Skip to main content
NCBI home page
International Journal of Sexual Health logoLink to International Journal of Sexual Health
. 2021 May 6;33(3):385–395. doi: 10.1080/19317611.2021.1919951

Sexual Function and the Role of Sexual Communication in Women Diagnosed with Cervical Cancer: A Systematic Review

Magdalena Liberacka-Dwojak 1,✉, Paweł Izdebski 1
PMCID: PMC10903643  PMID: 38595751

Abstract

The objective of this systematic review was to summarize the changes in sexual function in cervical cancer survivors. The additional objective was to exhibit the role of sexual communication in adapting to these changes. A systematic search was performed across four electronic databases. Eighteen studies met the inclusion criteria. The most common sexual dysfunction was pain during sexual intercourse, vaginal dryness, decreased level of satisfaction and sexual interest. Some changes in vaginal anatomy and effects on psychosocial functioning were described. We confirmed that sexual communication with healthcare professionals and partners may be essential to help improve sexuality in CC survivors.

Keywords: Sexual function, cervical cancer, sexual communication, a systematic review

Worldwide, cervical cancer (CC) is the third most common cancer among women, with 85% of cases occurring in developing countries. The peak of the disease is observed among women in the sixth decade of life. In recent years, there has been an increase in morbidity in women in the age range between 35 and 44 (Jensen, Groenvold, et al., 2004; Krajowy Rejestr Nowotworów, 2018). Cervical cancer is most often caused by certain types of human papillomavirus (Ferlay et al., 2019), a common sexually transmitted infection, frequent in women aged 18–30. Over 40 HPV types can infect the genital tract, with fifteen high-risk genotypes that can lead to cancer. Two HPV types (16 and 18) cause 70% of cervical cancers and pre-cancerous cervical lesions (Berman & Schiller, 2017; Leser & Francis, 2014; Nagele et al., 2016).

The major risk factor for HPV infections is sexual behavior (Chelimo et al., 2013). The detection of these diseases increases significantly with an increasing number of lifetime sexual partners, early age of sexual initiation and having a non-monogamous partner. Other co-factors are long-term oral contraceptive use, high parity, cigarette smoking, co-infection with HIV, and other sexually transmitted infections (Chelimo et al., 2013; Coskun et al., 2013; “Letters to the Editor,” 2003; Nkfusai et al., 2019; Santelli et al., 2006). Nevertheless, both HPV infection and cervical cancer are preventable diseases. Well-proven ways to prevent cancer are screening tests and HPV vaccinations, and both of these methods are highly efficacious (Scarinci et al., 2010). Some prevention efforts, such as sex education in schools, families, and mass media, contribute to reducing the burden of disease among women. Researchers suggest that parent-child communication is an effective strategy for protecting children from engaging in high-risk sexual behaviors and in creating awareness for vaccinating and screening (Jerman & Constantine, 2010; Leser & Francis, 2014; Nkfusai et al., 2019).

Cervical cancer diagnosis and treatment often deteriorate the quality of life, sexual and reproductive health, and the psychosocial situation of the family. The World Health Organization defines sexual health as “a state of physical, emotional, mental, and social well-being related to sexuality; it is not merely the absence of disease, dysfunction, or infirmity” (UNDP, UNFPA, UNICEF, WHO, 2002). This definition shows that sexuality is a complex phenomenon, combining physical and psychosocial elements that contribute to better mental and physical health (Greenwald & McCorkle, 2008). Sexual function, including desire, arousal, orgasm, satisfaction, and pain, are the core components of sexual health (Dawson et al., 2020; Rosen et al., 2000).

Published studies have rarely explored the relationship between the impact of cervical cancer on sexual function. Nevertheless, the treatment process can cause many complications that significantly disrupt and sometimes even preclude sexual activity (Frumovitz et al., 2005; Hordern & Street, 2007). Open sexual communication is crucial for positive adaptation to those changes. Patients seek information and emotional support from their partners and health professionals who should support them to adapt to sexual changes (Badr & Carmack Taylor, 2009; Hordern & Street, 2007). Communication about sexual issues can often be challenging due to fear and stigma related to disease, treatment complications, and the role of sexual activity in society (Masjoudi et al., 2019).

The objective of this systematic review was to summarize the changes in sexual function in women diagnosed with cervical cancer. The additional aim was to exhibit the role of sexual communication in adapting to these changes. This review reports on (1) what changes in sexual function were examined in women with cervical cancer, (2) the importance of sexual communication in various areas: relationship and patient-provider, (3) the current gaps in the literature.

Materials and methods

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The following databases were queried: Medline, Academic Search Ultimate, Health Source: Nursing/Academic Edition, Scopus. The following keywords were searched: “sexual function” OR “sexual dysfunction” OR “sexual problems” OR “sexual difficulty” OR “sexuality” AND “cervical cancer” OR “cervical carcinoma” OR “cancer of the cervix” OR “cervix neoplasm.” After first insight on the literature, only four databases were chosen in the systematic review since the material in other databases was repeated.

The inclusion criteria were listed as follows: (1) publication written in English, (2) published in peer-reviewed journals as original research, (3) studies of sexual function in women diagnosed with cervical cancer before, during or after different treatment modalities. No date restrictions were applied. Studies were excluded if (1) they were letters to the editor, reviews, meta-analyses, conference proceedings, guidelines, dissertations, or abstracts without full text, (2) subjects were not over the age of 18, (3) patients had mixed gynecological cancer.

The search results from separate databases were combined, and any duplicates were removed. Then, the titles and abstracts were evaluated to determine if the study met the inclusion criteria. The remaining articles were obtained for full-text review, and their methods and results sections were read to compare against the criteria for inclusion and exclusion. Finally, the reference lists were checked to identify additional articles, not singled out during the database search. Details of the selection process, using the PRISMA methodology, are set out in Figure 1.

Figure 1.

Figure 1.

