Sexual Activity, Psychosexual Distress, and Fear of Progression in Women with Human Papillomavirus-Related Premalignant Genital Lesions

Abstract

Introduction Genital human papillomavirus (HPV) infections are very common in women 18 to 30 years old and substantially affect women's sexual health. Aim To examine sexual activity, psychosexual distress, and fear of progression in women diagnosed with HPV-related precancerous genital lesions. Methods In this observational study, women diagnosed with premalignant lesions of the cervix, vagina, or vulva were recruited from a university hospital–based colposcopy clinic. Main Outcome Measures Quantitative data from three validated patient-administered questionnaires (Sexual Activity Questionnaire, German version of the Cervical Dysplasia Distress Questionnaire, and Fear of Progression Questionnaire) were compared within the study population, according to the location of the genital lesion, and with relevant reference populations. Qualitative data from two written open-ended questions about women's thoughts regarding diagnosis and information were analyzed. Results Two-hundred nine women completed the questionnaires. Seventy-eight percent of women (n = 162) were referred for evaluation of suspect lesions of the cervix, 8% (n = 17) of the vagina, and 14% (n = 30) of the vulva. There were no significant differences in questionnaire results among the three patient groups, except for sexual consequences (Cervical Dysplasia Distress Questionnaire) and recent sexual activity (Sexual Activity Questionnaire). Women with vulvar lesions were most likely to worry about sexual consequences (ie, being unable to have children, being sexually less attractive, or infecting a sexual partner; P = .04). The Sexual Activity Questionnaire subscales sexual pleasure (P = .15) and sexual habits (P = 1.00) were similar to those in a healthy control population, whereas sexual discomfort (P = .51) was comparable to that in a reference population of women who survived cervical cancer. The subscale partner-specific concerns (Fear of Progression Questionnaire) was similar to that in a reference population of patients with cancer (P = .28). Conclusion HPV-related precancerous genital lesions, especially of the vulva, are likely to cause concerns about sexual health. Effective information and communication are important to lessen negative sexual consequences and anxiety.

Psychological distress in cervical cancer screening: results from a German online survey

“…Our questionnaire comprised, besides explorative questions, also validated elements. One of these, the Cervical Dysplasia Distress Questionnaire [ 19 ] aims at measuring the women’s perception of diagnostic procedures, their distress and sexual concerns concerning a precancerous genital lesion [ 20 ]. The other element, the “Impact of Event Scale-Revised”, allows to estimate if some of the women experience signs of post-traumatic stress disorder which is known to significantly reduce quality of life and influence morbidity and mortality [ 26 , 27 ].…”

“…Participants went through a 37-item survey including the “Impact of Event Scale-Revised”—German Version as well as parts of the Cervical Dysplasia Distress [ 19 , 20 , 23 ] questionnaires, to evaluate the psychological and emotional burden of recurrent abnormal Pap smears.…”

“…Several studies are known which collected data from women having abnormal Pap smear findings [ 15 – 19 ] or abnormal findings during screening routine in general [ 20 , 21 ]. In these studies, study population was rather small, with two exceptions: (1) the TOMBOLA trial comprises 3331 women [ 18 ] and (2) Balasubramani and colleagues collected data from 1752 women, but limited to women who underwent colposcopy [ 22 ].…”

Effect of Genital Warts on Female Sexual Function and Quality of Life: An Egyptian Study

“…The increased access to effective information and communication are important to lessen negative sexual consequences and anxiety about GWs [24] .…”

Psychological distress among women with abnormal pap smear results in Serbia: Validity and reliability of the Cervical Dysplasia Distress Questionnaire

“…Although the CDDQ scale was developed in English, it has not been widely translated. Even though in the available literature there is no data on its psychometric characteristics, there is a German version of CDDQ with three subscales—tension and discomfort, embarrassment during a gynaecological examination, and concerns about sexual and reproductive consequences—with use reported in women diagnosed with human papilloma virus-related precancerous genital lesions [14]. One subscale (health consequences) was omitted in the German version of CDDQ, because investigators believed that the items were inappropriate for the study population.…”