(006) Do Individual-Level or Relationship-Level Coping Constructs Moderate the Effects of Sexual Function on Sexual Satisfaction and Distress for Breast Cancer Survivors?
Authors: Reese J B , Sorice K A , Handorf E , Porter L S , Lepore S J 
Published: May 2023

Abstract

Introduction
Breast cancer survivors commonly report impaired sexual function, decreased sexual satisfaction, and elevated sexual distress. Theoretically, how one copes with sexual concerns on an individual level (self-efficacy [confidence] in coping with sexual concerns; sexual script flexibility) and relationship level (dyadic sexual communication) could influence the associations between survivors’ sexual function and their sexual satisfaction and distress. Understanding how individual and relational coping constructs influence breast cancer survivors’ sexual outcomes would inform the design of interventions to improve sexual outcomes in this population.

Objective
The objective was to examine whether self-efficacy for coping with sexual concerns, sexual script flexibility, and dyadic sexual communication moderate effects of sexual function on sexual satisfaction and distress in a sample of breast cancer survivors.

Methods
Partnered female survivors of non-metastatic breast cancer who reported some sexual concerns (&gt; 3; range=0-10) and were participating in a couple-based intimacy enhancement intervention trial completed self-report surveys at baseline (pre-intervention). Measures included sexual function (Female Sexual Function Index; FSFI, with Satisfaction removed), sexual satisfaction (FSFI Satisfaction domain), sexual distress (Female Sexual Distress Scale-Revised), self-efficacy for coping with sexual concerns (published 3-item measure), sexual script flexibility (SexFlex scale), and dyadic (partnered) sexual communication (Dyadic Sexual Communication Scale). Linear regression or ordinal logistic regression were conducted to examine the main effects of sexual function on distress and satisfaction, respectively; separate regression models were run for each moderator (including the main effect and interaction with sexual function). Age was controlled in regressions.

Results
120 survivors (Mean age=50.8; 83% White; 13% Black; 4% other; Mean time since diagnosis=30 months; Mean relationship length=21 years) participated. For sexual satisfaction, there was a significant main effect of sexual function, whereby greater function was associated with greater satisfaction, proportional OR = 1.15, 95% CI (1.09, 1.20), p&lt;.001. As shown in Figures 1 and 2, there was evidence of moderation by self-efficacy (p=.009) and dyadic sexual communication (p=.006); specifically, in women with relatively high levels of self-efficacy or communication, the positive relationship between sexual function and satisfaction was stronger than in those with relatively low levels of these moderators. Sexual script flexibility was not a significant moderator. For sexual distress, there was a significant main effect of sexual function, whereby greater function was associated with lower distress, B = -0.60, 95% CI (-0.86, -0.35), p&lt;.001. None of the coping constructs moderated this association.

Conclusions
Findings showed that in a sample of breast cancer survivors reporting sexual concerns, achieving sexual satisfaction may depend on the combination of high sexual function with high confidence for coping effectively with sexual concerns or with high-quality communication with one's intimate partner about sexual issues. Specifically, findings suggest that for the survivors with the lowest self-efficacy for coping with sexual concerns or the poorest dyadic sexual communication, increases in sexual function do not translate to greater sexual satisfaction. These findings underscore the importance of improving survivors’ skills for coping with sexual concerns, especially their skills for communication about sexual issues, in addition to addressing problems with function to improve overall sexual outcomes in this population.

Disclosure
No