Open in a new tab

Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) of the selection process with reasons for exclusion.

Results

Sexual functioning

Eighteen articles were included in the analysis. The publication dates ranged from 1989 to 2020, and almost every article was published in 2005 or later (n = 16). Indeed, almost half of the studies (n = 7) were published during the last five years, reflecting the importance of the topic. All the studies were written in English. Most of them followed a quantitative design (n = 17), one was qualitative. The mean age of the total sample was 44.25. Sample sizes ranged from 16 (Ntinga & Maree, 2015) to 1,354 (Park et al., 2007) participants. The studies evaluated patients from 6 weeks to 17.5 years after diagnosis and from 6 weeks to 7.5 years after the conclusion of therapy. Six studies did not include the time after diagnosis or the conclusion of the treatment. Thirteen included a control group. The most commonly applied questionnaire for assessing sexuality was the Female Sexual Function Index (n = 8). The average score on the FSFI was 23.09. Table 1 shows the characteristics of the studies.

Table 1.

Main characteristics of the selected articles on sexual function in women with cervical cancer and human papillomavirus.

Study Participants Years since diagnosis/end of the treatment Instruments Main results Major limitations
Lee et al., 2016 N = 208 (104 CC** survivors, 104 healthy women)
Mean age: 45.95 (SD = 7.98)
Disease type: cervical cancer		 5 months–17.5 years EORTC QLQ-C30a,
EORTC QLQ-CX24b,
Female Sexual Function Index		 Higher scores for lymphedema and shorted vaginal length were observed in the CC survivors compared with the healthy women group. Sexual activity, enjoyment, worry, and desire, arousal, lubrication, orgasm, satisfaction, and pain were similar between the groups Use of self-reported measures, only women who had engaged in sexual activity within 3 months were included
Corrêa et al., 2016 N = 74 (34 CC survivors, 34 healthy women)
Mean age: 50.88 (SD = 12.97)
Disease type: cervical cancer		 3 months–7.5 years after conclusion of the treatment Female Sexual Function Index CC group reported 64.9% vaginal stenosis or shortening; 90% showed dysfunction. The total FSFI* score was classified as sexual dysfunction and was statistically significantly lower than in the healthy women group Use of self-reported measures, small sample
Greenwald & McCorkle, 2008 N = 179
Mean age: 51.7 (SD = 8.7)
Disease type: cervical cancer		 6–29 years Sexual Adjustment Scale, the MOS-36c, CES-Dd Most women were sexually active (81.1%) and desired (81.4%) and enjoyed (90.9%) sexual activity. Women after hysterectomies less often reported a lack of interest and desire No control group, use of self-reported measures
Grion et al., 2016 N = 80
Mean age: 48.1 (SD = 13.5)
Disease type: cervical cancer		 N/A Female Sexual Function Index, WHOQOL-BREFe Women reported bleeding (41.7%), lack of pleasure (33.3%), pain (25%), and vaginal dryness (16.7%). The FSFI score showed significant sexual dysfunction Use of self-reported measures, no control group, 56 women had not been sexually active within 3 months
Jensen, Groenvold, et al., 2004 N = 501 (173 CC survivors, 328 healthy women)
Mean age: 42.7
Disease type: cervical cancer		 5 weeks–24 months after RH*** The Sexual Function-Vaginal changes Questionnaire CC patients experienced problems and uncomfortable sexual intercourse due to a reduced vaginal size for 6 months after RH, severe pain during the first 3 months, and sexual dissatisfaction during 5 weeks after RH. Lack of sexual interest and lubrication were reported during the first 2 years after RH Use of self-reported measures, conducting longitudinal study without sexual function assessment before treatment
Krumm & Lamberti, 1993 N = 21
Mean age: 54.4
Disease type: cervical cancer		 Minimum 6 months after the conclusion of the treatment The sexual behavior questionnaire Decreased frequency of masturbation and intercourse, less satisfaction, and enjoyment were confirmed. The majority reported decreased self-esteem, sex desirability, and attractiveness Small sample, no control group, use of self-reported measures
Ntinga & Maree, 2015 N = 16
Mean age: 44.1
Disease type: cervical cancer		 12 months after the conclusion of the treatment Interview with the initial question: please tell me what problems you are experiencing at this stage which were caused by the treatment… Women reported sexual dysfunctions, such as shortened vaginal length, experiencing pain during intercourse, lower sexual desire, and pleasure, which led to emotional distress and influence intimate partner relationship Use of the qualitative method
Schover et al., 1989 N = 61
Mean age: 38 (SD = 9)
Disease type: cervical cancer		 N/A Dyadic Adjustment Inventory, the Sex History Form, the Brief Symptom Inventory Sexual satisfaction, capacity for orgasm, and frequency of masturbation remained stable. The frequency of sexual activity decreased. Women after RT**** developed pain and reported problems with sexual desire and arousal Use of self-reported methods, no control group
Song et al., 2012 N = 105
Mean age: 35.4(SD = 3.9)
Disease type: cervical cancer		 28 months after RH Female Sexual Function Index The total FSFI score in the cervical conization group was 30.72, in the radical trachelectomy was 21.78 and in the RH 22.40, suggesting sexual dysfunctions Use of self-reported measures, no control group, recall bias due to the retrospective questions about sexual function before RH
Donovan et al., 2007 N = 100 (50 CC survivors, 50 healthy women)
Mean age: 45.3(9.9)
Disease type: cervical cancer		 1–5 years The Sexual Function-Vaginal Changes, Dyadic Adjustment Scale, SSSWf, BDSRQ-PAEg CC survivors reported less sexual interest, more sexual dysfunction (vaginal changes, physical appearance, and sexual self-schema changes, and lower sexual satisfaction Use of self-reported measures, the small number of patients who underwent adjuvant RT versus hysterectomy
Tian, 2013 N = 106
Mean age: 43.92 (SD = 7.05)
Disease type: cervical cancer		 6 months after conclusion of the treatment Questions about sexual life, FACT-Cxh 59% of women abandoned sexual life and 65.09% were unsatisfied with it, due to side effects of the treatment (52.38%), fear of damaging surgical sites (23.81%), lacked libido (9.52%), and fear of transmitting the disease to a spouse (4.76%) Use of self-reported measures, no control group
Shankar et al., 2020 N = 85
Mean age: 50
Disease type: cervical cancer		 N/A LENT-SOMA scale; questions from the vagina and sexual dysfunction-female sections 32.9% women reported pain during intercourse, 24.7% had sexual problems, 22.3% reported alternation in sexual interest, 75.29% had vaginal stenosis which decreased intercourse frequency in 16.4% patients Use of self-reported measures, no control group, no data about years since diagnosis or conclusion of the treatment
Dahbi et al., 2018 N = 300 (100 CC survivors, 100 non-gynecological cancer, 100 healthy women)
Mean age: 52.8
Disease type: cervical cancer		 N/A Female Sexual Function Index The total FSFI score was 19.9 which suggests sexual dysfunctions. 97% of patients stopped sexual activity at the time of treatment and the time interval between treatment and sexual activity for the CC group was 8 months Use of self-reported measures, a small group of women after RH versus radiation and CT*****
Wallin et al., 2019 N = 26
Mean age: 44
Disease type: cervical cancer		 1–14 months after RH Questionnaire assessed urinary function, bowel problems, lymphedema, sexual dysfunction, and sexual distress Sexual distress symptoms were reported 1 year after RH, which were labia changes, deep pain during intercourse, lymphedema, and bladder problems Use of self-reported measures, small group, no control group
Park et al., 2007 N = 1,354 (860 CC survivors, 494 control group)
Mean age: 55
Disease type: cervical cancer		 Median: 5.86 years EORTC QLQ-C30a, sexual function items CC survivors reported more severe lymphedema, menopausal symptoms, worse body image, sexual and/or vaginal functioning, and sexual worry Use of self-reported measures, wide variation of time since treatment
Frumovitz et al., 2005 N = 114 (37 after RH, 37 after RT, 40 control group)
Mean age: 44.4
Disease type: cervical cancer
7.5 years		 Female Sexual Function Index, SF-12i, BSI-18j Patients after RT had significantly lower scores for sexual functioning. There were no differences between patients after RH and control group in sexual functioning Use of self-reported measures, no assessment of sexual function before cervical cancer
Greimel et al., 2009 N = 121 (63 after RH, 38 after RH and CT, 20 after RH and RT)
Mean age: 45.5
Disease type: cervical cancer		 9.7 years EORTC QLQ-C30a, QLQ-CX24k Sexual Activity Questionnaire Women treated with RT had lower levels of sexual activity. There were no differences in sexual pleasure and discomfort between groups Use of self-reported measures, no assessment of sexual function before cervical cancer
Carter et al., 2010 N = 52 (33 RT, 19 RH)
Mean age: 35.22(SD = 0.83)
Disease type: cervical cancer		 3–24 months after surgery Female Sexual Function Index, FACT-Cxh CES-Dd, Impact of Event Scale Women after radical trachelectomy reported sexual dysfunction after the two years after treatment. The total FSFI score raised from 16.79 to 23.78 by 12 months and to 22.20 at 24 months Use of self-reported measures, small sample
Open in a new tab
a

