Academic journal article
By Syrjala, Karen L.; Schroeder, Thomas C.; Abrams, Janet R.; Atkins, Tamara Z.; Brown, Wendy S.; Sanders, Jean E.; Schubert, Mary A.; Heiman, Julia R.
The Journal of Sex Research , Vol. 37, No. 3
Schroeder, Thomas C.
Abrams, Janet R.
Atkins, Tamara Z.
Brown, Wendy S.
Sanders, Jean E.
Schubert, Mary A.
Heiman, Julia R.
Researchers and cancer survivor advocates are focusing increased attention on sexual function as a fundamental component of quality of life. This focus is warranted by the ever-increasing numbers of cancer survivors, with a relative rate of over 50% of people diagnosed with cancer now living five or more years past initial diagnosis (American Cancer Society, 1999). While findings are still rudimentary and vary by diagnosis, type of treatment, and gender, difficulties with sexual function are some of the more prevalent long-term complications following cancer treatment (Ganz, Rowland, Desmond, Meyerowitz, & Wyatt, 1998; Syrjala et al., 1998).
A major barrier to documenting sexual problems and needs in these populations has been the lack of appropriate, well-standardized tools with which to measure explicit behaviors, specific problems, and subjective experience of sexual function appropriate for cancer survivors (Cull, 1992; Rosen, 1998). As researchers initiate clinical trials to treat sexuality difficulties, adequate measurement for evaluating outcomes is essential. To fit this purpose, we have developed and tested a measure in adult cancer survivors as well as in matched, noncancer control subjects. While the instigation for this measure derived from work with cancer survivors the tool itself is not specific to such survivors, and we believe it could be utilized in research on other populations, including physically healthy groups.
Evaluating Sexual Difficulties in Cancer Survivors
Research into the sexual lives of cancer survivors has almost exclusively focused on the prevalence of various types of sexual problems reported by these survivors. This information assists in defining types of problems that need to be assessed but does not facilitate understanding how cancer survivors adapt to these difficulties, or whether they are able to achieve sexual satisfaction despite these difficulties.
Using the phases of sexual response (American Psychiatric Association [APA], 1994), research on cancer survivors has indicated that lack of sexual desire is reported by 3% to 11% of survivors, arousal problems by 9% to 15%, and orgasm infrequency or inability by 4% to 12% of the survivor population surveyed (Andersen, 1993; Andersen, Anderson, & deProsse, 1989; Andersen, Van der Does, & Anderson, 1992; Schover, Fife, & Gershenson, 1989; Spector & Carey, 1990). These deficits within phases do not fully reflect the diversity of problems cancer survivors have reported. Furthermore, prevalence data are subject to the possible measurement inadequacies described in this paper.
As a normative comparison, Lauman, Paik, and Rosen (1999) examined rates of sexual dysfunction within a national probability sample in the United States. They found that 43% of women and 31% of men reported some component of sexual dysfunction. Lower education, not being married, and emotional or stress-related problems increased the risk of sexual dysfunction for both genders. Poor health increased risk only for dyspareunia in women. The high rates of reported sexual difficulties in normative samples and the varying rates reported by cancer survivors highlight the necessity of standardizing assessment tools to permit comparisons across diseases and with noncancer norms.
Most sexual function research in oncology has been investigated separately by gender and disease. For women, assessment has focused on psychosexual problems following treatments for breast and gynecologic cancers (Andersen, 1990; Andersen et al., 1989; Bergmark, Avall-Lundqvist, Dickman, Henningsohn, & Steineck, 1999; Bines, Oleske, & Cobleigh, 1996; Ganz, 1997; Ganz et al., 1998; Kaplan, 1992; Lamb, 1995; Loprinizi et al., 1997; Schag, Ganz, Polinsky, Fred, Hirfi, & Petersen, 1993; Schover, 1994; Schover et al., 1995). For example, 23% to 28% of breast cancer survivors reported vaginal discomfort to be very severe during intercourse (Loprinizi et al. …