Feeling well and talking about sex: psycho-social predictors of sexual functioning after cancer

Abstract

BackgroundChanges to sexual wellbeing are acknowledged to be a long-term negative consequence of cancer and cancer treatment. These changes can have a negative effect on psychological well-being, quality of life and couple relationships. Whilst previous conclusions are based on univariate analysis, multivariate research can facilitate examination of the complex interaction between sexual function and psycho-social variables such as psychological wellbeing, quality of life, and relationship satisfaction and communication in the context of cancer, the aim of the present study.MethodSix hundred and fifty seven people with cancer (535 women, 122 men) and 148 partners (87 women, 61 men), across a range of sexual and non-sexual cancers, completed a survey consisting of standardized measures of sexual functioning, depression and anxiety, quality of life, relationship satisfaction, dyadic sexual communication, and self-silencing, as well as ratings of the importance of sex to life and relationships.ResultsMen and women participants, reported reductions in sexual functioning after cancer across cancer type, for both people with cancer and partners. Multiple regression analysis examined psycho-social predictors of sexual functioning. Physical quality of life was a predictor for men and women with cancer, and for male partners. Dyadic sexual communication was a predictor for women with cancer, and for men and women partners. Mental quality of life and depression were also predictors for women with cancer, and the lower self-sacrifice subscale of self-silencing a predictor for men with cancer.ConclusionThese results suggest that information and supportive interventions developed to alleviate sexual difficulties and facilitate sexual renegotiation should be offered to men and women with both sexual and non-sexual cancers, rather than primarily focused on individuals with sexual and reproductive cancers, as is the case currently. It is also important to include partners in supportive interventions. Interventions aimed at improving sexual functioning should include elements aimed at improving physical quality of life and sexual communication, with a focus on psychological wellbeing also being important for women with cancer.

Importance of sexuality in colorectal cancer: predictors, changes, and response to an intimacy enhancement intervention

“…Notably, the factors associated with lower importance of sexuality in this study differ from those found to be associated with worse sexual function in colorectal cancer patients (e.g., older age) [31], suggesting that importance of sexuality is a concept related to but distinct from sexual function. Sexuality was rated as marginally more important for male than female patients in the prospective sample, which is consistent with prior research in a mixed cancer patient sample [7]. However, in the current colorectal cancer sample, we found that treatment-related factors and sexual function status were more important predictors of the importance of sexuality than gender.…”

“…While patients with a range of cancer diagnoses rate sexuality as being important [7], this belief likely does not stay stagnant after a cancer diagnosis. For instance, sexual activity seems to be of a lower priority for individuals undergoing treatment for cancer or those who have advanced disease relative to other priorities such as getting through treatment and dealing with the uncertainty of finding a cure [8,9], although intimacy can remain important to patients who have advanced or recurrent disease [10].…”

Development of oncosexuality and oncofertility in France: Why now? Cultural and psychosociological aspects

“…Cette approche positive a été également soulignée par le… Comité consultatif national d'éthique [13] : « …la réussite d'une vie sexuelle participe au sentiment du bien-être… et inversement un sentiment de bien-être est généralement nécessaire à la vie sexuelle…, toute amélioration des troubles de la santé sexuelle contribue au bien-être de l'individu… ». Par conséquent, son abord n'est ni déplacé ni intrusif mais, au contraire, rassurant car témoin d'un souci de prise en charge globale (patient-centered care) et d'une meilleure efficacité par l'équipe soignante [4,5,7,8]. Ne pas informer des impacts potentiels (immédiats ou différés, transitoires ou durables, légers ou sévères) et des risques de séquelles relève là aussi d'une mauvaise pratique médicale avec des conséquences médicolégales potentielles [14] : • les malades et leurs partenaires sont presque tous demandeurs, au minimum, d'information et de réassurance et, souvent, d'une prise en charge (préventive ou curative), notamment les plus jeunes [2,[5][6][7][8].…”

“…Nombre de couples, notamment âgés ou ayant une sexualité peu active, s'en accommodent. La sexualité est facultative et se caractérise par de considérables variations inter-et intraindividuelles en fonction de l'environnement et du temps [2,3,[5][6][7][8]. Dans la vraie vie, elle n'est ni homogène ni systé-matique expliquant que près d'un malade sur deux (plutôt féminin, âgé et sans partenaire) soit peu ou pas concerné, temporairement ou plus longtemps [2,12].…”

“…Elles figurent ainsi parmi les principaux soins de support non satisfaits expliquant que près d'un patient sur deux surfe sur Internet à la recherche d'informations et de témoignages alors qu'il attend à juste titre du professionnel de santé une information validée [7]. Paradoxalement, toutes les enquêtes auprès de patients et de professionnels de santé témoignent, chez une très large majorité, d'une réelle sensibilisation et d'une forte demande d'information [1][2][3]5,8]. Quand près d'un adulte sur huit (malade, partenaire, parent) est potentiellement concerné, ce constat d'une forte demande et d'une faible réponse n'est plus acceptable.…”