Abstract
Objective
This report describes initial activities of the Cancer Patient-Reported Outcomes Measurement Information System (PROMIS) Sexual Function domain group (CaPS-SF), part of the National Institutes of Health (NIH) Roadmap Initiative to develop brief questionnaires or individually-tailored assessments of quality of life domains. Our literature review of sexual function measures used in cancer populations, and descriptions of domains found in those measures, is presented.
Methods
Using a consensus-driven approach, an electronic bibliographic search was conducted for articles published 1991-2007, yielding 486 articles for in-depth review.
Results
A total of 257 articles reported the administration of a psychometrically evaluated sexual function measure to individuals diagnosed with cancer. Apart from the UCLA Prostate Cancer Index, the International Index of Erectile Function, and the Female Sexual Function Index, the 31 identified measures have not been widely tested in cancer populations. Most measures were multidimensional and included domains related to the sexual response cycle and to general sexual satisfaction.
Conclusions
Our review supports the need for a flexible, psychometrically robust measure of sexual function for use in oncology settings and strongly justifies the development of the PROMIS-SF instrument. After PROMIS-SF is publicly available, cancer clinicians and researchers will have another measure to assess patient-reported sexual function outcomes in addition to the few legacy measures identified through our review.
Keywords: neoplasms, psychometrics, quality of life, sexual function
Introduction
In 1987, the American Cancer Society published a review article on sexual function and cancer to encourage clinicians to address the sexual concerns of cancer survivors [1]. Since that time, the number of individuals alive with a history of cancer in the U.S. population has almost doubled from an estimated 5.9 million to an estimated 11.1 million [2]. Thus, while the number of cancer survivors who consider sexual function to be an essential component of quality of life is increasing, the assessment and treatment of sexual concerns or sexual dysfunction has yet to be practiced routinely in oncology settings [3]. Although the prevalence of sexual dysfunction for all cancer survivors is unknown, the rate of erectile dysfunction may be as high as 100% among prostate cancer survivors following radical prostectomy [4] and the rate of problems with sexual desire or orgasms disorders may be as high as 75% among ovarian cancer survivors [5]. The detection and treatment of sexual problems, and an understanding of how various cancer treatments affect sexual function, are important because sexual dysfunction may disrupt relationship intimacy, contribute to emotional distress, reinforce negative body image, or serve as a constant reminder of one’s cancer history. Identifying the presence and severity of sexual concerns should be considered part of cancer treatment and follow up care [6, 7] because such concerns are likely to be long-standing or worsen over time [8]. Additionally, the assessment of sexual function in clinical settings may help inform treatment choice, most notably for prostate, gynecologic, breast, and colorectal cancer treatments. Such assessment may provide data that lead to modifications of surgical approaches [9, 10]; the type and dosage of chemotherapy [11, 12]; the timing, location, type and amount of radiation [13]; the timing and maintenance schedule of hormonal therapy [14]; and posttreatment symptom management [15, 16].
Unfortunately, efforts to characterize the epidemiology and treatment of sexual problems in cancer have been hampered by a lack of consensus regarding valid outcome measures that can be used in a variety of contexts [17 - 20]. This shortcoming is not unique to cancer, as documented by Arrington et al.’s [21] review of sexual function instruments used with general and medically ill populations. To facilitate communication between cancer survivors and their physicians and to design informative clinical research, the field requires a measure that can be used across the continuum of care for different cancer sites and stages of disease, regardless of gender, sexual orientation, partner status, age, literacy level and cultural background. Ideally, such a measure would be sensitive to differential treatment effects when applicable, be able to detect clinically meaningful changes in sexual function, be sufficiently flexible to provide tailored assessments based on personal, illness and treatment characteristics, and generate information that is useful for implementing and evaluating clinical interventions. A measure of sexual function developed specifically for cancer populations may likewise serve as a diagnostic tool with cancer and other chronic diseases, and assist in the systematic documentation of this quality of life domain.
In response to this assessment need, the National Cancer Institute is funding a supplement to the National Institutes of Health (NIH) Roadmap Initiative for the Patient-Reported Outcomes Measurement Information System (PROMIS) [22, 23] and collaborating with Duke University Medical Center and Evanston Northwestern Healthcare to develop a computerized measure of sexual function that addresses the above concerns. Specifically, item banks will be created to allow researchers the flexibility to assess sexual functioning with either brief, fixed-length questionnaires or individually-tailored assessments (i.e., computerized-adaptive testing, CAT). Item banks are groupings of questions whose measurement properties are carefully calibrated such that they can provide an operational definition of a concept (e.g., satisfaction with sex life) and accurately assess the entire continuum (e.g., severity or frequency) of that concept [24]. We used the developmental process of the PROMIS item banks [22, 25] which integrates the methods from qualitative research, psychometrics, health survey methods, and informatics to create efficient, precise, and valid measures to focus on sexual function. Key to this process is the continual input from cancer patients, clinicians, and survey methodologists to create the PROMIS-SF item banks.
The purpose of this paper is to report on the initial activities of the NIH-funded Cancer PROMIS Supplement Sexual Function (CaPS-SF) domain group. Specifically, we present selected findings from our CaPS-SF literature review of sexual function measures used in cancer populations, and describe how we identified the major sexual function domains found in those measures. Our secondary purpose is to provide oncology clinicians a compendium of psychometrically tested, patient-reported measures of sexual function along with corresponding cancer research citations. While our major intent is to inform the oncology community about the development of PROMIS-SF, we use the compendium to guide our recommendations to oncology clinicians and researchers in their current efforts to assess the sexual function of their patients.
Methods
Using a modified Delphi, consensus-driven approach developed by the PROMIS steering committee [24], we conducted an electronic bibliographic search using OVID Medline to identify measures of sexual function used in cancer populations. We used the search terms “cancer” or “neoplasms” in combination with two other sets of search terms under the rubrics of “measurement” and “sexual function.” Additional electronic searches were conducted using PsychInfo, PubMed, HAPI, Embase, CINAHL, and SCOPUS (1992 - 2007). Approximately 1200 citations were generated. The following criteria were used to select a final subset of 486 articles for in-depth review: the article was research-based, published in English between 1991 and 2007, described a sample of participants diagnosed with cancer, and described the administration of a self-report measure of sexual function.
The in-depth review ascertained the name(s) of the sexual function measure(s), the domains included in the measure, the original instrument citation(s), the number and type of items, the type of responses, the sample size, and the characteristics of the cancer population. Where possible, the original psychometric report for each measure was reviewed in order to obtain information about dimensionality, domains, the type of psychometric analysis, and the overall reliability and validity. We coded the type(s) of reliability as internal consistency (Cronbach alpha coefficient, the Kuder-Richardson Formula 20), test-retest (Pearson correlation coefficient, interclass correlation coefficients), split-half (Spearman-Brown prophecy formula, the Guttman split-half reliability coefficient, Rulon formula), and inter-rater agreement (kappa statistic or intraclass correlation coefficients). Validity, for purposes of this review, was classified as content, construct (convergent validity or discriminant validity), and criterion (concurrent validity or predictive validity) (see: The American Psychological Association Standards for Educational and Psychological Testing, 1999). In a few instances, we contacted the developer(s) of the measure to obtain psychometric information and to inquire about the measure’s use in oncology.
