Gynecologic cancer disrupts sexual function, over the short term and the long term
Jensen PT, Groenvold M, Klee MC, Thranov I, Petersen MA, Machin D. Early-stage cervical carcinoma, radical hysterectomy, and sexual function: a longitudinal study. Cancer. 2004;100(1):97–106.
Vaz AF, Pinto-Neto AM, Conde DM, et al. Quality of life and menopausal and sexual symptoms in gynecologic cancer survivors: a cohort study. Menopause. 2011;18(6):662–669.
These two studies explored sexual function after treatment for gynecologic cancer. The investigators found significant disruption of function.
Jensen et al: Radical hysterectomy for cervical Ca damages sexual function significantly
This was a prospective cohort study of 173 women who had early-stage cervical carcinoma and who underwent radical hysterectomy with pelvic lymphadenectomy (all of them node-negative). A validated questionnaire was administered six times, from 5 weeks to 24 months after surgery. An age-matched group of women without cancer was used for comparison. At the 12-month follow-up, patients were asked to report their sexual function at baseline and compare it to their current status. Overall, the women had a higher level of dissatisfaction with their sexual experiences 12 months after surgery than at baseline.
Details of the study
Women in the Jensen study were 23 to 75 years old (median age, 42.7 years), and 93% were sexually active at the time of diagnosis, reporting an average of one to two sexual activities in a week. Forty-six women (25%) were postmenopausal at diagnosis, compared with 34% of the control group. Only 8% of patients were using HT at study entry, compared with 25% of women in the control group. By 12 months after surgery, however, 25% of gynecologic cancer patients were taking systemic HT.
Findings included low libido and other ills
Severe lack of lubrication and low or no sexual desire were reported by cancer patients throughout the first 2 years after surgery. Patients also reported severe problems achieving orgasm as long as 6 months after surgery, as well as reduced vaginal size; both problems rendered their sexual experiences unsatisfactory. Nevertheless, 40% of patients reported at least some sexual activity by 5 weeks after surgery. By 6 months after surgery, there were almost as many sexually active women among the patient group as there were in the control group. However, at 18 months after treatment, patients reported less interest in intimacy—among both themselves and their partners—than among women in the control group. Overall, women treated for cervical cancer had a higher level of dissatisfaction with their sexual experiences 12 months after surgery than they did before diagnosis.
Although 91% of women who were sexually active before surgery resumed intercourse within 12 months, the frequency of sexual activity declined from one to two times per week to three to four times per month. Major long-term changes occurred in regard to libido (interest in sexual relations), arousal (vaginal lubrication), and vaginal size. Although dyspareunia was a significant problem 5 weeks to 3 months after surgery, it resolved within 1 to 2 years.
Jensen and colleagues concluded that radical hysterectomy for treatment of early-stage cervical cancer has significant negative effects on sexual function in the short and long term. They postulated a neurogenic basis for the sexual complaints and discussed both histologic and clinical studies to support this hypothesis.
They also emphasized the need to discuss the risks and management of sexual dysfunction with patients before and after surgery. Better management of the psychosocial consequences of a cancer diagnosis and the physical effects of radical hysterectomy may help avoid the negative experiences that were reported in this study.
Vaz et al: Rate of dyspareunia was high among women treated for endometrial or cervical Ca
Investigators followed 107 women from initial consultation for radiation therapy through 3 years post-treatment. Although a significant percentage (50%) of the cohort was lost to follow-up—many due to death or tumor recurrence—50% of those who remained reported dyspareunia 3 years after radiotherapy.
Women in this study were 21 to 75 years old (median age, 60 years) and had cervical or endometrial carcinoma. Eighty-nine women (83%) received external pelvic radiation as well as brachytherapy. Before beginning radiation therapy, 37.4% of the cohort underwent surgery for treatment of their cancer. Sixty-four percent of the cohort had stage III or IV disease.
At enrollment, 50% of women reported having a life partner, 82% were postmenopausal, and 11.2% were taking HT. However, only 21.5% of women reported sexual activity. The authors opine that this low rate of sexual activity may have been due to recent surgery, bleeding, or pain related to cancer.