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ORIGINAL ARTICLE
Year : 2019  |  Volume : 56  |  Issue : 2  |  Page : 157-162
 

Effects of some characteristics of gynecological cancer diagnosis and treatment on women's sexual life quality


1 Department of Gynecology and Obstetric Nursing, Faculty of Nursing, Institute of Health Sciences, Dokuz Eylul University Faculty of Nursing, Izmir, Turkey
2 Faculty of Health Sciences, University of Kyrenia, Kyrenia, Cyprus

Date of Web Publication2-May-2019

Correspondence Address:
Buse Güler
Department of Gynecology and Obstetric Nursing, Faculty of Nursing, Institute of Health Sciences, Dokuz Eylul University Faculty of Nursing, Izmir
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijc.IJC_127_18

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 » Abstract 


BACKGROUND: Gynecological cancers can cause changes in women's sexual life.
AIM: The aim of this study was to evaluate the factors affecting sexual quality of life (SQoL) of women with gynecological cancer.
MATERIALS AND METHODS: A descriptive, cross-sectional study design was used. The study was conducted on 276 women with gynecological cancers in Turkey. Information form and SQoL scale was used in the study. The data were evaluated using Mann–Whitney U-test and Kruskal–Wallis test.
RESULTS: The SQoL mean score was 68.83 ± 21.17. There was no significant difference in the SQoL mean score according to the individual/sociodemographic characteristics or gynecological cancer-related characteristics. However, it was found that the difference was due to higher SQoL score in the group with a diagnosis time of 25 months and above (KW (Χ2) = 6.356, P = 0.046).
CONCLUSION: The reason for significant difference in the SQoL mean score according to diagnosis over time might be that women adapted to cancer diagnosis. For this reason, the SQoL of women with a diagnosis time of < 25 months should be assessed and these women should be supported.


Keywords: Gynecological cancers, sexuality, SQoL


How to cite this article:
Güler B, Mete S. Effects of some characteristics of gynecological cancer diagnosis and treatment on women's sexual life quality. Indian J Cancer 2019;56:157-62

How to cite this URL:
Güler B, Mete S. Effects of some characteristics of gynecological cancer diagnosis and treatment on women's sexual life quality. Indian J Cancer [serial online] 2019 [cited 2019 Dec 10];56:157-62. Available from: http://www.indianjcancer.com/text.asp?2019/56/2/157/257542





 » Introduction Top


Gynecological cancers are common worldwide and are one of the major problems affecting women's health. Gynecological cancer and its treatment affect women physically, psychologically, and socially.[1],[2],[3] Because the cancer is located around the genital organs, sexuality is one of the most affected areas. Gynecological cancers can disrupt the functioning of the female genital organs and can affect sexual life and its quality as a result of both the symptoms of cancer and the side effects of cancer treatment.[3]

There are many studies in the literature that show how women's sexual functioning,[4],[5],[6],[7],[8] self-perception, self-esteem, body image,[7],[9],[10] and sexual roles and sexual identities (such as the concept of motherhood, wife, and femininity)[9] are affected.

Although there are many studies on women with gynecological cancer that examine the sexual functions and sexual activity, the results of these studies are not consistent. Furthermore, only one study examining the quality of sexual life has been found. New and further studies need to be conducted as there are not sufficient studies in this area. This study thus aimed to evaluate the factors that affect the sexual quality of life (SQoL) of women with gynecological cancer.


 » Materials and Methods Top


This cross-sectional and descriptive study was carried out on 276 women with gynecological cancer whose primary diagnosis was endometrium, cervix, ovarian, tubular, vulvar, and vaginal cancer, who attended a gynecological oncology department as outpatients between January and March 2016, who were aware of their diagnosis, between the ages of 18 and 65 years, literate, and could understand and speak Turkish.

The sample size was calculated on the basis of a sample determination formula with an unknown number in the universe and it was found to be 272. The rate of prevalence of the cases examined was 0.23 according to Turkish data from 2015.[11] A total of 276 women were included in the study. The participation of the respondents was voluntary and informed consent was obtained from each participant. The study was approved by the Non-Intervention Research Assessment Commission of the University (Ethical Consideration Number: 2016/01-23).