EORTC QLQ-C30: The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30.

b

EORTC QLQ-CX24: The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire—Cervical Cancer Module.

c

the MOS-36: The MOS-36 item short-form health survey.

d

CES-D: Center for Epidemiological Studies-Depression Scale.

e

WHOQOL-BREF: World Health Organization Quality of Life-Bref.

f

SSSW: The Sexual Self-Schema Scale for Women.

g

BDSRQ-PAE: The Body Self Relations Questionnaire-Physical Appearance Evaluation subscale.

h

FACT-Cx: Functional Assessment of Cancer Therapy-Cervix.

i

SF-12: an abbreviated version of the SF-36: Medical Outcomes Study—36-item Short Form Survey.

j

BSI-18: Brief Symptom Index-18.

k

QLQ-CX24: The Cervix Cancer Module.

*FSFI: Female Sexual Function Index. A total score of 26 or less indicates risk for sexual dysfunction. **Cervical cancer: CC. ***Radiotherapy: RT. ****Chemotherapy: CT. *****Radical hysterectomy: RH.

The most common changes in sexual function in cervical cancer survivors were pain during sexual intercourse (Grion et al., 2016; Jensen, Groenvold, et al., 2004; Lee et al., 2016; Ntinga & Maree, 2015; Schover et al., 1989; Shankar et al., 2016, 2020), vaginal dryness (Grion et al., 2016; Jensen et al., 2004; Lee et al., 2016), dissatisfaction or decreased level of satisfaction (Donovan et al., 2007; Jensen, Groenvold, et al., 2004; Krumm & Lamberti, 1993; Lee et al., 2016; Tian, 2013), and lack of sexual interest (Donovan et al., 2007; Greenwald & McCorkle, 2008; Jensen, Klee, et al., 2004; Lee et al., 2016; Schover et al., 1989; Shankar et al., 2020). Changes in vaginal anatomy (Corrêa et al., 2016; Donovan et al., 2007; Jensen, Klee, et al., 2004; Lee et al., 2016; Ntinga & Maree, 2015; Shankar et al., 2020) and bleeding (Grion et al., 2016) were also frequently reported. Additionally, some effects on psychosocial functioning were described, more specifically speaking: lower self-esteem and attractiveness (Donovan et al., 2007; Krumm & Lamberti, 1993). Furthermore, radiotherapy (RT) often affected the level of sexual function (Donovan et al., 2007; Frumovitz et al., 2005; Greimel et al., 2009; Schover et al., 1989). Cervical cancer conducted anatomical and physiological changes regarding sexuality, which led to emotional distress (decreased level of body image satisfaction and worry about own and partner’s sexual health).

