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Poorer Psychosexual Functioning in Adult Female Survivors of Childhood Cancer

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Key Points

  • Survivors had significantly poorer overall sexual function, interest, desire, arousal, satisfaction, masturbation, and activity, and those with ovarian failure had poorer function than those without.
  • Risk factors for poorer sexual function among survivors included older age at assessment, ovarian failure at a younger age, treatment with cranial radiation, and cancer diagnosis during adolescence.

In an analysis in the Childhood Cancer Survivor Study population reported in the Journal of Clinical Oncology, Ford et al found that adult woman survivors of childhood cancer have poorer psychosexual function than their siblings without childhood cancer. Risk factors for poorer function included ovarian failure, older age at assessment, ovarian failure at a younger age, treatment with cranial radiation, and cancer diagnosis during adolescence.

Study Details

In the study, 2,178 survivors and 408 female siblings completed the 122-item Women’s Sexual Health Questionnaire, which includes the Sexual Functioning Questionnaire (SFQ), Women’s Health Questionnaire (WHQ), Sexual Self-Schema (SSS) for women, and the Medical Outcomes Survey Short Form-36 (SF-36).

Survivors had a mean age of 29 years (range = 18–51 years) at the time of the survey and had been diagnosed with cancer at a median age of 8.5 years (range = 0–20 years). The most common diagnoses were leukemia (33%), Hodgkin lymphoma (15%), kidney cancer (Wilms' tumor; 11%), and bone cancer (10%).

Survivors Less Active

A total of 28% of survivors and 17% of siblings reported that they had not been sexually active within the past month (these subjects were excluded from analysis of psychosexual function), with 7% and 2.4% reporting never having been sexually active. A smaller proportion of survivors (77.4% vs 86.9%, P < .001) reported having a current sexual partner.

Poorer Function

After adjustment for  age at time of the study, marital status, education level, income, and ethnicity/race, survivors had significantly lower scores for overall sexual function (P < . 02), interest (P < .001), desire ( P < .001), arousal (P < .001), satisfaction (P = .01), masturbation (P = .03), and activity (P = .02).

Ovarian Failure as Risk Factor

On multivariate analysis, survivors with ovarian failure (n = 235) had significantly (all P < .001 except as noted) lower scores than those without ovarian failure for sexual interest, desire, arousal, and masturbation, a higher score for sexual problems (P < .01; including higher scores for vaginal dryness and tightness, painful penetration, and vaginal bleeding), and a lower overall sexual function score. These findings were related to sleep and vasomotor problems in survivors with ovarian failure, but these survivors did not report higher rates of such psychological problems as depression, somatization, or anxiety. The investigators noted: “Survivors’ sexual dysfunction seems to be related to physiologic damage from cancer treatment rather than being related to sexual self-perception.”

Overall, risk factors for poorer psychosexual function among survivors included older age at assessment, ovarian failure at a younger age, treatment with cranial radiation, and cancer diagnosis during adolescence.

The investigators concluded: “Decreased sexual functioning among female survivors of childhood cancers seems to be unrelated to emotional factors and is likely to be an under-addressed issue. Several risk factors among survivors have been identified that assist in defining high-risk subgroups who may benefit from targeted screening and interventions.”

Jennifer S. Ford, PhD, of Memorial Sloan Kettering Cancer Center, is the corresponding author for the Journal of Clinical Oncology article.

The study was supported by grants from the National Institutes of Health, American Lebanese Syrian Associated Charities, and National Cancer Institute. The study authors reported no potential conflicts of interest.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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