynecologic cancer survivors. Future research should systematically evaluate the full range of sexual concerns in large, representative samples of GYN cancer survivors and develop and test interventions to address those concerns.

Highlights

► Literature focuses on physical sexual dysfunction in gynecologic cancer survivors. ► Women report range of sexual concerns: physical, psychological, social. ► Research should include comprehensive/systematic assessment of sexual concerns.

Section snippets

Introduction/Background

Over 76,500 new cases of gynecological cancer are diagnosed in the United States each year [1]. Treatment for gynecological cancer may cause significant physical, psychological, and social (or interpersonal) side effects that can interfere with a woman's sexuality [2], [3]. Investigators report that between 30-100% of gynecological cancer survivors experience some form of physical sexual dysfunction [for reviews see [4], [5], [6], [7]]. Female sexual dysfunction is characterized by decreased

Method

A systematic review of literature was conducted to answer the question, “What are the physical, psychological and social concerns that GYN cancer survivors experience related to their sexuality; including, but not limited to, sexual dysfunction?” The first author (KAA) searched CINAHL, PubMed, PsycInfo, and Google Scholar databases through August 2011. No date limitation was set: the earliest date covered in the database was 1948. The following terms were used in various combinations: GYN*,

Results

Over 1000 research articles were located that addressed a broad range of themes related to sexuality in cancer patients. A total of 37 articles met our inclusion criteria, with publication dates from 1988 to 2011. Thirty-four studies explored sexual concerns following gynecological cancer diagnosis and treatment, and three studies investigated effects of interventions designed to address sexual concerns in women with a variety of gynecological cancer diagnoses. Table 1 provides information

Discussion

Of the 34 studies reviewed to identify sexual concerns, all but one identified physical sexual concerns. In that one study, participants were asked to discuss how treatment affected their sexuality and the relationship with their partner, but no physical sexual concerns were raised [35]. A total of 16 physical concerns were identified in this review. The scope of physical sexual concerns encompassed effects from structural changes and changes in hormonal status. Dyspareunia was commonly

Conclusion

This review provided evidence that gynecological cancer survivors experience sexual concerns across physical, psychological and social dimensions of sexuality; but it appears that physical sexual concerns have received greater attention than psychological and social concerns. More research is needed that includes comprehensive and systematic assessment of sexual concerns, using reliable and valid measures in large representative samples that include all gynecologic cancer diagnoses, stages of

Conflict of interest statement

All authors declare that they have no conflicts of interest regarding this manuscript.

Acknowledgements

This work is supported in part by the Doctoral Degree Scholarship in Cancer Nursing #121325-DSCN-11-209-01-SCN from the American Cancer Society and the Gwen Shapiro Wisconsin Distinguished Doctoral fellowship. The authors would like to thank Rebecca J. Muehrer, PhD, RN, Sandra Ward, PhD, RN, FAAN, and the Kwekkeboom Research Group for their review and feedback on earlier versions of the manuscript.

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