There were two studies with a longitudinal design. Jensen, Groenvold, et al. (2004) reported the impact of radical hysterectomy (RH) in patients with early-stage cervical cancer on sexual function. The patients completed self-measured questionnaires 5 weeks, 3 months, 6 months, 18 months, and 24 months after RH. Women experienced sexual dissatisfaction during the first 5 weeks after RH, pain during intercourse in the first 3 months, severe orgasmic problems, and uncomfortable sexual intercourse due to a shortened vaginal length during the first 6 months. A lack of sexual interest and decreased lubrication were reported in the 12 months after RH compared with the pre-diagnosis state. A persistent lack of sexual interest and lubrication were confirmed during the first 2 years after RH. Jensen et al. showed that radical hysterectomy had a persistent and negative impact on patients’ sexual interests and functions, whereas most sexual problems disappeared over time. Carter et al. (2010) reported the impact of radical trachelectomy and radical hysterectomy for early-stage cervical carcinoma. Mood, distress, sexual function, and quality of life did not differ by surgical type. Out of expectation, the RH group reported a higher FSFI score on the orgasm subscale, suggesting better functioning at 12 months. The total FSFI score rose from 16.79 preoperatively to 23.78 by 12 months and to 22.20 at 24 months.

The treatment type affected the level of sexual function in women with cervical cancer. Frumovitz et al. (2005) showed that RT negatively impacted sexual function within a long-term follow-up period (7 years). The women who were subjected to radiotherapy had more difficulties with arousal, lubrication, orgasm, satisfaction, and pain during sexual intercourse than women who only underwent surgery. Schover et al. (1989) reported more sexual problems one year after treatment in the RT group: dyspareunia, lower level of sexual desire and arousal. Greimel et al. (2009) confirmed that women treated with RT had lower levels of sexual activity. There were no differences in sexual pleasure and discomfort among women treated with RH, CT, and RT. Carter et al. (2010) reported that women after radical trachelectomy showed better orgasm capacity than women who underwent a radical hysterectomy. Park et al. (2007) showed that dyspareunia reveals more often in women after radiotherapy and chemotherapy (CT).

The Female Sexual Function Index is a widely used measure of female sexual dysfunction. It assesses six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain (Rosen et al., 2000). A total score of 26 or less has been validated as a cutoff score for diagnosing sexual dysfunction. Seven studies included the FSFI score with the average score of 23.09. Song et al. (2012) reported the total FSFI score for different types of treatment. In the cervical conization group the average score was 30.72, suggesting no sexual dysfunction, 21.78 in women after radical trachelectomy, and 22.40 after RH. Furthermore, Frumovitz et al. (2005) showed that patients after RT had significantly lower scores of sexual functioning (17.1) in comparison to RH (25.1), confirming the fact that the treatment type affected the level of sexual function. Carter et al. (2010) confirmed changes in the total FSFI score, which rose from 16.79 preoperatively to 23.78 at 12 months and 22.20 at 24 months.

Sexual communication

The additional aim of this study was to exhibit the role of sexual communication in adapting to changes in sexuality induced by cervical cancer. The importance of open partner communication for adaptation to diseases is well documented (Badr & Carmack Taylor, 2009), however, published studies have rarely explored the role of sexual communication, especially in terms of cervical cancer. It involves revealing and receiving facts, feelings, and thoughts, which allow the woman to express concerns and burdens, to inform others about her needs and changes, and renegotiate sexual activity in response to disease-related dysfunction (Gilbert et al., 2010; Seidler et al., 2016). Studies report that satisfactory communication is crucial to adjustment after disease treatment (Arthur et al., 2020), lowers the level of distress, and increases satisfaction and closeness between partners (Perz et al., 2014). Open sexual communication is also associated with a better quality of life because it plays a major role in overcoming difficulties and developing new sexual practices (Perz et al., 2014; Ussher et al., 2013).

Researchers have suggested that patients and their partners often avoid discussing the diagnosis and how it affects their relationship and emotions. It can result from both individual and dyadic barriers. The individual ones include discomfort, awkwardness in self-disclosing, low self-efficacy in sexual communication, and low self-esteem. Communicating feelings was reported by women with gynecological cancer as one of the most problematic aspects of dealing with illness or treatment (Cleary & Hegarty, 2011). Dyadic barriers include partners’ conflicts, lack of intimacy, partners’ viewpoints on the disease, fear of upsetting a partner, and lack of reciprocation. Moreover, cultural barriers and type of parental communication about sexual issues can be crucial in openness to sex conversations with partners (Badr & Carmack Taylor, 2009; Masjoudi et al., 2019; Seidler et al., 2016). Otherwise, studies report that many partners are over-protective toward the ill person and engage in protective behaviors to prevent disease (Kuijer et al., 2000), which is characterized by compulsive caring, pleasing the other, and inhibition of self-expression. By contrast, such behaviors leave unmet needs in this area (Kuijer et al., 2000; Perz et al., 2014). Poor communication results in dissatisfaction with the relationship and sexual activity, more partner-related concerns, feelings of isolation, anxiety, depression, and inadequacy (Gilbert et al., 2010). Couples who have difficulties in communicating about sexual matters also have more sex-related problems, including feelings of isolation, anxiety, depression, and inadequacy (Gilbert et al., 2010).