Results
From a review of 486 cancer-related articles, a total of 257 articles were found that describe the use of at least one dedicated, self-report, sexual function measure with documented levels of reliability and validity. Approximately 76% of these articles focused on prostate cancer, followed by breast (9%) and gynecologic cancers (7%), then bladder, rectal, testicular, hematologic, and head and neck cancers (<2% each). As shown in Table 1, we identified 31 unique self-report measures. Although not a dedicated sexual function measure, we included the University of California Los Angeles Prostate Cancer Index (UCLA PCI) [26] because it was used in half of the reviewed studies that focused on prostate cancer; items on sexual function and sexual bother are included with items about urinary and bowel function and bother.
Table 1.
Instrument Name | Domains & Internal Consistency | Reliability and Validity | Cancer site and references |
---|---|---|---|
Arizona Sexual Experience Scale (ASEX) McGahuey, et al., 2000 |
Sex drive Arousal Lubrication/Erection Ability to reach orgasm Satisfaction from orgasm |
Overall alpha = .91 Concurrent, construct |
Female cancers - Mathias, et al., 2005 Breast - Mathias, et al. 2006 |
Brief Index of Sexual Functioning for Women (BISF-W) Taylor, et al., 1994; Mazer, et al., 2000 |
Sexual interest/desire Sexual activity Sexual satisfaction |
Internal consistencies of subscales = .39 - .74; overall alpha = .83 Test-retest r = .68 – .78 Concurrent, construct |
Breast or gyn/I-Iib - Scott, et al., 2004 Gynecologic - Du, et al., 2005 Prostate (spouses) - Soloway, et al., 2005 |
Brief Sexual Function Questionnaire for Men (BSFQ) Reynolds et al, 1988 |
Sexual activity/performance Interest Satisfaction Physiological competence |
Guttman total test-retest reliability = .94 Concurrent, construct |
Prostate - Soloway, et al., 2005 |
Brief Sexual Function Inventory (BSFI) O’Leary, et al., 1995 |
Interest Function Ejaculation Problems/satisfaction |
Internal consistency of domains alpha = .62 - .92 Test-retest r = .68 - .70 Concurrent, construct |
Prostate - Bradley, et al., 2004 - Deliveliotis, et al., 2004 - Rajagopal, et al.,2003 - Valicenti, et al., 2002 - Chen, et al., 2001 - Valicenti, et al., 2001 - Krupski, et al., 2000 - Hong, et al., 1999 |
Changes in Sexual Functioning Questionnaire (CSFQ) Clayton et al., 1997a, 1997b; Keller, et al., 2006 |
Desire/Frequency Desire/Interest Arousal/Excitement Orgasm/Completion Pleasure |
Internal consistency of domains = .64 - .80 Test-retest r = 0.45 – 1.00 Construct |
All female cancer sites - Barton, et al., 2007 Gynaecological cancer - Lagana, et al., 2005 - Caldwell, et al., 2003 |
Derogatis Interview for Sexual Functioning-Self Report (DISF-SR) Derogatis, 1997 |
Cognition/fantasy Arousal Sexual behavior Orgasm Drive |
Internal consistency alpha of domains = .74 – 0.80 | Cervical cancer - Schroder, et al., 2005 |
Derogatis Sexual Functioning Inventory (DSFI) Derogatis, 1979 |
Information Experience Drive Attitudes Psychological Distress Gender Role Fantasy Body Image Sexual satisfaction Frequency of activity |
Internal consistency of domains alpha = .56 - .97 Test-retest.61 - .96 Construct |
All sites - Ananth, et al., 2003 Breast - Young-McCaughan, 1996 Cervix - Grumann, et al., 2001 - Schroder, et al., 2005 Head and neck - Monga, et al., 1997 Hematologic - Marks, et al., 1996 |
Erectile Dysfunction - Effect on Quality of Life (ED-EQoL) MacDonagh, et al. 2004 |
Erectile dysfunction | Internal consistency alpha = .94 Construct (Discriminant: Ferguson’s delta = .86) |
Prostate - Meyer, et al., 2003 |
Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) Althof, et al., 1999 |
Erectile dysfunction | Internal consistency (patient) alpha = .90; (partner) alpha = .76 Test-retest (patient) r = .98; (partner) r = .83 Content |
Prostate - Ramsawh, et al., 2005 - Montorsi, et al., 2004 |
Female Sexual Function Index (FSFI) Rosen et al., 2000 Wiegel et al., 2005 |
Desire Arousal Lubrication Orgasm Satisfaction Pain |
Internal consistency alpha > .90 Test-retest r = 0.79-0.86 Construct |
Bladder - Bhatt, et al., 2006 Breast - Schover, et al., 2006 - Speer, et al., 2005 Cervix - Frumovitz, et al., 2005 - Schroder, et al., 2005 Gynecologic - Carter, et al., 2005 Rectal - Hendren, et al., 2005 - Jayne, et al., 2005 Vulvar 46,47 - Likes, et al., 2007a - Likes, et al., 2007b |
Golombok Rust Inventory of Sexual Satisfaction (GRISS) Rust, et al., 1985, 1986; ter Kuile, et al., 1999; van Lankveld, et al., 1999; 2003 |
Erectile dysfunction Premature ejaculation Anorgasmia Vaginismus Noncommunication Infrequency Male and Female: Avoidance Nonsensuality Dissatisfaction |
Internal consistency of subscales alpha = .72 - .98 Test-retest of subscale r = .72 - .90 Predictive, construct |
Breast - Onen Sertoz, et al., 2004 Testicular - Sheppard, et al., 2001 |
International Continence Society questionnaire (male and sex subscales) (ICS) Donovan, et al., 2000 |
Erectile function | Internal consistency of subscales alpha = .69 - .91 Test-retest of symptom score r = .78; problem score r = .83 Criterion, construct |
Prostate - Henderson, et al. 2006 - Rozet, et al., 2005 - Selli, et al., 2004 - Gacci, et al., 2003 - Hara, et al., 2003 |
Index of Female Sexual Function (IFSF-modified) - Kaplan, et al. 1999 Zippe, et al. 2004 |
Free of pain during intercourse Degree of vaginal Lubrication Overall sexual desire and interest Ability to achieve orgasm Overall sexual satisfaction |
