(263) Sexuality and Fertility among Young Women Treated for Cervical Cancer
Authors: Kaabia O , Belkahla A 
Published: March 2024

Abstract

Introduction
Cervical cancer is the fourth cancer in women. Its incidence is particularly high in developing countries. The increase in cases among young women in low- and middle-income countries may be due to changes in sexual behaviors and an increased risk of HPV infection and the absence of vaccination programs. The mortality and morbidity rates of cervical cancer are very high if diagnosed at an advanced stage. It is a preventable Human Papilloma Virus (HPV) related cancer. Cervical cancer patients are often stigmatized because of the idea that this cancer is associated with early-onset sexuality. Furthermore, the treatments for such cancer are mutilating for women often causing definitive infertility and sexual and/or couple dysfunctions.

Objective
This study aims to describe the changes in sexuality and fertility among young women diagnosed and treated for cervical cancer

Methods
It is a monocentric cross-sectional study based on a phone survey. We included and contacted all young women (under 40) when they were diagnosed with and/or treated for cervical cancer in our institution for 11 years from January 2010 to December 2020. We excluded all patients with a history of chronic disease other than cervical cancer. The study took place from January To May 2022. We developed an 8-item questionnaire in the local dialect and used the validated translation of the Female Sexual Function Index (FSFI) to evaluate the participants' sexual function.

Results
We included 23 cases of cervical cancer in young women, i.e. a response rate of 4.6%. The average age of our sample was 34.7 years (±4.7). The median age of first sexual intercourse was 21.5 years [20–25.25]. The abortion rate was 2 [0.25–2.75] per participant. The median age of the first pregnancy was 21 years [21–27]. The most common symptom leading to the cancer diagnosis was post-coital metrorrhagia in 12 (52.2%) of cases. The first Pap smear led to a cervical cancer diagnosis in 13 cases (56.5%). Five patients had a tumor size ≤ 40 mm and 4 patients were metastatic at the time of the diagnosis. Eighteen patients underwent surgical treatment of whom 5 had a fertility-sparing technique. All patients got radiation. The average duration of follow-up was 5.72 years ±0.3.247. The average survival is 9.7 years (±0.9 years; 95% CI 7.9 – 11.5 years). The 3-year survival rate is 82.6%, and the 5-year survival rate is 82.6%. Five patients expressed a desire for pregnancy after the treatment, one got pregnant after 5 years. Five patients expressed that there was an impact on their sexuality after the treatment with sexual disorders with pain, in particular dyspareunia and vulvodynia, and a decrease in female desire associated with a guilty feeling. All patients had pathological FSFI scores regarding all the domains of female sexual function

Conclusions
Sexuality and fertility are taboo among young cervical cancer survivors. The sexual stigma of cervical cancer as a sexually transmitted disease is present in our population. Fertility-sparing surgical techniques and less sexually harmful radiation techniques are still to be perfected.

Disclosure
No.