Healthcare professionals also play a crucial role in the adjustment to these changes, by discussing sexuality in the context of disease. It mostly involves psychoeducation related to the effects of treatment, which informs women and encourages them to openly discuss sexual issues with their partners (Gilbert et al., 2010). For patients, it is relevant to gain knowledge about their sexual health issues and to confirm that their difficulties are not unique. Such concerns should be discussed as early as possible to prepare patients for potential changes in sexual function (Park et al., 2009). There are many treatment types for sexual dysfunction, from psychological to pharmacological, which can be highly effective in disease-related sexual concerns. Medical staff should also provide more practical advice, such as the use of lubricants, or suggest alternative sexual practices, which may help reduce any discomfort during sexual intercourse. Nonetheless, healthcare professionals should initiate discussions about sexuality to normalize those concerns, provide education, and convince women to seek further help (Park et al., 2009; Stead et al., 2002). Besides, studies show that patient-provider communication also has a protective role for many diseases, through health promotion (Murayama et al., 2013; Politi et al., 2008). Discussing sexual history can impact screening behaviors and openness to disclose relevant health information (Politi et al., 2008).

Vermeer et al. (2015) reported that only 7–40% of CC survivors sought or received such help, due to difficulties in accessing healthcare services. 90% of cancer survivors report that their oncologist rarely discusses sexual issues (Reese et al., 2017). Lack of appropriate training and skills, embarrassment, time pressure, and prioritizing other physical symptoms are the most common barriers preventing providers from considering sexual health concerns (Reese et al., 2017; Sporn et al., 2015; Stead et al., 2003). Patients may also find it burdensome to initiate a conversation about sexual issues. Only about 30% of males and 10% of females consult sexual problems with a healthcare professional, despite considering them important, preferring providers to initiate such conversations. For this reason, medical staff needs to receive proper training to address sexual health concerns. Providers should be aware that CC survivors are vulnerable to sexual dysfunctions, and should understand the importance of initiating sexual discussion (Sporn et al., 2015).

Discussion

Diagnosis of cervical cancer can have a negative impact on the sexual function of women. The major dysfunctions are pain during sexual intercourse, vaginal dryness, dissatisfaction, and lack of sexual interest. The findings of the studies conclude that the treatment type affects the sexual function of patients, with more severe complications after radiotherapy. In the long-term perspective, some of the dysfunctions may disappear. Women also experience anxiety and depression, which negatively influence their adaptation to the treatment and increase psychosocial vulnerability, decreasing sexual activity (Santos et al., 2019).

Sexuality is an essential part of health, and thus sexual dysfunctions caused by diseases have an impact on quality of life. Chronic illness changes not only the physiology of the body but also a sense of “self.” A woman constructs and confirms a new identity for the ill person, which involves renegotiating her own sexual self-concept (Gilbert et al., 2010). Changes in sexuality can lead to emotional distress, specifically speaking lower self-esteem, a more negative body image and self-schema, and poorer perceived appearance (Cleary & Hegarty, 2011). Moreover, dysfunctions can result in embarrassment, frustration, or avoidance of those topics. Unpleasant emotions may also affect the couple’s relationship. Partners of women diagnosed with CC can also experience difficulties and negative emotions from changes in their sexual life. Both partners often have to adapt to their new sexual identity, as well as overcome embarrassment, which requires a great deal of self-awareness, open communication, and physical therapy (Corrêa et al., 2015; Seidler et al., 2016; Vermeer et al., 2015).

The study confirmed the importance of sexuality and sexual function in the diagnosis and treatment of cervical cancer. Researchers have rarely explored the importance of sexuality for CC survivors, especially considering the role of sexual communication on various levels, which shows the current gaps in this area. The results demonstrate that therapies for cervical cancer impair sexuality. Based on own experience and other authors cited, good interpersonal communication, whether with health professionals or with their partner, is essential to help improve sexuality in survivors of cervical cancer. The findings confirm that a large majority of women and partners would appreciate receiving psychosexual support.

Implications for clinical practice

Healthcare professionals should be aware that many women report sexual dysfunction after CC treatment. For this reason, sexual communication should be a part of the medical appointment. It should involve psychoeducation about what to expect in terms of sexual life, side effects of treatment, possible ways to improve sexual activity, such as the use of lubricants or trying new sexual practices, but also convincing women to turn to sexologists for help. It may allow women to gain knowledge and empower them to openly discuss sexual difficulties with their partners. Furthermore, sexual health communication may encourage women to participate in cancer screening tests, which may contribute to lowering the incidence rate of cervical cancer. Similarly, satisfactory communication in a relationship may increase satisfaction and closeness between partners or even increase the level of sexual functioning, as it helps in developing new sexual practices.

Limitations

The major limitation was that not many studies were included, due to the strict inclusion criteria, which could fail to capture some important research works. Furthermore, all the studies included self-reported measures. The responses may have been distorted under the influence of multiple factors, which may contribute to the limitation of data accuracy.

Conclusions

  1. CC survivors report sexual dysfunction, most commonly: shortened vaginal length, pain during sexual intercourse, dissatisfaction, and lack of sexual interest.

  2. The type of treatment affects the sexual function of patients, with more severe complications following radiotherapy.

  3. Sexual dysfunction leads to emotional distress, lower self-esteem, more negative body image, and poorer perceived appearance, along with embarrassment, frustration, and difficulties in the relationship.

  4. Open sexual communication with healthcare professionals may help in adapting to changes in sexual life, by gaining knowledge about those changes, possible ways to treat them, and may empower women to openly discuss sexual issues with their partners.

Disclosure statement

No potential conflict of interest was reported by the author(s).

