Cervical Cancer Treatment and Its Effects on Sexual Function: Recent Evidence and Approach

Review Article

Austin J Womens Health. 2015;2(1): 1010.

Cervical Cancer Treatment and Its Effects on Sexual Function: Recent Evidence and Approach

Corrêa CSL¹*, Leite ICG², Andrade APS³ and Guerra MR4

¹Physiotherapist, Masters in Public Health – Faculty of Medicine at the Federal University of Juiz de Fora – (UFJF) – Juiz de Fora (MG), Brazil

²PhD in Public Health; Deputy Professor of the Department of Public Health in the Faculty of Medicine at the Federal University of Juiz de Fora – (UFJF) – Juiz de Fora (MG), Brazil. CNPq Productivity Scholarship, Process Number 303464/2013-5

³Undergraduate student, School of Medicine, Federal University of Juiz de Fora - (UFJF); Scientific Initiation Scholarship Recipient - Juiz de Fora (MG), Brazil

4PhD in Public Health; Deputy Professor of the Department of Public Health in the Faculty of Medicine at the Federal University of Juiz de Fora – (UFJF) – Juiz de Fora (MG), Brazil

*Corresponding author: Corrêa CSL, Department of Public Health, School of Medicine at the Federal University of Juiz de Fora, Avenida Eugënio do Nascimento, Dom Bosco, Juiz de Fora, MG, Brazil

Received: January 09, 2015; Accepted: June 15, 2015; Published: June 16, 2015

Abstract

The high curability of Cervical Cancer (CC), when detected early, combined with the latest scientific advances in the treatment of this disease, has contributed to greater survival of patients. However, its treatment can lead to significant late adverse effects, such as sexual dysfunction, significantly compromising quality of life. This study aims to conduct a systematic literature review on the effects of treatment for cervical cancer on sexual function. It is observed that sexual dysfunctions resulting from the treatment of the disease may include: decreased elasticity, mucosal atrophy, shortening, and stenosis of the vagina; reduced lubrication and reduction / loss of vaginal sensation; dyspareunia; reduced sexual desire and arousal; and anorgasmia. Despite growing evidence of sexual morbidity after treatment for cervical cancer, its proper assessment and management are still neglected in routine follow-up care. The need for a positive approach for patients to express their actual daily life situations is highlighted, emphasizing, in this regard, the specific assessment of sexual function, guidance with regard to resuming sexual activity after undergoing treatment, and the necessary interdisciplinary approach in the treatment of sexual dysfunction, when such a condition is identified.

Keywords: Uterine Cervical Neoplasms; Psychological Sexual Dysfunctions; Review Literature as a Topic

Abbreviations

CC: Cervical cancer; WHO: World Health Organization; CIS: Carcinoma in situ; QOL: Quality of life; SG: Surgery group; SCG: Surgery and chemotherapy group; SRG: Surgery and radiotherapy group; RT: Radical trachelectomy; RH: Radical hysterectomy; PFM: Pelvic floor muscles; HRQOL: Health-related quality of life; PFRP: Pelvic floor rehabilitation program

Introduction

A good sex life is an integral part of an individual’s health and well-being, and is very important in a loving relationship [1]. According to the World Health Organization (WHO), sexuality is one of the indicators of quality of life; it influences thoughts, feelings, actions, social integration, and therefore, physical and mental health [2,3]. It is multi factorial and has a complex structure, influenced by biological, psychological, socioeconomic, intellectual, religious, and sociocultural factors, thus its practice depends on the integration of all these factors [4].

Gynecological cancer and its treatments can affect one or more phases of the sexual response cycle, through alterations of sexual function [5]. This is characterized by a disturbance in the processes that constitute the sexual response cycle, due to a lack, an excess, discomfort and/or pain in their expression and development [6].

The high curability of Cervical Cancer (CC), when detected early, combined with the latest scientific advances in medical treatment, has contributed to greater survival of patients [7-11]. However, treatment of this neoplasm can, on the other hand, lead to late adverse effects [11-14], primarily related to radiotherapy, caused by its action on healthy tissue and organs adjacent to the tumor. The area’s most affected are the vagina, bowel/rectum, and bladder, which undergo changes in the mucosa, and may evolve into a series of changes and disorders, being primarily sexual, fecal, and urinary [11,12].

According to some authors, sexual dysfunction is the major source of suffering for patients after treatment for CC [15]. Golbasi and Erenel [1] state that female sexuality is more negatively affected by gynecological cancers, as compared with other types of cancers and chronic diseases, and the adverse physical and psychological effects tend to diminish with time, although the effects on sex life persist for a long time.

Among the main sexual dysfunctions resulting from CC treatment, the most notable are decreased elasticity, mucosal atrophy, shortening, and stenosis of the vagina; reduced lubrication and reduction/loss of vaginal sensation; dyspareunia; reduced sexual desire and arousal, anorgasmia, reduced frequency of sexual activity, and vaginal bleeding during or after intercourse [5,11,12,15-24].

There is seen, in clinical practice, an incipient and nonconsensual approach to sexual complications arising from treatment for cervical cancer, particularly with regard to sexual dysfunctions, which reinforces the need for reflection on the recommended workup and therapy in these circumstances.

This study aimed to perform a systematic literature review concerning the effects of treatment for cervical cancer on sexual function, intending to verify current knowledge available in the scientific literature on this subject, identifying the main instruments used to measure sexual function, as well as the main factors associated with it.

Methods

A literature review was conducted in the SciELO and PubMed databases, using the keywords “uterine cervical neoplasms” or “gynecological neoplasms”, and “psychological sexual dysfunction”. The search included only original articles related to humans, with an abstract and full text available, published between the years 2004 and 2012, in English or Portuguese that evaluated sexual function in women treated for gynecological cancer, and more specifically, for cervical cancer.

To select the studies, an initial reading of the retrieved abstracts was carried out, excluding literature review articles, or studies using only a qualitative methodology, or for the validation of instruments, or with a sample that did not contain women treated for cervical cancer. Subsequently, the articles that met the eligibility criteria for the study were accessed in full, and from these articles the following information was extracted for a compilation of the results: characteristics of the sample under study; comparison groups; instruments used; main findings and conclusions.

Among the articles selected, one was located in the SciELO bibliographic database, and 13 were located in the PubMed bibliographic database, totaling 14 articles, whose main results are summarized in Table 1.

Citation: Corrêa CSL, Leite ICG, Andrade APS and Guerra MR. Cervical Cancer Treatment and Its Effects on Sexual Function: Recent Evidence and Approach. Austin J Womens Health. 2015;2(1): 1010.