Internal consistency alpha = .80 - .90 Test retest of subscales r = .71 - .76; total scale r = .70 Construct |
Bladder - Zippe, et al., 2004 |
International Index of Erectile Function Sexual Health Inventory for Men (IIEF-15, SHIM, IIEF-5) Rosen, et al., 1997, 1999, 2002; Rhoden, et al., 2002; Cappelleri et al., 2005 |
Erectile function Orgasm Desire Intercourse satisfaction Overall satisfaction IIEF-5 Erectile function Intercourse satisfaction |
Internal consistency of domains alpha = 0.73–0.99 Test–retest of domains r = 0.64–0.84 Construct |
Bladder - Davila, et al., 2007 - Wang, et al., 2007 - Columbo, et al., 2004 Prostate - Cesaretti, et al., 2007 - Chang, et al., 2007 - Davison, et al., 2007 - Incrocci, et al., 2007 - Kava, et al., 2007 - Kohler, et al., 2007 - Lee, et al., 2007 - Lu, et al., 2007 - Madeb, et al., 2007 - Mattei, 2007 - Matthew, et al, 2007 - Papadoukakis, et al., 2007 - Wille, et al., 2007 - Zagar, et al., 2007 - Bannowsky, et al., 2006 - Chaplin, et al., 2006 - Col, et al., 2006 - Incrocci, et al., 2006 - Kim, et al., 2006 - Long, et al., 2006 - Latini, et al., 2006 (a) - Latini, et al., 2006 (b) - Ponholzer, et al., 2006 - Salonia, et al., 2006 - Titta, et al., 2006 - Wilke, et al., 2006 - Zucchi, et al., 2006 - Bannowsky, et al., 2005 - Bellina, et al., 2005 - Canada, et al., 2005 - De Lorenzo, et al., 2005 - Dinelli, et al., 2005 - Karakiewicz, et al., 2005 - Mabjeesh, et al., 2005 - Menon, et al., 2005 - Matzkin, et al., 2005 - Merrick, et al., 2005 - Mulhall, et al., 2005 - Ohebshalom, et al., 2005 - Pompeu, et al., 2005 - Porpiglia, et al., 2005 - Ponholzer, et al., 2005 - Rozet, et al., 2005 - Shindel, et al., 2005 - Trinchieri, et al., 2005 - Yatim, 2005 - Alduais, et al., 2004 - Colombo, et al., 2004 - Davison, et al., 2004 - Fujioka, et al., 2004 - Montorsi, et al., 2004 - Ogura, et al., 2004 - Raina, et al., 2004 - Saidi, et al., 2004 - Anastasiadis, et al., 2003 - Gacci, et al., 2003 - Hara, et al., 2003 - Incrocci, et al., 2003 - Lee, et al., 2003 - Menon, et al., 2003 - Penson, et al., 2003 - Raina, et al., 2003 - Noldus, et al., 2002 - Schover, et al., 2002a - Schover, et al., 2002b - Merrick, et al., 2001 - Incrocci, et al., 2001 - Matzkin, et al., 2001 - Saito, et al., 2001 - Blander, et al. 2000 - Kedia, et al., 1999 Testicular - Wiechno, et al., 2007 - Lackner, et al., 2005 Rectal - He & Pu, 2005 - Hendren, et al., 2005 - Jayne, et al., 2005 |
Medical Outcomes Study (MOS) Sexual Functioning Scale (MOS-SFS) Sherbourne, 1992, in Stewart & Ware (eds.), 1992; McHorney, et al., 1994; Hays, et al.,1993 |
Sexual activity Difficulty becoming aroused Difficulty relaxing/enjoying sex Difficulty achieving orgasm |
Internal consistency (men) alpha = .90; (omen) r = .92 Construct |
Breast - Burwell, et al., 2006 - Broeckel, et al., 2002 Head and Neck - Siston, et al., 1997 |
UCLA Prostate Cancer Index-Sexual Function/Sexual Bother (UCLA PCI-SF/SB) Lubeck, et al., 1997 Litwin, et al., 1998, 2002; Karakiewicz, et al. 2003; Krongrad, et al 1998 UCLA Prostate Cancer Index + [Dutch] Sexual Activities module Incrocci, et al., 2001; Korfage, et al., 2003 UCLA Expanded Prostate Index Composite (EPIC) Wei, et al., 2000 Japanese adapted EPIC Takegami, et al., 2005; Kakehi, et al., 2007; Namiki, et al., 2007a |
Sexual function Sexual bother |
Internal consistency of subscales > .78 Cross-cultural validity, construct |
Prostate - Anger, et al., 2007 - Arredondo, et al., 2007 - Ash, et al., 2007 - Campbell, et al., 2007 - Dearnaley, et al., 2007 - Frank, et al., 2007 - Kakehi, et al., 2007 - Kato, et al., 2007 - Kübler, et al., 2007 - Litwin, et al., 2007 - Namiki, et al., 2007b - Namiki, et al., 2007c - Penedo, et al., 2007 - Stevens, et al. 2007 - Van der Wielen, et al., 2007 - Ball, et al., 2006 - Dalkin, et al., 2006 - Ishihara, et al., 2006 - Joseph, et al., 2006 - Miller, et al., 2006 - Montgomery, et al., 2006 - Namiki, et al., 2006 - Newton, et al., 2006 - Pinkawa, et al., 2006a - Pinkawa, et al., 2006b - Sanderson, et al., 2006 - Tseng, et al., 2006 - Wagner, et al., 2006 - Dahn, et al., 2005 - Descazeaud, et al., 2005 - Jayadevappa, et al., 2005 - Korfage, et al., 2005 - Krupski, et al., 2005 - Link, et al., 2005 - Penson, et al., 2005 - Soderdahl, et al., 2005 - Steginga, et al., 2005 - Wiygul, et al., 2005 - Yang, et al., 2005 - Campbell, et al., 2004 - Dahn, et al., 2004 - Descazeaud, et al., 2004 - Hoffman, et al., - Hollenbeck, et al., 2004 - Hu, et al., 2004 - Jenkins, et al., 2004 - Lepore, et al., 2004 - Merrick, et al., 2004 - Namiki, et al., 2004a - Namiki, et al., 2004b - Schover, et al., 2004 - Su, et al., 2004 - Cooperberg, et al., 2003 - Downs, et al., 2003 - Hollenbeck, et al., 2003 - Korfage, et al., 2003 - Krahn, et al., 2003 - Oefelein, 2003 - Penson, et al., 2003 - Bacon, et al., 2002 - Hollenbeck, et al., - 2002 - Katz, et al., 2002 - Smith, et al., 2002 - Valicenti, et al., 2002 - Wei, et al., 2002 - Chen, et al., 2001 - Davis, et al., 2001 - Fulmer, et al., 2001 - Kupelian, et al., 2001 - Litwin, et al., 2001 - Lubeck, et al., 2001a - Lubeck, et al., 2001b - Madalinska, et al., 2001a - Madalinska, et al., 2001b - Penson, et al., 2001 - Pietrow, et al., 2001 - Schapira, et al., 2001 - Brandeis, et al., 2000 - Gralnek, et al., 2000 - Potosky, et al., 2000 - Sanchez-Ortiz, et al., 2000 - Smith, et al., 2000 - Litwin, et al., 1999 - Perrotte, et al., 1999 - Krongrad, et al., 1998 - Litwin, et al., 1998 - Yarbro, et al., 1998 |
Psychological Impact of Erectile Dysfunction (PIED) Latini, et al., 2002 |
Sexual experience Emotional life |