References

  1. Arthur, E. K., Wills, C. E., Browning, K., Overcash, J., & Menon, U. (2020). The Self-Efficacy to Communicate about Sex and Intimacy (SECSI) scale: Psychometric assessment in women treated for cancer. Supportive Care in Cancer, 28(3), 1449–1457. 10.1007/s00520-019-04963-2 [DOI] [PubMed] [Google Scholar]
  2. Badr, H., & Carmack Taylor, C. L. (2009). Sexual dysfunction and spousal communication in couples coping with prostate cancer. Psycho-Oncology, 18(7), 735–746. 10.1002/pon.1449 [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Berman, T. A., & Schiller, J. T. (2017). Human papillomavirus in cervical cancer and oropharyngeal cancer: One cause, two diseases. Cancer, 123(12), 2219–2229. 10.1002/cncr.30588 [DOI] [PubMed] [Google Scholar]
  4. Carter, J., Sonoda, Y., Baser, R. E., Raviv, L., Chi, D. S., Barakat, R. R., Iasonos, A., Brown, C. L., & Abu-Rustum, N. R. (2010). A 2-year prospective study assessing the emotional, sexual, and quality of life concerns of women undergoing radical trachelectomy versus radical hysterectomy for treatment of early-stage cervical cancer. Gynecologic Oncology, 119(2), 358–365. 10.1016/j.ygyno.2010.07.016 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Chelimo, C., Wouldes, T. A., Cameron, L. D., & Elwood, J. M. (2013). Risk factors for and prevention of human papillomaviruses (HPV), genital warts and cervical cancer. The Journal of Infection, 66(3), 207–217. 10.1016/j.jinf.2012.10.024 [DOI] [PubMed] [Google Scholar]
  6. Cleary, V., & Hegarty, J. (2011). Understanding sexuality in women with gynaecological cancer. European Journal of Oncology Nursing, 15(1), 38–45. 10.1016/j.ejon.2010.05.008 [DOI] [PubMed] [Google Scholar]
  7. Corrêa, C., Leite, I., Andrade, A., & Guerra, M. (2015). Cervical cancer treatment and its effects on sexual function: Recent evidence and approach. Austin Journal of Women’s Health, 2(1), 1–7. [Google Scholar]
  8. Corrêa, C. S. L., Leite, I. C. G., Andrade, A. P. S., de Souza Sérgio Ferreira, A., Carvalho, S. M., & Guerra, M. R. (2016). Sexual function of women surviving cervical cancer. Archives of Gynecology and Obstetrics, 293(5), 1053–1063. 10.1007/s00404-015-3857-0 [DOI] [PubMed] [Google Scholar]
  9. Coskun, S., Can, H., & Turan, S. (2013). Knowledge about cervical cancer risk factors and Pap smear testing behavior among female primary health care workers: A study from South Turkey. Asian Pacific Journal of Cancer Prevention, 14(11), 6389–6392. 10.7314/APJCP.2013.14.11.6389 [DOI] [PubMed] [Google Scholar]
  10. Dahbi, Z., Sbai, A., & Mezouar, L. (2018). Sexuality of Moroccan survivors of cervical cancer: A prospective data. Asian Pacific Journal of Cancer Prevention, 19(11), 3077–3079. 10.31557/APJCP.2018.19.11.3077 [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Dawson, S. J., Vaillancourt-Morel, M.-P., Pierce, M., & Rosen, N. O. (2020). Biopsychosocial predictors of trajectories of postpartum sexual function in first-time mothers. Health Psychology, 39(8), 700–710. 10.1037/hea0000861 [DOI] [PubMed] [Google Scholar]
  12. Donovan, K. A., Taliaferro, L. A., Alvarez, E. M., Jacobsen, P. B., Roetzheim, R. G., & Wenham, R. M. (2007). Sexual health in women treated for cervical cancer: Characteristics and correlates. Gynecologic Oncology, 104(2), 428–434. 10.1016/j.ygyno.2006.08.009 [DOI] [PubMed] [Google Scholar]
  13. Ferlay, J., Colombet, M., Soerjomataram, I., Mathers, C., Parkin, D. M., Piñeros, M., Znaor, A., & Bray, F. (2019). Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. International Journal of Cancer, 144(8), 1941–1953. 10.1002/ijc.31937 [DOI] [PubMed] [Google Scholar]
  14. Frumovitz, M., Sun, C. C., Schover, L. R., Munsell, M. F., Jhingran, A., Wharton, J. T., Eifel, P., Bevers, T. B., Levenback, C. F., Gershenson, D. M., & Bodurka, D. C. (2005). Quality of life and sexual functioning in cervical cancer survivors. Journal of Clinical Oncology, 23(30), 7428–7436. 10.1200/JCO.2004.00.3996 [DOI] [PubMed] [Google Scholar]
  15. Gilbert, E., Ussher, J. M., & Perz, J. (2010). Renegotiating sexuality and intimacy in the context of cancer: The experiences of carers. Archives of Sexual Behavior, 39(4), 998–1009. 10.1007/s10508-008-9416-z [DOI] [PubMed] [Google Scholar]
  16. Greenwald, H. P., & McCorkle, R. (2008). Sexuality and sexual function in long-term survivors of cervical cancer. Journal of Women's Health, 17(6), 955–963. 10.1089/jwh.2007.0613 [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Greimel, E. R., Winter, R., Kapp, K. S., & Haas, J. (2009). Quality of life and sexual functioning after cervical cancer treatment: A long-term follow-up study. Psycho-Oncology, 18(5), 476–482. 10.1002/pon.1426 [DOI] [PubMed] [Google Scholar]
  18. Grion, R. C., Baccaro, L. F., Vaz, A. F., Costa-Paiva, L., Conde, D. M., & Pinto-Neto, A. M. (2016). Sexual function and quality of life in women with cervical cancer before radiotherapy: A pilot study. Archives of Gynecology and Obstetrics, 293(4), 879–886. 10.1007/s00404-015-3874-z [DOI] [PubMed] [Google Scholar]
  19. Hordern, A. J., & Street, A. F. (2007). Communicating about patient sexuality and intimacy after cancer: Mismatched expectations and unmet needs. Medical Journal of Australia, 186(5), 224–227. 10.5694/j.1326-5377.2007.tb00877.x [DOI] [PubMed] [Google Scholar]
