Sexual Self Schema as a Moderator of Sexual and Psychological Outcomes for Gynecologic Cancer Survivors

Abstract

Gynecologic cancer patients are at high risk for emotional distress and sexual dysfunction. The present study tested sexual self schema as an individual difference variable that might be useful in identifying those at risk for unfavorable outcomes. First, we tested schema as a predictor of sexual outcomes,including bodychangestress. Second,we examined schema as a contributor to broader quality of life outcomes, specifically as a moderator of the relationship between sexual satisfaction and psychological statue (depressive symptoms and quality of life). A cross-sectional design was used. Gynecologic cancer survivors (N = 175) 2−10 years post treatment were assessed during routine follow up. In regression analyses controlling for sociodemographic variables, patients' physical symptoms/signs as evaluated by nurses, health status, and extent of partner sexual difficulties, sexual self schema accounted for significant variance in the prediction of current sexual behavior, responsiveness, and satisfaction. Moreover, schema moderated the relationship between sexual satisfaction and psychological outcomes, suggesting that a positive sexual self schema might "buffer" patients from depressive symptoms when their sexual satisfaction is low. Furthermore, the combination of a negative sexual self schema and low sexual satisfaction might heighten survivors' risk for psychological distress, including depressive symptomatology. These data support the consideration of sexual self schema as a predictor of sexual morbidity among gynecologic cancer survivors.

Physical Sequelae and Depressive Symptoms in Gynecologic Cancer Survivors: Meaning in Life as a Mediator

“…Gynecologic patients report fatigue that is life disrupting as do many other cancer patients [58,59], but their higher incidence of sexual difficulties distinguish their survivorship [60]. Vaginal changes, as assessed here, covary with decreased sexual functioning [61] and may negatively impact a woman's view of herself as a sexual person [61,62]. Thus, there are many changes that may alter meaning for gynecologic survivors, some unique to their disease and others not.…”

Sexual Self-Esteem and Psychosocial Functioning in Military Veterans After Cancer

“…If further evidence confirms our findings, addressing potential and established sexual concerns with Veteran patients as a part of their survivorship care may be warranted. These findings may be particularly relevant for professionals who also address mental health concerns, given the accumulating evidence that sexual and mental health symptoms frequently co-occur and are associated with overall adjustment Carpenter, Andersen, Fowler, & Maxwell, 2009;Dizon, 2009;Stein et al, 2008).…”

Filling in the gaps: Sociodemographic and medical predictors of sexual health and other supportive care needs, and desire for help in gynecological cancer survivors

“…Future studies with higher statistical power could address many of our study limitations by: (a) allowing a less stringent alpha level that may detect additional significant relationships; and (b) exploring other predictors such as socioeconomic variables (e.g., rural/urban settings, work status, income), gynecological cancer type, education, and baseline psychological factors such as sexual self-schema (Carpenter et al, 2009). …”

“…Left unmet, these needs are linked to increased psychosocial distress and lower overall quality of life (Carpenter, Andersen, Fowler, & Maxwell, 2009). Most post-treatment needs appear to be non-physical in nature (Steele & Fitch, 2008;Beesley, Eakin, Steginga, Aitken, Dunn, & Battistutta, 2008;Hodgkinson et al, 2007).…”

“…Research has, however, identified potential risk factors for sexual dysfunction and/or distress across all gynecological cancer sites; these include having radiation therapy and/or chemotherapy, being partnered, poor body image, and a negative sexual self-schema, or view of oneself as a sexual being (Lagana et al, 2005;Carpenter et al, 2009;Bruner et al, 1993;Jensen et al, 2004a;Lutgendorf et al, 2000;Schover, 2012). Further exploration of these potential predictors of unmet needs would help identify at risk patient groups that would benefit most from preventative and treatment interventions (Hodgkinson et al, 2007) The current literature also provides interesting research directions with regard to patient readiness for help with unmet needs.…”