Psychological Correlates of Sexual Dysfunction in Female Rectal and Anal Cancer Survivors: Analysis of Baseline Intervention Data

Abstract

Introduction Sexual dysfunction represents a complex and multifactorial construct that can affect both men and women and has been noted to often deteriorate significantly after treatment for rectal and anal cancer. Despite this, it remains an understudied, underreported and undertreated issue in the field of cancer survivorship. Aim This study examined the characteristics of women enrolled in an intervention trial to treat sexual dysfunction, and explored the relationship between sexual functioning and psychological well-being. Main Outcomes Measures Quality of life (EORTC-QLQ-C30 & QLQ-CR38), sexual functioning (FSFI) and psychological well-being (BSI Depression/Anxiety, IES-R, CR-38 Body Image). Methods There were 70 female post-treatment anal or rectal cancer survivors assessed as part of the current study. Participants were enrolled in a randomized intervention trial to treat sexual dysfunction and completed outcome measures prior to randomization. Results Women enrolled in the study intervention were on average 55 years old, predominantly Caucasian (79%), married (57%) and a median of 4 years post-primary treatment. For those reporting sexual activity at baseline (N=41), sexual dysfunction was associated with a range of specific measures of psychological well-being, all in the hypothesized direction. The Sexual/Relationship Satisfaction subscale was associated with all measures of psychological well-being (r=−.45 to −.70, all p<.01). Body image, anxiety and cancer-specific post-traumatic distress were notable in their association with subscales of sexual functioning, while a global quality of life measure was largely unrelated. Conclusions For sexually-active female rectal and anal cancer survivors enrolled in a sexual health intervention, sexual dysfunction was significantly and consistently associated with specific measures of psychological well-being, most notably Sexual/Relationship Satisfaction. These results suggest that sexual functioning may require focused assessment by providers, beyond broad quality of life assessments, and that attention to Sexual/Relationship Satisfaction may be critical in the development and implementation of interventions for this cohort of patients.

Sexual Function and Health-Related Quality of Life in Long-Term Rectal Cancer Survivors

“…We also found evidence of this in our qualitative data, where the ostomy appliance was described as “ugly” and “not appealing.” Evidence suggests that sexual dysfunction is associated with a range of psychological well-being outcomes, including body image, anxiety, and posttraumatic distress. 27,28 Survivors with permanent ostomies are also more likely to experience social distress post-treatment. 29 Similar to other studies 4,5 , we found a high prevalence of persistent sexual dysfunction associated symptoms in both female and male survivors regardless of ostomy status.…”

The sexual health of female rectal and anal cancer survivors: results of a pilot randomized psycho-educational intervention trial

“…Therefore, we also calculated these effect sizes excluding women who were not sexually active at baseline (see Table 2). Similar to prior studies [33, 34], women who left blank or indicated no sexual activity/ intercourse to ≥8 of the 15 FSFI questions with this response option were considered to have insufficient sexual activity for the FSFI to be a valid assessment of their functioning. This analysis of the subgroup of women considered sexually active at baseline was not a part of the original analysis plan in the protocol for this RCT; however, given that the validity of the FSFI as an outcome measure is contingent upon its use among sexually active respondents, we felt it important to present the effect sizes for this sexually active subgroup in order to provide the most appropriate effect size estimates for researchers planning similar studies that will utilize the FSFI.…”

Investigation of body image as a mediator of the effects of bowel and GI symptoms on psychological distress in female survivors of rectal and anal cancer

“…Participants (N=70) were part of a sexual health intervention study for women reporting low to moderate satisfaction with their sexual functioning and overall sexual life (see Philip and colleagues [28] for full study information). Sexual satisfaction was assessed using an item from the Female Sexual Function Index (“Over the past 4 weeks, how satisfied have you been with your overall sexual life?”; 5=Very Satisfied to 1=Very Dissatisfied) and individuals scoring a 5 were excluded [29].…”