Psychosexual morbidity in women with ovarian cancer

Abstract

Increasing numbers of women are surviving for longer with epithelial ovarian cancer. Consequently, there is increased focus on long-term quality of life in national guidance. Psychosexual morbidity including vaginal dryness, pain during intercourse (dyspareunia), reduced libido, and negative perceived body image exacerbate stress and anxiety and impact intimate relationships. Although a priority for women with epithelial ovarian cancer, clinicians seldom discuss sexual problems. Therefore, psychosexual morbidity and the associated distress remain unaddressed. We synthesize evidence from primary qualitative and quantitative research studies exploring psychosexual morbidity in women with epithelial ovarian cancer to identify potential risk factors and common symptoms, to facilitate the identification and management of sexual problems in clinic. Literature (2008–19) from 10 databases identified 29 suitable publications (4116 patients). The papers were assessed to answer the question: “What are the key potential risk factors and presentations of psychosexual morbidity in women with epithelial ovarian cancer?” Current literature lacks consensus in defining clinically significant psychosexual morbidity in women with epithelial ovarian cancer. Discrepancies in measurement tools, questionnaires, and primary outcome measures confound result interpretation, limiting wider application. Key potential risk factors identified included: younger age (<53 years); pre-menopausal status at diagnosis; aim of treatment; extent of surgery; more courses of chemotherapy; cardiovascular co-morbidities; and anxiety and depression. Up to 75% of women with epithelial ovarian cancer reported adverse changes in their sex lives following diagnosis and, of the sexually active, vaginal dryness affected 81–87% and pain 77%. Other prevalent symptoms included: reduced sexual desire and activity, impaired orgasm, diminished perceived body image, and reduced partner intimacy. Psychosexual morbidity represents a significant unmet need for women with epithelial ovarian cancer. Effective treatment necessitates a multimodal approach encompassing medical, psychoeducational, and physiotherapy-based strategies. Future studies need agreement in their questionnaires, definitions, thresholds, and primary outcome measures for meaningful interstudy comparisons to be drawn.

Areas to Improve Quality of Life After Ovarian Tumor Surgery and Adjuvant Treatment

“…Dysparenunia was a common physical symptom prevalent according to the above mentioned review (35) but in this study when analyzing the data, we removed the question about vaginal dryness from our calculations about sexuality since less than half of the participating women had answered the question. Increased vaginal dryness in gyneacological cancer survivors could be due to older age, more years since menopause but also that fewer women may use local oestrogen treatment due to a malignant diagnosis (36,37). Patients with ovarian cancer diagnosis were less satisfied with their body image compared with patients with benign tumors.…”

“…All cancer diagnoses and cancer treatment can affect sexual health, and the healthcare team must address the topic of sexual health with the cancer patient and her partner in order to show the patient that it is a not neglected subject. Logue et al described that psychosocial morbidity is a relevant topic that needs to be explored more and future studies need consensus in their questionnaires, definitions, thresholds, and primary outcome measures (37).…”

Psychosexual Morbidity in Women With Ovarian Cancer: Evaluation by Germline BRCA Gene Mutational Status

“…4 Up to 75% of women with ovarian cancer experience psychosexual morbidity. 5 The common symptoms reported include dyspareunia, vaginal dryness, negative changes to sex lives, diminished perceived body image and reduced intimacy with partners. 5 Over half of women with ovarian cancer are at risk of anxiety and over a third are vulnerable to depression.…”

“…6,7 We recently identified potential risk factors for psychosexual morbidity in women with ovarian cancer: younger age; premenopausal status at diagnosis; noncurative aim of treatment; extensive surgery; high courses of chemotherapy; cardiovascular comorbidities; anxiety, and depression. 5 Women with ovarian cancer are living longer with the side effects of treatment; the latest U.K. data shows 5-year survival increased from 42.3% to 46.2% (2006−2011). 1 This was largely attributed to greater access to optimal primary treatment, more use of maintenance therapies and more aggressive treatment of recurrent disease.…”

“…The FSFI assesses both the physical and psychological aspects of sexual functioning and is commonly used across the literature. 5 Women with ovarian cancer and a germline BRCA1/2 mutation (gBRCAm) may be at greater risk of psychosexual morbidity, as they are on average 10 years younger at diagnosis, more likely to have undergone surgical menopause, breast cancer surgery or risk-reducing bilateral mastectomies. 2 Distinct treatment options are available specifically for women with gBRCAm ovarian cancer with notably favourable outcomes.…”