Trial Information

Cervical or Endometrial Cancer and Sexual Health Study

Whereas relatively more research and therapy options exist for physical treatments of sexual
dysfunction in women with a history of cervical cancer (e.g. hormone replacement, surgery;
Denton & Maher, 2003), there is some evidence that psychological interventions have positive
effects on sexuality. For example, a brief psychoeducational program for women with
early-stage cervical cancer resulted in significant improvements in the frequency of coital
activity (Capone et al., 1980), and enhanced compliance with sexual rehabilitation, reduced
fear about intercourse and improved sexual knowledge compared to a control condition
(Robinson et al., 1999). Unfortunately, neither study targeted nor assessed sexual arousal
or genital sensations - symptoms documented to be most problematic and distressing in this
group of women. There is also evidence that providing a venue for women to receive
education and discuss sexual concerns following cervical cancer is therapeutic as it might
encourage women to be more aware of their sexual rehabilitation and capacity for change,
thus evoking a more active coping style (Leenhouts et al., 2002). Taken together, these
studies suggest that psychoeducational interventions are feasible and significantly improve
general domains of sexual function, such as sexual frequency and knowledge, in cervical
cancer survivors.

Although directly targeting psychological constructs such as thoughts, affect, and
behaviour, psychological treatments can also evoke physiological change. In cervical
cancer-related sexual dysfunction where the psychological and physical contributors of
impairment are difficult to tease apart, a psychoeducational intervention that addresses
both etiological domains is essential. We have recently developed a 3-session
psychoeducational intervention designed to address both the physical and psychological
consequences of cervical cancer on sexual arousal. The sexual arousal concerns reported by
this group of women fit the criteria for Female Sexual Arousal Disorder (FSAD), defined by
the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revised
(DSM-IV-TR) as "persistent or recurrent inability to attain, or to maintain until completion
of the sexual activity, an adequate lubrication-swelling response of sexual excitement"
where "the disturbance causes marked distress or interpersonal difficulty" (American
Psychiatric Association, 2000). A proportion of these women also experience new onset
difficulties becoming subjectively sexually aroused, likely as a direct result of the
genital arousal difficulties, but also due to the impact of cancer and hysterectomy on
psychological function. Despite the wide prevalence of such subjective arousal concerns,
this is not a diagnostic category in the DSM-IV-TR. However, the International Consultation
on Sexual Dysfunctions, in collaboration with the World Health Organization, has suggested
that "Subjective Sexual Arousal Disorder" be recognized as a valid concern (Basson et al.,
2003). Evidence-based treatments for FSAD related to genital or subjective arousal
difficulties do not exist, and persisting distress due to untreated sexual dysfunction can
compromise mental and physical health. The contents of our psychoeducational intervention
were based on:

- empirically supported techniques in other areas of female sexual dysfunction (e.g.,
sensate focus, challenging of maladaptive cognitions and sexual myths);

- discussions with gynecological oncologists at the University of Washington who are
usually the first-line recipients of such sexual complaints; and

- pilot interviews conducted with 18 cervical and endometrial cancer survivors to date.

The intervention focuses primarily on sexual arousal, both genital and subjective, and
secondarily on the interaction between cervical cancer and hysterectomy with relationship
satisfaction, body image, and beliefs about health.