All participants were evaluated by using the Descriptive Information Form and the SQoL scale. The Descriptive Information Form consisted of introductory features such as age, educational status, and employment status, as well as obstetric information, general health background, and characteristics of the cancer.

Sexual quality of life (SQoL)

The validity and reliability of the Turkish version of SQoL scale was conducted by Tuǧut and Gölbaşı in 2010.[12] The scale was of a Likert-scale type and consisted of 18 items. Each item was scored between one and six (1= “I completely agree,” 2= “I mostly agree,” 3= “I somewhat agree,” 4= “I somewhat disagree,” 5= “I mostly disagree,” and 6= “I completely disagree”). The scores obtainable from the scale are between 18 and 108 and the total score is converted to 100. There is no cutoff point for the scale and a high score represents a good sexual life. The Cronbach's alpha coefficient for the internal consistency measurement of the SQoL was 0.83.[12] The aim in selecting this questionnaire was to include all dimensions of sexuality.

All analyses were performed using SPSS, version 15.0. The data were presented as mean ± SD, percentages, and min and max. The Mann–Whitney U-test was used to compare two groups and Kruskal–Wallis variance analysis was used to compare multiple groups. The Bonferroni corrected Mann–Whitney U-test was performed to find the difference between the groups after the Kruskal–Wallis variance analysis. Statistical significance was accepted when the P value was < 0.05.[13]


 » Results Top


The participants were women (58%) who were over 50 years of age and 72.8% were primary school graduates [Table 1]. The most prevalent cancer was endometrium cancer (43.2%). The mean time for the diagnosis was 41.80 ± 47.64 months.
Table 1: Descriptive and obstetric features of women who are diagnosed with gynecological cancer and have been treated (n: 276)

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According to the results of this study, there was no significant difference between SQoL scores and women's ages, educational status, employment status, parental status, status consideration of having another child [Table 2], their primary diagnosis, cancer recurrence, type of treatment and surgical operation, time passed after the surgical operation and radiotherapy, and type of radiotherapy [Table 3] (P > 0.05).
Table 2: Comparison of SQoL scores of women who are diagnosed with gynecological cancer and have been treated and their descriptive characteristics (n: 276)

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Table 3: Comparison of the cancer-related characteristics of patients and the SQoL scale scores of women who are diagnosed with gynecological cancer (n: 276)

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There was a significant difference between the time of diagnosis and the mean SQoL score (Χ2 KW = 6.356, P = 0.042) [Table 3]. The Mann–Whitney U-test with a Bonferroni correction was used to determine the group in which there was a significant difference between the time of the diagnosis and the mean SQoL score. Consequently, it was found that the difference was due to higher SQoL score in the group of those who had been diagnosed 25 months or more (P = 0.012).


 » Discussion Top


Sexual health affects the biological, psychological, socioeconomic, intellectual, religious, and sociocultural values of the individual.[1],[2],[3] The mean SQoL score was found to be 68.83 ± 21.17 (min: 0, max: 100).Gölbaşı and Erenel (2012) found the SQoL mean score of women with gynecological cancer to be 52.50.[14] The score for SQoL of women with gynecological cancer was higher than that found in this study. Because ovarian cancer is diagnosed at a later stage and has a higher morbidity rate, it may affect the SQoL of women. In Gölbaşı and Erenel's study, the rate of women with ovarian cancer was higher. For this reason the score for SQoL may have been higher.

The results of this study revealed that age did not affect SQoL. This finding is consistent with Gölbaşı and Erenel's study. It stated that the SQoL of women with gynecological cancer was not affected by age.[14] In studies examining sexual function, there was no difference found between women younger than 45 years of age and women older than 45 years of age. However, post-sexual satisfaction and sexual activity were higher in women over 45 years of age.[15] Menopausal symptoms and a negative body image in young patients receiving gynecological cancer treatment, and fertility problems and concerns due to loss of feminine organs negatively affect sexuality.[9],[16] Studies have shown that women's positive body image increases with age[5] and there are fewer worries about sexual function in middle and older age patient groups compared with younger patients.[17] There was no difference between the age groups and the mean SQoL, and this may be related to the fact that 58% of the women were 50 years old or older, that positive body image increases in older ages, and concerns about sexual life reduce with age.