  20. Jensen, P. T., Groenvold, M., Klee, M. C., Thranov, I., Petersen, M. A., & Machin, D. (2004). Early-stage cervical carcinoma, radical hysterectomy, and sexual function: A longitudinal study. Cancer, 100(1), 97–106. 10.1002/cncr.11877 [DOI] [PubMed] [Google Scholar]
  21. Jensen, P. T., Klee, M. C., Thranov, I., & Groenvold, M. (2004). Validation of a questionnaire for self-assessment of sexual function and vaginal changes after gynaecological cancer. Psycho-oncology, 13(8), 577–592. 10.1002/pon.757 [DOI] [PubMed] [Google Scholar]
  22. Jerman, P., & Constantine, N. A. (2010). Demographic and psychological predictors of parent-adolescent communication about sex: A representative statewide analysis. Journal of Youth and Adolescence, 39(10), 1164–1174. 10.1007/s10964-010-9546-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Krajowy Rejestr Nowotworów . (2018). http://onkologia.org.pl/nowotwory-szyjki-macicy-kobiet/
  24. Krumm, S., & Lamberti, J. (1993). Changes in sexual behavior following radiation therapy for cervical cancer. Journal of Psychosomatic Obstetrics and Gynaecology, 14(1), 51–63. 10.3109/01674829309084430 [DOI] [PubMed] [Google Scholar]
  25. Kuijer, R. G., Ybema, J. F., Buunk, B. P., De Jong, G. M., Thijs-Boer, F., & Sanderman, R. (2000). Active engagement, protective buffering, and overprotection: Three ways of giving support by intimate partners of patients with cancer. Journal of Social and Clinical Psychology, 19(2), 256–275. 10.1521/jscp.2000.19.2.256 [DOI] [Google Scholar]
  26. Lee, Y., Lim, M. C., Kim, S. I., Joo, J., Lee, D. O., & Park, S. Y. (2016). Comparison of quality of life and sexuality between cervical cancer survivors and healthy women. Cancer Research and Treatment, 48(4), 1321–1329. 10.4143/crt.2015.425 [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Leser, K. A., & Francis, S. A. (2014). Mother-child communication about sexual health, HPV and cervical cancer among antenatal clinic attendees in Johannesburg, South Africa. African Journal of Reproductive Health, 18(1), 123–126. [PubMed] [Google Scholar]
  28. Letters to the Editor . (2003). Chemical Health and Safety, 10(6), 5. 10.1016/j.chs.2003.09.001 [DOI] [Google Scholar]
  29. Masjoudi, M., Keshavarz, Z., Akbari, M. E., Kashani, F. L., Nasiri, M., & Mirzaei, H. R. (2019). Barriers to sexual health communication in breast cancer survivors: A qualitative study. Journal of Clinical and Diagnostic Research, 13(5), XC01–XC04. 10.7860/JCDR/2019/40073.12825 [DOI] [Google Scholar]
  30. Murayama, H., Taguchi, A., & Murashima, S. (2013). Exploring the ideal combination of activity satisfaction and burden among health promotion volunteers: A cross-sectional study in Japan. BMC Public Health, 13, 205. 10.1186/1471-2458-13-205 [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Nagele, E., Reich, O., Greimel, E., Dorfer, M., Haas, J., & Trutnovsky, G. (2016). Sexual activity, psychosexual distress, and fear of progression in women with human papillomavirus-related premalignant genital lesions. The Journal of Sexual Medicine, 13(2), 253–259. 10.1016/j.jsxm.2015.12.012 [DOI] [PubMed] [Google Scholar]
  32. Nkfusai, N. C., Cumber, S. N., Anchang-Kimbi, J. K., Nji, K. E., Shirinde, J., & Anong, N. D. (2019). Assessment of the current state of knowledge and risk factors of cervical cancer among women in the Buea Health district. Pan African Medical Journal, 33, 1–10. 10.11604/pamj.2019.33.38.16767 [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Ntinga, S., & Maree, J. (2015). Living with the late effects of cervical cancer treatment: a descriptive qualitative study at an academic hospital in Gauteng. Southern African Journal of Gynaecological Oncology, 7(1), 21–26. 10.1080/20742835.2015.1030890 [DOI] [Google Scholar]
  34. Park, E. R., Norris, R. L., & Bober, S. L. (2009). Sexual health communication during cancer care: Barriers and recommendations. Cancer Journal, 15(1), 74–77. 10.1097/PPO.0b013e31819587dc [DOI] [PubMed] [Google Scholar]
  35. Park, S. Y., Bae, D.-S., Nam, J. H., Park, C. T., Cho, C.-H., Lee, J. M., Lee, M. K., Kim, S. H., Park, S. M., & Yun, Y. H. (2007). Quality of life and sexual problems in disease-free survivors of cervical cancer compared with the general population. Cancer, 110(12), 2716–2725. http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=17960806&site=ehost-live 10.1002/cncr.23094 [DOI] [PubMed] [Google Scholar]
  36. Perz, J., Ussher, J. M., Gilbert, E., Wain, G., Batt, G., Sundquist, K., Hobbs, K., Mason, C., Kirsten, L., & Carrick, S. (2014). Feeling well and talking about sex: Psycho-social predictors of sexual functioning after cancer. BMC Cancer, 14(1), 1–19. 10.1186/1471-2407-14-228 [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Politi, M. C., Clark, M. A., Rogers, M. L., McGarry, K., & Sciamanna, C. N. (2008). Patient-provider communication and cancer screening among unmarried women. Patient Education and Counseling, 73(2), 251–255. 10.1016/j.pec.2008.07.030 [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Reese, J. B., Sorice, K., Beach, M. C., Porter, L. S., Tulsky, J. A., Daly, M. B., & Lepore, S. J. (2017). Patient-provider communication about sexual concerns in cancer: A systematic review. Journal of Cancer Survivorship, 11(2), 175–188. 10.1007/s11764-016-0577-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Rosen, R., Brown, C., Heiman, J., Leiblum, S., Meston, C., Shabsigh, R., Ferguson, D., & D’Agostino, R. (2000). The female sexual function index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. Journal of Sex and Marital Therapy, 26(2), 191–205. 10.1080/009262300278597 [DOI] [PubMed] [Google Scholar]