Internal consistency of subscales alpha = .72 - .91 Test-retest of subscales r = .66 - .76 Construct |
Prostate - Penson, et al., 2003 |
Sapporo Medical University Sexual Function Questionnaire (SMUSFQ) Kato, et al., 1999 |
Sexual desire Erectile function Satisfaction after sex Sexual activity Overall satisfaction |
Reliability not reported Construct |
Prostate - Yoshimura, et al., 2004 - Yoshimura, et al., 2003 - Miyao, et al., 2001 - Arai, et al., 1999 - Shibuya, et al., 1997 |
Sexual Adjustment Questionnaire RTOG Modified Sexual Adjustment Questionnaire (SAQ-H) Waterhouse, et al., 1986; Bruner, et al., 1998 |
Activity Arousal Libido Orgasm Satisfaction Relationships Techniques Sexual dysfunction |
Test-retest (females) r = 0.67 Construct |
Prostate - Feigenberg, et al., 2005 - Bruner, et al., 2004 - Bruner, et al., 1998 Gynecologic - Ratliff, et al., 1996 |
Sexual Activity Questionnaire (SAQ) Thirlaway, et al., 1996 |
Frequency of sexual activity Sexual interest/desire Arousal/vaginal dryness Sexually related pain |
Internal consistency alpha = .56 - .88 Test-retest kappa = .50 – 1.0 |
Breast - Ganz, et al., 2003 - Ganz, et al., 2002 - Fobair, et al., 2001 Ovarian - Carmack Taylor, et al., 2004 Gynecologic - Wenzel, et al., 2002 |
Sexual Arousability Inventory (SAI) Hoon, et al., 1976 |
Sexual arousability | Internal consistency alpha = .91 - .92 Split half r = .92 Content, construct |
Breast - Wellisch, et al., ,1996 - Wellisch, et al., ,1992 - Wellisch, et al., 1991 |
Sexual Adjustment Questionnaire (SAQ-modified) O’Farrell, et al., 1997 |
Overall satisfaction Frequency of intercourse Discrepancy between desire and actual frequency Communication Ease of refusal Satisfaction with specific aspects Satisfaction with privacy and context Sexual dysfunction |
Reliability not reported Content, construct |
Prostate - Soloway, et al., 2005 |
Sexual Beliefs and Information Questionnaire (SBIQ) Adams, et al., 1996 |
Time/patience Stress/pressure Aging Sexual satifaction Other/basic knowledge |
Internal consistency total alpha = .81; factors alpha = .42 - .93 Test-retest r = .82 Content |
Gynecologic - Brotto, et al., 2007 |
Sexual Function After Treatment for Gynecologic Cancer (SFAGIS) Bransfield, et al., 1984 |
Fears about sexual activity Partner fears about sexual activity Initiation of activity Vaginal condition Vaginal lubrication Health provider intervention Desire for sexual information Changes in sexual activity |
Split half r= .80 Kuder-Richardson 20 internal consistency = .76 Content |
Gynecologic - Bruner, et al., 1999 |
Sexual Function Inventory Questionnaire (SFIQ) Klotz, et al., 2000 |
Not reported | Reliability and validity not reported | Prostate - Klotz, et al., 2000 |
Sexual Function Questionnaire (SFQ) Syrjala, et al., 2000 |
Sexual activity Specific problems Interest Desire Arousal Orgasm Satisfaction Masturbation Relationship |
Internal consistency of domains alpha > .80; overall alpha = .94 Criterion, construct |
All cancers - Syrjala, et al., 2000 Hematologic - Syrjala, et al., 2005 |
Sexual History Form (SHF) Schover & Jensen, 1988 |
Sexual behavior Frequency Satisfaction |
Reliability on 12 of 28 original items: Internal consistency (men) alpha = .65 Test-retest (women) r = .92; (men) r = .98 |
Bladder - Hart, et al., 1999 Breast -Greendale, et al., 2001 - Mortimer, et al., 1999 - Makar, et al., 1997 - Schover, et al., 1995 Prostate - Perez, et al., 2002 |
Sexual Self-Efficacy Scales-Erectile Functioning Sexual Self-Efficacy Scales-Female Functioning SSES: SSES-EF, SSES-FF Fichten, et al., 1998; Bailes, et al., 1998 |
SSES-M Unidimensional SSES-F Interpersonal Orgasm Individual Interest/Desire Sensuality Individual Arousal Affection Communication Body Acceptance Refusal |
SSES-M Internal consistency alpha = .86 - .92 Test-retest r = .97-.98 Concurrent, construct SSES-F Internal consistency alpha = .93 total; subscales alpha = .70 - .87 Test-retest r = .83 total; subscales r = .50 - .93 Concurrent |
Prostate - Latini, et al., 2006 - Penson, et al., 2003 |
Sexual Self-Schema Scale (SSSS) Andersen & Cyranowski, 1994 |
Passionate–romantic Open Embarrassed–Conservative |
Intercorrelations.65 - .80 Construct |
Ovarian - Champion, et al., 2007 - Gershenson, et al., 2007 Prostate - Schover, et al., 2004 - Jenkins, et al., 2004 - Schover, et al., 2002a - Schover, et al., 2002b Gynecologic - Andersen, et al., 1997 |
Sexual function-Vaginal changes Questionnaire (SVQ) Jensen, Klee, Thranov et al. 2004 |
Sexual interest Lubrication Orgasm Dyspareunia Vaginal dimensions Intimacy Sexual problems of partner Sexual activity Sexual satisfaction Body image Sexual and vaginal problems |
Internal consistency for subscales alpha = .76 - .83 Median kappa (patient/observer) = .80 Construct |
Cervix - Jensen, et al., 2004 - Jensen, et al., 2003 |
Watts Sexual Function Questionnaire (WSFQ) Watts, 1982 |
Not reported | Internal consistency alpha = 0.80 Test-retest r = 0.83 |
Breast - Rowland, et al., 2000 Prostate - Basaria, et al., 2002 |
References for Table 1 are available upon request.
Only three measures with well-documented reliability and validity were used in 10 or more of the reviewed articles: the UCLA PCI and its longer versions, the Expanded Prostate Index Composite (EPIC)[27]; the International Index of Erectile Function (IIEF) [28] and its shorter version, the IIEF-5 [29]; and the Female Sexual Function Index (FSFI) [30]. About 34% (n = 87) of the 257 reviewed articles reported using the UCLA PCI or the EPIC; 30.7% (n = 79) reported using the IIEF, and 3.9% (n = 10) reported using the FSFI.