There was a nonsignificant difference between the educational status and SQoL. In the literature, some studies have shown that there is no significant difference between the educational status of women and their SQoL[14] and sexual functions.[18] However, a small number of studies have found that a lower education level has been shown to affect the prevalence of sexual dysfunction, sexual function,[19] and satisfaction[20] in women with ovarian and cervical cancer. Our study consisted solely of gynecological cancer patients. For this reason, educational status may not have affected the SQoL of these women.

In terms of having at least one child, there was a nonsignificant difference. It has been shown that the maternal role of gynecological cancer women with at least one child was not affected.[9] However, this situation can lead to a great trauma in young and childless women who have lost their fertility and these women feel themselves worthless, incomplete, and useless.[8] In our opinion, the women who were diagnosed with and treated for gynecological cancer after having at least one child were not affected in how they perceived themselves as females. For this reason, their SQoL was not affected.

When the effects of the menopause on sexuality were examined, it did not affect SQoL. Many women argue that having a healthy uterus and childbearing is necessary to be defined as a “woman” and it is known that a loss of fertility causes anxiety and stress in women who want to maintain their fertility.[7] Women may have already adapted to the menopause because 58% of them were between the ages of 50 and 65 years and had at least one child.

Some studies indicate that the type of gynecological cancer does not affect sexual arousal, satisfaction,[21] and the SQoL.[14] Our finding is consistent with these studies. The fact that the type of gynecological cancer did not affect the SQoL may be because that all types of gynecological cancer affect in a similar way.

It was found that the recurrence of cancer did not affect the women's SQoL. It has been shown that the sexual function is not affected by the cancer recurrence in vulvar intraepithelial neoplasia and vulvar cancer patients. Having experienced a recurrence did not affect women's sexual function but women with recurrent disease were less likely to be sexually active.[22] It has also been shown in other studies that the recurrence and spread of gynecological cancer may cause anxiety and depression in women and that women avoid sexual intercourse because of their concerns about their cancer recurring and spreading.[8],[9] Sexual activity can decrease in women with gynecologic cancer. It is thought that SQoL may not be affected because sexual life can be maintained by establishing sexual intimacy.

Result of this study revealed that the type of treatment did not affect the women's SQoL. Patients who undergo surgery and receive an adjuvant radiotherapy have lower levels of sexual activity than patients who receive only surgical therapy. However, there is no difference between these patients in terms of sexual function.[23] Göker et al.[1] stated that radiotherapy treatment does not affect the physical, role, and emotional function areas of women with gynecological cancer. The SQoL does not consist only of sexual activity and sexual function. Studies generally only examine sexual functions and activities. This could be the reason that the SQoL was not seen to be affected by the type of the treatment.

It was found that the type of radiotherapy did not affect SQoL. In a study examining the type of radiotherapy used, there was no significant difference in terms of sexual function.[24] However, sexual changes are more common in women who receive brachytherapy.[25] Juraskova et al.[16] found that women receiving combined radiotherapy have more post-treatment sexual satisfaction and sexual activity problems. The fact that the radiotherapy did not affect the SQoL could be related to the dose of radiotherapy and the duration of treatment.

There is no study examining the type of the surgical operation and SQoL. However, there are various studies examining the type of the surgical operation and sexual functions. It has been shown that there is a reduction in sexual activity and desire after surgery while sexual interest and activity increased after 6 months in endometrium cancer patients who had total abdominal hysterectomy bilateral salfingooferectomy (TAH+BSO).[26] Women with radical hysterectomy have a severe vaginal lubrication deficiency and decreased sexual desire during the first 2 years after surgery, and a small proportion of the patients experience dyspareunia and undergo problems with orgasm during the next 6 months of surgery, and also experience stress related to the vaginal contraction.[6] Women with cervical cancer who undergo radical hysterectomy and pelvic lymphadenectomy have decreased lubrication after 3–24 months of treatment and experience a decrease in sexual satisfaction and insensitivity around the labia in the first 2 years.[4] In the literature, studies were carried out for 6 months after the operation. In this study, the time passed after the operation was longer, 25 months or longer. It is thought that the women had adapted during this period and the SQoL was thus not affected by these causes.

