The Human Papilloma Virus Effect on Sexual Life
Condition: Human Papillomavirus Infection
MeSH terms: Papillomavirus Infections; Papilloma
Study type: Observational

Summary: 
      Human Papilloma Virus (HPV) is one of the most common causes of sexually transmitted diseases
      and its link with malignancies is well established, especially with anogenital tract cancers
      (cervical, vaginal, vulvar, anal cancers). HPV 16 and 18 are the most commonly isolated HPV
      types in cervical cancer, however not all infections with HPV 16 or 18 progress to cancer.
      After the HPV test has been used in cervical cancer screening, there have been concerns about
      whether women carry this virus. Although HPV testing may cause negative emotional responses,
      adverse emotional responses are related to HPV infection rather than testing. In this
      respect, there were several studies which evaluated the quality of life and psychological
      responses of women with positive HPV test results and it is known that positive HPV test
      results cause additional anxiety, distress and negative emotional responses in women. We
      hypothesized that the awareness of having a sexually transmitted infection in women with HPV
      and, therefore, a close follow-up and the need for further investigation such as colposcopy
      can affect their sexual life. In this study, we aimed to observe the changes in sexual
      function and anxiety of the HPV positive women with validated objective tools after being
      informed about their co-test results.
    

Detailed description: 
      The present prospective, observational study was undertaken among women who were attended to
      our gynecology outpatient clinic due to HPV positivity according to the cervical cancer
      screening programme. After the ethics approval was obtained from our hospital's local ethics
      committee, women aged between 30 and 50 years, sexually active, and who were first diagnosed
      with high risk HPV positive (HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 69, 82)
      were included in the study. Women with HPV positive were given standard information about HPV
      and HPV testing (co-test) developed by a clinical expert. This information includes; sexually
      transmitted nature of HPV, its high prevalence in sexually active women, usually transient
      nature of HPV, the association between high risk and low- risk HPV types and cervical
      intraepithelial neoplasia (CIN) and cervical cancer, the importance of HPV 16/18 positivity
      for cervical premalignant and malign lesions. After given the standard information, the
      patients were informed about their co-test results including HPV genotype, cytology results.
      The demographic data of the patients such as gravidity, parity,Body Mass Index (BMI),
      educational status, and marital status were recorded at the time of admission. The routine
      gynecologic examination was performed to all participants. The BMI was calculated as weight
      (kg) divided by the square of the height (m2). The patients were divided into four groups
      according to their HPV genotype and cytology results. The patients were divided into four
      groups according to their HPV genotype and cytology results. Group 1: HPV 16/18 (+), cytology
      normal, Group 2: HPV 16/18 (+), cytology abnormal, Group 3: non-16/18 HPV (+), cytology
      abnormal, Group 4: non-16/18 HPV (+), cytology normal. In our clinic, we manage the patients
      with abnormal co-test results according to the American Society for Colposcopy and Cervical
      Pathology guidelines. The patients in group 1, 2, and 3 were referred to colposcopy according
      to American Society for Colposcopy and Cervical Pathology (ASCCP) guideline and the patients
      in group 4 were referred to colposcopy according to their symptoms and vaginal examination
      results such as suspicious cervical observation for cervical intraepithelial neoplasia,
      postcoital bleeding and all of the participants were informed about the colposcopy procedure.
      All of the patients called for a follow-up visit two months later and were performed a
      colposcopy. Sexual function of the patients was assessed at the time of admission and two
      months later via the self-administered Female Sexual Function Index (FSFI) questionnaire. The
      anxiety status of the patients has assessed via the Beck Anxiety Inventory (BAI)
      questionnaire at the time of admission and 2 months later.

      Cervical Cancer Screening and management of the results:

      According to the national cervical cancer screening program in our country, screening is
      initiating at the age of 21 and women age <30 are screening with Papanicolaou test alone at
      intervals of every three years. Women ≥ 30 years have been screening with co-testing (HPV
      testing and Pap test) every five years. When HPV positivity is detected in the co-test, the
      HPV genotype is determined and the pap test is evaluated cytologically. While the patients
      with HPV 16/18 positive (cytology normal or abnormal) and non-HPV 16/18 positive and cytology
      abnormal referred to a specialist gynecologist for colposcopy, it is recommended that
      patients who have a non-HPV 16/18 positive and cytology normal should have a co-test after 1
      year.

      Beck Anxiety Inventory The Beck Anxiety Inventor (BAI) is a brief measure of anxiety with a
      focus on somatic symptoms of anxiety that was developed as a measure adept at discriminating
      between anxiety and depression. The BAI is administered via self-report and includes
      assessment of symptoms such as nervousness, dizziness, inability to relax, etc. The BAI has a
      total of 21 items. Respondents indicate how much they have been bothered by each symptom over
      the past week. Responses are rated on a 4-point Likert scale and range from 0 (not at all) to
      3 (severely). The BAI is used in efforts to obtain a purer measure of anxiety that is
      relatively independent of depression. The total score is calculated by finding the sum of the
      21 items. It is defined as; Score of 0-21 = low anxiety Score of 22-35 = moderate anxiety
      Score of 36 and above = potentially concerning levels of anxiety Female Sexual Function Index
      Sexual dysfunction was assessed via the self-administered FSFI which was adapted to the
      Turkish population. This is a 19-item questionnaire that covers six domains: desire (two
      questions); arousal and lubrication (four questions each); and orgasm, satisfaction, and pain
      (three questions each). The possible scores are 0-5 for the arousal, lubrication, orgasm, and
      pain domains; 1-5 for the satisfaction domain; and 1-5 for the desire domain. Domain scores
      were obtained by summing the scores of the individual items comprising the domain and then
      multiplying by the following domain factors: 0.6 for desire, 0.3 for arousal and lubrication,
      and 0.4 for orgasm, satisfaction, and pain. Regarding the individual domains, a score of less
      than 65% of the maximum achievable score was considered to indicate dysfunction in that
      domain. Thus, a score of less than 3.9 in each domain was considered to indicate Female
      sexual disorder (FSD). The full score is obtained by adding the six domain scores. FSFI
      scores range from 2.0 to 36.0, with higher scores indicating better sexual functioning. The
      total FSFI score was calculated and categorized as a dichotomous variable using 26.55 as a
      cutoff for overall Female sexual disorder. Sexual function was further categorized into four
      groups, as described previously: normal sexual function (total FSFI score ≥26.55), mild
      Female sexual disorder (total FSFI score 18-26.55), moderate Female sexual disorder (total
      FSFI score 11-17), and severe Female sexual disorder (total FSFI score ≤10).

      We compared the FSFI and BAI scores between the groups and between the time of admission and
      2 months later.
    

Intervention name(s): FSFI
Intervention type(s): Other
Intervention description(s): Sexual dysfunction was assessed via the self-administered Female Sexual Function Index Questionnaire which was adapted to the Turkish population. This is a 19-item questionnaire that covers six domains: desire; arousal, lubrication, orgasm, satisfaction, and pain. The full score is obtained by adding the six domain scores. FSFI scores range from 2.0 to 36.0, with higher scores indicating better sexual functioning.
Other intervention name(s): Female Sexual Function Index Questionnaire
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Women who were attended to our gynecology outpatient clinic due to HPV positivity according
        to the cervical cancer screening programme were recruited in this study.