"Sexual adjustment after cancer treatment is a major problem for many, many couples," says Dr. Barbara Andersen, a psychologist and member of The Ohio State University Comprehensive Cancer Center. Andersen has been studying cancer and its impact on sexual activity for nearly 20 years, and says studies have shown that anywhere from 30 percent to 50 percent of women with gynecological cancers face serious disruption in their sexual lives following treatment.
"This is becoming a much more visible issue because new treatments and earlier detection have enabled a growing percentage of women to survive these diseases," says Andersen. According to the National Cancer Institute, women with gynecological malignancies constitute almost 12 percent of the nearly 9 million cancer survivors in the United States today.
Among cancer patients, women with gynecological cancers may have the most difficulty with sexual adjustment because they face the most complex recovery issues. Cancer therapy depends upon the extent of the disease at diagnosis, but can often include surgery, radiation and chemotherapy – all difficult under any circumstances, but even more so when surgery disrupts parts of the body that reflect social imperatives underlying a person's sense of self-worth and feelings about their own sexuality, says Andersen.
Surgery to treat gynecological cancers can be extensive. Some patients require the removal of all their pelvic organs; others face procedures that shorten or tighten the vagina, making lubrication and intercourse difficult; and chemotherapy often obliterates ovarian function, robbing a woman of her ability to have children. "These are all extreme measures, and while they can often save a woman's life, they will also dramatically impact the quality of her life afterwards," says Kristen Carpenter, a doctoral candidate who works with Andersen.
Carpenter says if researchers could predict which women will have more difficulty than others, they then might be able to offer psychological intervention early in their treatment that will help them with adjustment later on. Andersen and Carpenter studied 73 women referred by their family physicians to oncologists specializing in gynecological malignancies at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute. The women were ages 23-80 and were interviewed during their initial visit before a cancer diagnosis was confirmed.
Study participants filled out questionnaires about their sexual relationship with their partner, and also completed a personality self-assessment from a list of 24 adjectives describing attitudes and social behaviors. In earlier research, Andersen was able to clump these traits into three axes she calls "sexual schema," or broad descriptors of personality types that help predict sexual adjustment; loving-romantic, direct-openness and embarrassed-conservative. The researchers then followed the women for a period of 12 months after surgery.
They found that women who underwent adjuvant therapy and women with sexual difficulties before treatment had the most difficulty making a satisfactory sexual adjustment following treatment. In terms of emotional adjustment, women with more depressive symptoms at diagnosis and women who underwent adjuvant therapy also fared worse after treatment.
Interestingly, those attributes alone did not fully predict adjustment. Other factors come into play, too, including the degree of satisfaction in a relationship before the cancer diagnosis, and the frequency of intercourse and other sexual activity before treatment. In other words, says Carpenter, "what is emerging is that how happy you are with your partner appears to be an important protective element against the onslaught of cancer therapy."
The study is part of related research on sexual outcomes among breast cancer patients funded by the National Cancer Institute.