  40. Santelli, J. S., Morrow, B., Anderson, J. E., & Lindberg, L. D. (2006). Contraceptive Use and pregnancy risk among U.S. high school students, 1991-2003. Perspectives on Sexual and Reproductive Health, 38(2), 106–111. 10.1363/3810606 [DOI] [PubMed] [Google Scholar]
  41. Santos, B. D., Carvalho, E. C., & Pereira, M. G. (2019). Dyadic adjustment in HPV-infected women one year after diagnosis. Psychiatry, 82(3), 216–227. 10.1080/00332747.2019.1608782 [DOI] [PubMed] [Google Scholar]
  42. Scarinci, I. C., Garcia, F. A. R., Kobetz, E., Partridge, E. E., Brandt, H. M., Bell, M. C., Dignan, M., Ma, G. X., Daye, J. L., & Castle, P. E. (2010). Cervical cancer prevention: New tools and old barriers. Cancer, 116(11), NA–2542. 10.1002/cncr.25065 [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Schover, L. R., Fife, M., & Gershenson, D. M. (1989). Sexual dysfunction and treatment for early stage cervical cancer. Cancer, 63(1), 204–212. [DOI] [PubMed] [Google Scholar]
  44. Seidler, Z. E., Lawsin, C. R., Hoyt, M. A., & Dobinson, K. A. (2016). Let’s talk about sex after cancer: Exploring barriers and facilitators to sexual communication in male cancer survivors. Psycho-Oncology, 25(6), 670–676. 10.1002/pon.3994 [DOI] [PubMed] [Google Scholar]
  45. Shankar, A., Patil, J., Luther, A., Mandrelle, K., Chakraborty, A., Dubey, A., Saini, D., Bharat, R. P., Abrol, D., Bharti, S. J., & Bentrad, V. (2020). Sexual Dysfunction in Carcinoma Cervix: Assessment in Post Treated Cases by LENTSOMA Scale. Asian Pacific Journal of Cancer Prevention, 21(2), 349–354. 10.31557/APJCP.2020.21.2.349 [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Shankar, A., Patil, J., Luther, A., Mandrelle, K., Chakraborty, A., Dubey, A., Saini, D., Bharat, R. P., Abrol, D., Bharti, S. J., Bentrad, V., Zhang, Y., Sun, S., Ding, J., Hua, K., Wallin, E., Falconer, H., Rådestad, A. F., Mercan, R., … Shingleton, H. M. (2016). Sexual functioning of cervical cancer survivors: A review with a female perspective. Journal of Sexual Medicine, 24(1), 65–70. 10.1186/s12885-018-4785-8 [DOI] [Google Scholar]
  47. Song, T., Choi, C. H., Lee, Y.-Y., Kim, T.-J., Lee, J.-W., Kim, B.-G., & Bae, D.-S. (2012). Sexual function after surgery for early-stage cervical cancer: Is there a difference in it according to the extent of surgical radicality? The Journal of Sexual Medicine, 9(6), 1697–1704. 10.1111/j.1743-6109.2012.02723.x [DOI] [PubMed] [Google Scholar]
  48. Sporn, N. J., Smith, K. B., Pirl, W. F., Lennes, I. T., Hyland, K. A., & Park, E. R. (2015). Sexual health communication between cancer survivors and providers: How frequently does it occur and which providers are preferred? Psycho-oncology, 24(9), 1167–1173. 10.1002/pon.3736 [DOI] [PubMed] [Google Scholar]
  49. Stead, M. L., Brown, J. M., Fallowfield, L., & Selby, P. (2003). Lack of communication between healthcare professionals and women with ovarian cancer about sexual issues. British Journal of Cancer, 88(5), 666–671. 10.1038/sj.bjc.6600799 [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Stead, M. L., Brown, J. M., Fallowfield, L., & Selby, P. (2002). Communication about sexual problems and sexual concerns in ovarian cancer: A qualitative study. The Western Journal of Medicine, 176(1), 18–19. 10.1136/ewjm.176.1.18 [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Tian, J. (2013). Sexual well-being of cervical cancer survivors under 50 years old and the factors affecting their libido. Gynecologic and Obstetric Investigation, 76(3), 177–181. 10.1159/000355104 [DOI] [PubMed] [Google Scholar]
  52. UNDP, UNFPA, UNICEF, WHO, W. B . (2002). Defining sexual health Sexual health document series. Report of a Technical Consultation on Sexual Health, January, 1–35. [Google Scholar]
  53. Ussher, J. M., Perz, J., Gilbert, E., Wong, W. K. T., & Hobbs, K. (2013). Renegotiating sex and intimacy after cancer: Resisting the coital imperative. Cancer Nursing, 36(6), 454–462. 10.1097/NCC.0b013e3182759e21 [DOI] [PubMed] [Google Scholar]
  54. Vermeer, W. M., Bakker, R. M., Kenter, G. G., De Kroon, C. D., Stiggelbout, A. M., & Ter Kuile, M. M. (2015). Sexual issues among cervical cancer survivors: How can we help women seek help? Psycho-Oncology, 24(4), 458–464. 10.1002/pon.3663 [DOI] [PubMed] [Google Scholar]
  55. Wallin, E., Falconer, H., & Rådestad, A. F. (2019). Sexual, bladder, bowel and ovarian function 1 year after robot-assisted radical hysterectomy for early-stage cervical cancer. Acta Obstetricia et Gynecologica Scandinavica, 98(11), 1404–1412. 10.1111/aogs.13680 [DOI] [PubMed] [Google Scholar]

Articles from International Journal of Sexual Health are provided here courtesy of Taylor & Francis

RESOURCES