Only three of the identified measures appear to have been developed specifically for cancer populations, namely the Sexual Function After Treatment for Gynecologic Cancer [31], the UCLA PCI [26], and the Sexual Function-Vaginal Changes Questionnaire [32]. Almost all of the identified measures are gender-specific or have male and female forms (e.g. Derogatis Sexual Functioning Inventory [33], Changes in Sexual Functioning Questionnaire [34]) to permit matched comparisons.
In addition to the sexual function scales, several of the reviewed articles reported using functional status or quality of life measures that include one or more items related to sexual function. For example, the Functional Assessment of Cancer Therapy-Breast Scale (FACT-B) [35] assesses sexual function in its subscale about additional concerns, the Cancer Rehabilitation and Evaluation System Short Form (CARES-SF) contains a sexual function subscale [36], and the Psychosocial Adjustment to Illness Scale (PAIS) includes a subscale of sexual dysfunction and quality of dyadic relationship [37 - 39]. Likewise, several of the site-specific measures of the European Organization for Research and Treatment of Cancer quality of life questionnaires (EORTC QLQ) contain function or symptom subscales to assess sexual function or dysfunction, such as the EORTC QLQ Colorectal-38, the EORTC QLQ Breast-23, the EORTC QLQ Ovarian-28, and the EORTC QLQ Head & Neck-35 [40]. Additionally, Gotay and her colleagues [41], after conducting qualitative research with cancer survivors, added sexuality/intimacy items to the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – Cancer 30 (EORTC QLQ-C30).
Dimensionality and Domains
Only a few measures were purposively constructed to be unidimensional, the majority being multidimensional. Exploratory factor analysis or principal components analysis were the most common statistical methods used to identify or verify subdomains. No psychometric reports indicated the use of confirmatory factor analysis or item response theory.
Almost all measures included domains related to stages of the sexual response cycle as defined by Masters and Johnson [42], including excitement/arousal, plateau/continued arousal and orgasm, although the specific content varied considerably between measures. The most common domains and the number of measures (#) identifying these domains were:
Sexual arousal (lubrication, erectile (dys)function) (19)
Sexual (dis)satisfaction (16)
Sexual desire (interest, drive, avoidance, receptivity, nonsensuality) (15)
Sexual pleasure (orgasm) (12)
Frequency of sexual activity (12)
Problems affecting sexual function (anorgasmia, pain, vaginismus) (5)
Less common domains (or constructs) related to cognitive aspects, including sexual thoughts or fantasies, sexual self-esteem, sexual self-image, sexual self-reflection, psychosexual stimulation, emotional goals, and broader cognitive dimensions such as sexual attitudes and beliefs, motivation, values, and expectations. The most infrequent domains were sexual role, partner function or perceptions, nonsexual interactions or communication, relationship satisfaction, and health-specific sexual dysfunction. Our preliminary conceptual model, based on the sorting of the measures’ reported domains, contains five domains: Sexual Response, Intrapersonal, Interpersonal, Frequency, and Overall Satisfaction.
Our literature review highlights the wide array of sexual function measures administered to cancer populations. Although we focused exclusively on the cancer literature, our findings approximate those of other reviews that examined the domains and psychometric properties of sexual function instruments used with general and medically ill populations. The first review by Arrington et al. [21] identified 45 sexual function-specific measures and 12 global measures, and concluded that while there is no consensus on sexual function domains, the most common domains were excitement/arousal, interest/desire, satisfaction/quality, and performance. The second review by Corona et al. [18] identified 30 patient self-report measures of sexual function published in their entirety between 1969 and 2005, 22 measures for males and/or males and females, 8 measures for females only. Our secondary review of these 30 measures found 83 unique domains, the most common relating to psychological constructs (e.g., emotional responses to sexual problems, sexual concerns), sexual desire/interest, sexual partner or relationship, and overall sexual satisfaction or pleasure. These domains are consistent with our preliminary conceptual model which is expected to undergo revision after further qualitative and quantitative testing.
For measures of male sexual function, there appears to be complete accord for including erectile function as a domain. For measures of female sexual function, sexual interest or desire, and ability to reach orgasm are the most common domains. In contrast, there appears to be no consensus among measures for both males and females with respect to domains related to non-genital activity, affection behaviors, or sexual intimacy, and, rarely, partner sexual function, sexual attractiveness or body-image, or sexually-related cognitive or emotional dimensions. Others recommend that these latter domains be classified as secondary or mediating dimensions [20, 43 - 45].
Most of the identified measures were gender-specific, consistent with other reviews of general sex measures [18, 21]. For specific research applications, such as evaluating interventions to treat erectile dysfunction, the use of gender-specific measures is clear. In other settings, however, it may be desirable to assess the degree of sexual issues independent of gender. For example, describing the burden of sexual difficulties in long-term survivors would benefit from assessing men and women on comparable metrics where possible. Generating gender-neutral assessments is challenging and likely will require a modular approach to measure development.
From our review, only the UCLA PCI/EPIC, IIEF, and FSFI immerged as “legacy” measures, that is, measures with extensive psychometric testing and sufficient clinical administration in oncology settings to help set the standard for the development of subsequent sexual function measures intended for use with cancer survivors. Indeed, in the last 15 years the UCLA PCI/EPIC and the IIEF have been used in about two-thirds of studies that examine the sexual function of individuals treated for cancer. While both are reliable and valid indicators of male sexual function, there are important differences between these measures. The 20-item UCLA PCI was originally developed for use with the Rand 36-item Health Survey (SF-36) to yield a comprehensive quality of life assessment of men with prostate cancer [46]; the IIEF was developed with support from a pharmaceutical company for the purpose of evaluating multinational clinical trials of sildenafil citrate [47]. Another distinction is that the UCLA PCI and its 26-item and 50-item EPIC versions specifically target symptoms associated with prostate cancer compared to the IIEF which assesses sexual function only. Also, the UCLA PCI has been shown to discriminate between older men with and without prostate cancer [26], and has been successfully used in large prospective studies of prostate cancer conducted in the U.S. [e.g., 48 - 50]. The discriminant validity of the IIEF between men with and without cancer has not been reported, but the measure is able to discriminate between men receiving and not receiving sildenafil citrate for erectile dysfunction after radical prostatectomy, (e.g., 51], and between men receiving or not receiving tadalafil after radiation therapy for prostate cancer [15, 52]. Given their comparable levels of reliability and validity and use with cancer populations, decisions to use one or the other measure depend on research or clinical objectives as well as practical considerations. Measures that produce multiple conceptually precise subscales (e.g., EPIC) might be better suited for research purposes because of the need to detect subtle intergroup differences over time, whereas measures with fewer, more global dimensions (e.g., IIEF-5) might be adequate for clinical purposes (i.e., for screening to help identify who may be having problems, or as a catalyst to begin patient-provider communication about sexual function). Too, since both the UCLA/EPIC and IIEF are available at no cost, clinical use may favor the IIEF which takes about 5 – 10 minutes to self-administer while compared to the 20-30 minutes needed for the UCLA/EPIC versions. It should be noted that the male version of the CaPS SF will capture and test similar domains and items from both measures (in addition to those from other measures) with the goal of producing targeted, clinically relevant outcomes with the least possible administration and response burdens for all cancer sites.
