(512) Towards Scalable Future Interventions for Breast Cancer Survivors: Effects of a Brief Mindfulness Exercise on Genital and Subjective Sexual Arousal
Authors: Kronthaler S M , Friedrich M , Walk K , Oesterling C F , Groschkamp M S , Beier K M , Hatzler L 
Published: May 2023

Abstract

Introduction
Breast Cancer (BC) with a lifetime prevalence of 12.0%, is the most common cancer in women. Out of all BC cases, 70% are hormone receptor positive, requiring anti-hormonal therapy and, in some patients, supplementary chemotherapy. The condition itself, as well as respective BC treatment, often comes with physical impairments (i.e., diminished lubrication, vaginal atrophy), as well as psychological stressors (i.e., sexual self- and body-esteem, performance anxiety) that result in sexual problems in 73.4% of BC survivors (BCS). Sexual problems are frequently accompanied by sexual distress and impaired quality of life. Overall, limited attention is given to sexual health in oncology and treatment options are scarce. Currently, hardly any therapies target the interplay of physical and psychological symptoms to improve sexual distress and overall quality of life of BCS. Recently, meta-analyses have shown the efficacy of mindfulness-based cognitive behavioral therapy for women with sexual dysfunctions (i.e., experiencing sexual problems and simultaneous sexual distress) including BCS. However, the access to health care providers offering such treatments is limited. Psychophysiology studies have identified specific mindfulness exercises, which can lead to an increase of subjective and genital sexual arousal in non-clinical samples after a single brief session. These findings serve as an underpinning for the promising effects of including mindfulness tasks in future therapeutic interventions and scalable digital health applications in order to improve the access to evidence-based treatments for BCS with sexual dysfunctions.

Objectives
The aim of the present study is to test the effect of a brief audio-based mindfulness exercise on genital and subjective sexual arousal, and their concordance in BCS currently undergoing endocrine therapy.

Methods
For this study, 60 women (20 healthy controls, 40 premenopausal BCS currently undergoing anti-hormonal therapy) are recruited to participate in a psychophysiology lab study. Participants are randomly assigned to three experimental conditions: 1) neutral audio, 2) body scan mindfulness exercise, 3) mindfulness exercise with focus on genitals, followed by self-stimulation with a vacuum stimulation device (Womanizer Premium, WOW Tech™ GmbH) in all three groups. Genital arousal and subjective sexual arousal (SSA) serve as outcome variables. As a measure of genital arousal, the vaginal pulse amplitude (VPA) is continuously recorded using vaginal photoplethysmography (BIOPAC®). SSA is repeatedly measured on a scale from 0 (not aroused) to 10 (extremely aroused). Demographic data, hormone levels, heart rate variability, sexual self-esteem, sexual function, and sexual distress are assessed as control variables.

Results
In order to analyze the repeated measures data nested within individuals, intra- (SSA, VPA) and inter-individual (BCS, healthy controls) differences are appraised using hierarchical linear modelling (HLM). Separate 2-level mixed effect models are constructed for each outcome variable (subjective arousal, genital arousal). In order to measure the agreement of genital and subjective arousal (i.e., concordance) within-subject correlations between subjective and genital arousal are calculated.

Conclusion
If effective, a single brief evidence-based mindfulness exercise could serve as a directive for future clinical trials and potentially constitute an accessible treatment approach for sexual dysfunction in BCS.

Disclosure
Yes - WOW Tech™ GmbH