Cervical or Endometrial Cancer and Sexual Health Study
Condition: Sexual Dysfunctions, Psychological
MeSH terms: Endometrial Neoplasms; Sexual Dysfunctions, Psychological
Study type: Interventional

Summary: 
      Aim #1. To investigate the efficacy of the psychoeducational intervention (PED) on sexual
      arousal.

      H1: Compared to a control group and to baseline, PED will result in significant improvement
      in:

        -  self-reported subjective sexual arousal;

        -  self-reported genital sensitivity;

        -  psychophysiological sexual arousal.

      Aim #2. To investigate the efficacy of the PED on self-reported orgasm, sexual desire,
      distress, and relationship satisfaction.

      H2: Compared to a control group and to baseline, PED will result in significant improvement
      in self-reported orgasmic experience, sexual desire, sexual distress, and relationship
      satisfaction.

      Aim #3. To investigate the efficacy of the PED on depressive symptoms and quality of life.

      H3: Compared to a control group and to baseline, PED will result in significant improvement
      in self-reported depressive symptoms and quality of life.
    

Detailed description: 
      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.
    

Intervention name(s): psychoeducational intervention
Intervention type(s): Behavioral
Intervention description(s): three 75 minute long individual psychoeducational sessions
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: sexual dysfunction