Among the identified measures of female sexual function used in oncology, only one measure appears to be emerging as a legacy measure, namely the FSFI which was developed by the IIEF originator, again with the support of pharmaceutical funding [30, 53]. Used in studies of urologic [54], gynecologic [55 - 59], breast [60, 61], and rectal cancer survivors [62, 63], it appears to have undergone extensive psychometric testing, and is able to discriminate between clinical and non-clinical populations [64]. The 19-item FSFI takes less than 15 minutes to complete, uses a 4-week recall period, and is available at no cost [30]. This measure has been used in clinical trials of sildenafil citrate [65, 66] and vardenafil [67] to evaluate female partner satisfaction, and thus might be a particularly useful measure in studies of male cancers where partner assessments are included as an outcome. The use of the FSFI in studies of female cancer survivors also appears to be growing as indicated by reports published subsequent to our CaPS-SF literature review [e.g., 68, 69]. The extent to which the FSFI is used in clinical settings to help evaluate and treat the sexual function of female cancer survivors is unknown. Our female CaPS SF measure will capture and test similar domains and items as found in the FSFI.
Unexpectedly, our literature review indicates that sildenafil citrate, approved by the U. S. Food and Drug Administration in 1998 to treat erectile dysfunction, paved the way for sexual function measures to be used in oncology. As a consequence, among cancer populations, the assessment of male sexual function has far outpaced the assessment of female sexual function, an unanticipated finding given decades of research documenting compromised sexual function after treatment for gynecologic and breast cancer. Although several well-established measures of female sexual function are available (e.g., Derogatis Sexual Functioning Inventory, Brief Index of Sexual Function for Women, Female Sexual Function Index), it was also surprising that they have not been used as extensively as the UCLA-PCI or IIEF.
A significant limitation of the existing measures is the lack of data demonstrating the validity of the measures for different cancer sites and across the continuum of cancer care, a limitation that presents challenges for conducting meaningful cross-study comparisons across all cancer sites. As indicated above, important exceptions are the UCLA PCI and the IIEF both of which have been used post-diagnosis through long-term follow-up care.
Next Steps
The present findings echo those of Cull [20] who concluded that no one brief self-report measure of sexual function can be recommended for cancer clinical trials. Because sexual function is differentially affected by cancer site, cancer treatment, age, gender, partner status, sexual orientation, and cultural practices, researchers may need to develop their own measures to better reflect the characteristics of their targeted population. As discussed above, there are several advantages to developing a measure of sexual function that is sensitive, yet applicable, to a broader array of people. This review was undertaken as the first step in the PROMIS process for developing such a measure. Briefly, the remaining steps for our CaPS-SF subcommittee are to:
refine the domain hierarchy based on the results of recently completed focus groups with cancer patients;
review and standardize the items that remain from “binning and winnowing” the approximately 1500 captured items from publicly available measures;
write new items that address gaps identified through focus groups and cognitive testing;
cognitively test the items with cancer patients and survivors;
develop and refine our conceptual model informed by the above steps;
collect self-report data from a large diverse group of cancer survivors;
evaluate the psychometric properties of the items and calibrate the items for the PROMIS-SF item bank; and
create PROMIS-SF short form instruments and to implement computerized adaptive testing.
Subsequent reports will describe these next steps, as well as detail the remaining processes as we work to develop a flexible and psychometrically robust measure of sexual function for use in clinical oncology settings, and, eventually, in other chronic disease settings. The final CaPS-SF product will be internationally available in the public domain by October 2009. National and international cooperative groups are encouraged to consider collaborating with the PROMIS initiative to assist with establishing further construct validity of the PROMIS-SF in clinical trial settings. The complexity and resources needed to accomplish the CAPS-SF activities described above underscores the importance of support from the NIH Roadmap Initiative for Medical Research to develop psychometrically sound patient-reported outcome measures.
Acknowledgments
Acknowledgement of support: NIH Grant U 5 U01 AR052186
References
- 1.Glasgow M, Halfin V, Althausen AF. Sexual response and cancer. CA Cancer J Clin. 1987;37:322–333. doi: 10.3322/canjclin.37.6.322. [DOI] [PubMed] [Google Scholar]
- 2.Ries LAG, Melbert D, Krapcho M, et al., editors. SEER Cancer Statistics Review, 1975-2005. National Cancer Institute; Bethesda, MD: [May 1, 2008]. Available from URL: http://seer.cancer.gov/csr/1975_2005. [Google Scholar]
- 3.Institute of Medicine. Committee on Cancer Survivorship: Improving Care and Quality of Life. Washington, DC: National Academies Press; 2006. [PubMed] [Google Scholar]
- 4.Burnett AL, Aus G, Canby-Hagino ED, et al. Erectile function outcome reporting after clinically localized prostate cancer treatment. J Urol. 2007;178:597–601. doi: 10.1016/j.juro.2007.03.140. [DOI] [PubMed] [Google Scholar]
- 5.Carmack Taylor CL, Basen-Engquist K, Shinn EH, Bodurka DC. Predictors of sexual functioning in ovarian cancer patients. J Clin Oncol. 2004;22:881–889. doi: 10.1200/JCO.2004.08.150. [DOI] [PubMed] [Google Scholar]
- 6.Institute of Medicine. Implementing Cancer Survivorship Care Planning: Workshop Summary. Washington, DC: The National Academies Press; 2007. [Google Scholar]
- 7.Krebs LU. Sexual assessment in cancer care: Concepts, methods, and strategies for success. Semin Oncol Nurs. 2008;24:80–90. doi: 10.1016/j.soncn.2008.02.002. [DOI] [PubMed] [Google Scholar]
- 8.Schover LR, Fouladi RT, Warneke CL, et al. Defining sexual outcomes after treatment for localized prostate carcinoma. Cancer. 2002;95:1773–1785. doi: 10.1002/cncr.10848. [DOI] [PubMed] [Google Scholar]
- 9.Harris MJ. The anatomic radical perineal prostatectomy: an outcomes-based evolution. Eur Urol. 2007;52:81–88. doi: 10.1016/j.eururo.2006.10.041. [DOI] [PubMed] [Google Scholar]
- 10.Stanford JL, Feng Z, Hamilton AS, et al. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: the Prostate Cancer Outcomes Study. JAMA. 2000;283:354–360. doi: 10.1001/jama.283.3.354. [DOI] [PubMed] [Google Scholar]