The results of this study revealed that the type of primary surgery did not affect SQoL. According to Grimm et al.,[22] the type of primary surgery and multiple surgical interventions do not affect women's sexual functioning. Unlike these findings, women with subtotal hysterectomy had better orgasms, a greater frequency of sexual intercourse, and a better general sexual function than women who had undergone a total abdominal hysterectomy. However, there was no difference between these groups in terms of sexual desire, dyspareunia, and lubrication.[27] Our finding is similar to literature because most of the women were in the postmenopausal period or of an advanced age.

The time passed since radiotherapy did not affect SQoL. Radiotherapy causes changes in the vagina in the first 3 months after radiotherapy and these changes last for a year.[28] Frumovitz et al.[18] have reported that fibrotic changes in the irradiated tissue and vaginal atrophy persist for at least 2 years. It has been stated that the acute complications common in cervical cancer patients receiving radiotherapy are the changes that occur around the vagina and skin irritation and that these return to normal after a few months of treatment.[29] In another study, it was shown that cervical cancer patients had significantly reduced vaginal problems and pain during sexual intercourse 12 months after chemoradiotherapy compared with the situation before the chemoradiotherapy.[30] The fact that the time passed after radiotherapy did not affect the SQoL can be associated with this being a mean of 43 months of treatment.

It has been shown that the time since diagnosis affected SQoL. In the literature, the time passed after diagnosis did not affect the quality of women's sexual lives.[14],[20],[22] SQoL was not increased as linear according to patients' time of diagnosis. Although life and death problems are seen to be more important at the time of diagnosis, sexuality issues come to the fore when the survival process is entered.[31] Because of the late effects of surgery and radiotherapy following primary treatment, the SQoL in 13–24 months may be lower. Due to the completion of treatment and reduction of symptoms in the 2 years after diagnosis, the women in this study may have adapted to their new lives. This may have positively affected their SQoL.


 » Conclusion Top


The SQoL of women with gynecological cancer was not affected by sociodemographic characteristics. It was found that the time passed since diagnosis of gynecological cancer did affect the SQoL. The reason for the significant difference in the mean SQoL score according to diagnosis over time might be that the women had adapted to their cancer diagnosis. For this reason, SQoL of women with a diagnosis < 25 months previously should be assessed and these women should be supported.

Additionally, there is a need for studies in which the SQoL and sexual function are evaluated together. Qualitative studies have shown that the SQoL is affected, but studies using scales have shown that the SQoL is not affected. For this reason, more detailed scales are needed.

Limitations

Sexuality is a multidimensional phenomenon that comprised socioeconomic, psychological, and spiritual components. Gynecological cancer diagnosis and treatment process can affect the overall quality of life through these components. Therefore, sexuality, which is considered as a subdimension of general quality of life, may be affected in this process. Cancer quality of life and sexual life should be evaulated in future research.

In this study, women were divided into three groups according to time passed after diagnosis. It is thought that the inclusion of women in different periods of the diagnosis may affect the SQoL in different ways due to the adaptation to diagnosis, early and late effects of treatment. It is recommended to evaluate the quality of life within a certain period of time, such as at the time of diagnosis, completion of the radiotherapy process, and after surgical treatment.

Disclaimer

This study was presented at ICGOI 2017: 19th International Conference on Gynecology, Obstetrics, and Infertility as oral presentations on 17-18 August 2017, Barcelona, Spain.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Hayran M, Hayran M. Kruskal wallis test. In: Hayran M, Hayran M, editors. Basic Statistics for Health Research. 2nd ed. Ankara: Omega Araştırma; 2011. p. 255-73.  Back to cited text no. 13
    
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Gölbaşı Z, Erenel A. The quality of sexual life in women with gynaecological cancers. Arch Gynecol Obstet 2012;285:1713-7.  Back to cited text no. 14
    
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  [Table 1], [Table 2], [Table 3]



 

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