- 11.Malinovszky KM, Gould A, Foster E, et al. Quality of life and sexual function after high-dose or conventional chemotherapy for high-risk breast cancer. Br J Cancer. 2006;95:1626–1631. doi: 10.1038/sj.bjc.6603454. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Young-McCaughan S. Sexual functioning in women with breast cancer after treatment with adjuvant therapy. Cancer Nursing. 1996;19:308–319. doi: 10.1097/00002820-199608000-00007. [DOI] [PubMed] [Google Scholar]
- 13.Cesaretti JA, Kao J, Stone NN, Stock RG. Effect of low dose-rate prostate brachytherapy on the sexual health of men with optimal sexual function before treatment: analysis at > or = 7 years of follow-up. BJU Int. 2007;100:362–367. doi: 10.1111/j.1464-410X.2007.07016.x. [DOI] [PubMed] [Google Scholar]
- 14.Hollenbeck BK, Wei JT, Sanda MG, Dunn RL, Sandler HM. Neoadjuvant hormonal therapy impairs sexual outcome among younger men who undergo external beam radiotherapy for localized prostate cancer. Urology. 2004;63(5):946–50. doi: 10.1016/j.urology.2003.11.029. [DOI] [PubMed] [Google Scholar]
- 15.Incrocci L, Slagter C, Slob AK, Hop WC. A randomized, double-blind, placebo-controlled, cross-over study to assess the efficacy of tadalafil (Cialis) in the treatment of erectile dysfunction following three-dimensional conformal external-beam radiotherapy for prostatic carcinoma. Int J Radiat Oncol Biol Phys. 2006;66:439–444. doi: 10.1016/j.ijrobp.2006.04.047. [DOI] [PubMed] [Google Scholar]
- 16.Miller DC, Wei JT, Dunn RL, et al. Use of medications or devices for erectile dysfunction among long-term prostate cancer treatment survivors: potential influence of sexual motivation and/or indifference. Urology. 2006;68:166–171. doi: 10.1016/j.urology.2006.01.077. [DOI] [PubMed] [Google Scholar]
- 17.Burnett AL, Aus G, Canby-Hagino ED, et al. Erectile function outcome reporting after clinically localized prostate cancer treatment. J Urol. 2007;178:597–601. doi: 10.1016/j.juro.2007.03.140. [DOI] [PubMed] [Google Scholar]
- 18.Corona G, Jannini EA, Maggi M. Inventories for male and female sexual dysfunctions. Int J Impot Res. 2006;18:236–250. doi: 10.1038/sj.ijir.3901410. [DOI] [PubMed] [Google Scholar]
- 19.Derogatis LR, Laban MP. Psychological assessment measures of human sexual functioning in clinical trials. Int J Impot Res. 1998;10:S13–20. [PubMed] [Google Scholar]
- 20.Cull AM. The assessment of sexual function in cancer patients. Eur J Cancer Part A: General Topics. 1992;28:1680–1686. doi: 10.1016/0959-8049(92)90068-d. [DOI] [PubMed] [Google Scholar]
- 21.Arrington R, CoFrancesco J, Wu AW. Questionnaires to measure sexual quality of life. Qual Life Res. 2004;13:1643–1658. doi: 10.1007/s11136-004-7625-z. [DOI] [PubMed] [Google Scholar]
- 22.Reeve BB, Hays RD, Bjorner JB, et al. Psychometric evaluation and calibration of health-related quality of life item banks: plans for the Patient-Reported Outcomes Measurement Information System (PROMIS) Med Care. 2007;45(5):S22–31. doi: 10.1097/01.mlr.0000250483.85507.04. [DOI] [PubMed] [Google Scholar]
- 23.Garcia SF, Cella D, Clauser SB, et al. Standardizing patient-reported outcomes assessment in cancer clinical trials: a patient-reported outcomes measurement information system initiative. J Clin Oncol. 2007;25:5106–5112. doi: 10.1200/JCO.2007.12.2341. [DOI] [PubMed] [Google Scholar]
- 24.Cella D, Yount S, Rothrock N, et al. The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH Roadmap cooperative group during its first two years. Med Care. 2007;45(5):S3–S11. doi: 10.1097/01.mlr.0000258615.42478.55. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.DeWalt DA, Rothrock N, Yount S, Stone AA. PROMIS Cooperative Group. Evaluation of item candidates: the PROMIS qualitative item review. Med Care. 2007;45(5):S12–21. doi: 10.1097/01.mlr.0000254567.79743.e2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Litwin MS, Hays RD, Fink A, Ganz PA, Leake B, Brook RH. The UCLA Prostate Cancer Index: development, reliability, and validity of a health-related quality of life measure. Med Care. 1998;36:1002–1012. doi: 10.1097/00005650-199807000-00007. [DOI] [PubMed] [Google Scholar]
- 27.Wei JT, Dunn RL, Litwin MS, Sandler HM, Sanda MG. Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer. Urology. 2000;56(6):899–905. doi: 10.1016/s0090-4295(00)00858-x. [DOI] [PubMed] [Google Scholar]
- 28.Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49:822–830. doi: 10.1016/s0090-4295(97)00238-0. [DOI] [PubMed] [Google Scholar]
- 29.Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res. 1999;11:319–326. doi: 10.1038/sj.ijir.3900472. [DOI] [PubMed] [Google Scholar]
- 30.Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al. The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26:191–208. doi: 10.1080/009262300278597. [DOI] [PubMed] [Google Scholar]
- 31.Bransfield DD, Horiot JC, Nabid A. Development of a scale for assessing sexual function after treatment for gynecologic cancer. J Psychosoc Oncol. 1984;2:3–19. [Google Scholar]
- 32.Jensen PT, Klee MC, Thranov I, Groenvold M. Validation of a questionnaire for self-assessment of sexual function and vaginal changes after gynaecological cancer. Psychooncology. 2004;13:577–592. doi: 10.1002/pon.757. [DOI] [PubMed] [Google Scholar]
- 33.Derogatis LR. The Derogatis Interview for Sexual Functioning (DISF/DISF-SR): an introductory report. J Sex Marital Ther. 1997;23:291–304. doi: 10.1080/00926239708403933. [DOI] [PubMed] [Google Scholar]
- 34.Clayton AH, McGarvey EL, Clavet GJ. The Changes in Sexual Functioning Questionnaire (CSFQ): development, reliability, and validity. Psychopharmacol Bull. 1997;33:731–745. [PubMed] [Google Scholar]
- 35.Brady MJ, Cella DF, Mo F, et al. Reliability and validity of the functional assessment of cancer therapy- breast quality-of-life instrument. J Clin Oncol. 1997;15:974–986. doi: 10.1200/JCO.1997.15.3.974. [DOI] [PubMed] [Google Scholar]
- 36.Schag CAC, Ganz P, Heinrich RL. Cancer specific rehabilitation and quality of life instrument. Cancer. 1991;68:1406–1413. doi: 10.1002/1097-0142(19910915)68:6<1406::aid-cncr2820680638>3.0.co;2-2. [DOI] [PubMed] [Google Scholar]
- 37.Morrow GR, Chiarello RJ, Derogatis LR. A new scale for assessing patients’ psychosocial adjustment to medical illness. Psychol Med. 1978;8:605–610. doi: 10.1017/s003329170001881x. [DOI] [PubMed] [Google Scholar]
- 38.Derogatis LR. The psychosocial adjustment to illness scale (PAIS) J Psychosomatic Res. 1986;30:77–91. doi: 10.1016/0022-3999(86)90069-3. [DOI] [PubMed] [Google Scholar]
- 39.Rodrigue JR, Kanasky WF, Jr, Jackson SI, Perri MG. The psychosocial adjustment to illness scale - self-report: factor structure and item stability. Psychol Assessment. 2000;12:409–413. [PubMed] [Google Scholar]
- 40.European Organization for Research and Treatment of Cancer. [December 28, 2007]; Available from URL: http://groups.eortc.be/qol/questionnaires_modules.htm.
- 41.Gotay CC, Blaine D, Haynes SN, Holup J, Pagano IS. Assessment of quality of life in a multicultural cancer patient population. Psychol Assessment. 2002;14:439–450. doi: 10.1037//1040-3590.14.4.439. [DOI] [PubMed] [Google Scholar]
- 42.Masters WH, Johnson VE. Human Sexual Response. Boston: Little, Brown & Company; 1966. [Google Scholar]
- 43.Derogatis LR, Laban MP. Psychological assessment measures of human sexual functioning in clinical trials. Int J Impot Res. 1998;10(Suppl 2):S13–20. [PubMed] [Google Scholar]
- 44.Coeffin-Driol C, Giami A. The impact of infertility and its treatment on sexual life and marital relationships: review of the literature. Gynecol Obstet Fertil. 2004;32:624–637. doi: 10.1016/j.gyobfe.2004.06.004. [DOI] [PubMed] [Google Scholar]
- 45.West SL, Vinikoor LC, Zolnoun D. A systematic review of the literature on female sexual dysfunction prevalence and predictors. Annu Rev Sex Res. 2004;15:40–172. [PubMed] [Google Scholar]
- 46.Prostate Cancer Index. [August 11, 2008]; Available from http://www.uclaurology.com/conditions/Prost28.cfm.
- 47.Rosen RC, Cappelleri JC, Gendrano N., III The International Index of Erectile Function (IIEF): A state-of-the-science review. Int J Impot Res. 2002;14:226–244. doi: 10.1038/sj.ijir.3900857. [DOI] [PubMed] [Google Scholar]
- 48.Potosky AL, Legler J, Albertsen PC, Stanford JL, Gilliland FD, Hamilton AS, et al. Health outcomes after prostatectomy or radiotherapy for prostate cancer: Results from the prostate cancer outcomes study. JNCI. 2000;92:1582–1592. doi: 10.1093/jnci/92.19.1582. [DOI] [PubMed] [Google Scholar]
- 49.Arredondo SA, Latini DM, Sadetsky N, Kawakami J, Pasta DJ, DuChane J, et al. Quality of life for men receiving a second treatment for prostate cancer. J Urol. 2007;177:273–279. doi: 10.1016/j.juro.2006.08.061. [DOI] [PubMed] [Google Scholar]
- 50.Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, Hembroff L, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. NEJM. 2008;358:1250–1261. doi: 10.1056/NEJMoa074311. [DOI] [PubMed] [Google Scholar]
- 51.Bannowsky A, Schulze H, van der Horst C, Hautmann S, Jünemann KP. Recovery of erectile function after nerve-sparing radical prostatectomy: Improvement with nightly low-dose sildenafil. BJU Int. 2008;101(10):1279–83. doi: 10.1111/j.1464-410X.2008.07515.x. [DOI] [PubMed] [Google Scholar]
- 52.Incrocci L, Slob AK, Hop WC. Tadalafil (Cialis) and erectile dysfunction after radiotherapy for prostate cancer: an open-label extension of a blinded trial. Urology. 2007;70(6):1190–3. doi: 10.1016/j.urology.2007.08.029. [DOI] [PubMed] [Google Scholar]
- 53.Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther. 2005 Jan-Feb;31(1):1–20. doi: 10.1080/00926230590475206. [DOI] [PubMed] [Google Scholar]
- 54.Bhatt A, Nandipati K, Dhar N, Ulchaker J, Jones S, Rackley R, Zippe C. Neurovascular preservation in orthotopic cystectomy: impact on female sexual function. Urology. 2006 Apr;67(4):742–5. doi: 10.1016/j.urology.2005.10.015. [DOI] [PubMed] [Google Scholar]
- 55.Frumovitz M, Sun CC, Schover LR, Munsell MF, Jhingran A, Wharton JT, et al. Quality of life and sexual functioning in cervical cancer survivors. J Clin Oncol. 2005 Oct 20;23(30):7428–36. doi: 10.1200/JCO.2004.00.3996. [DOI] [PubMed] [Google Scholar]
- 56.Schroder M, Mell LK, Hurteau JA, Collins YC, Rotmensch J, Waggoner SE, et al. Clitoral therapy device for treatment of sexual dysfunction in irradiated cervical cancer patients. Int J Radiat Oncol Biol Physics. 2005 Mar 15;61(4):1078–86. doi: 10.1016/j.ijrobp.2004.07.728. [DOI] [PubMed] [Google Scholar]
- 57.Carter J, Rowland K, Chi D, Brown C, Abu-Rustum N, Castiel M, et al. Gynecologic cancer treatment and the impact of cancer-related infertility. Gynecol Oncol. 2005 Apr;97(1):90–5. doi: 10.1016/j.ygyno.2004.12.019. [DOI] [PubMed] [Google Scholar]
- 58.Likes WM, Stegbauer C, Tillmanns T, Pruett J. Pilot study of sexual function and quality of life after excision for vulvar intraepithelial neoplasia. J Reprod Med. 2007 Jan;52(1):23–7. [PubMed] [Google Scholar]
- 59.Likes WM, Stegbauer C, Tillmanns T, Pruett J. Correlates of sexual function following vulvar excision. Gynecol Oncol. 2007 Jun;105(3):600–3. doi: 10.1016/j.ygyno.2007.01.027. [DOI] [PubMed] [Google Scholar]
- 60.Schover LR, Jenkins R, Sui D, Adams JH, Marion MS, Jackson KE. Randomized trial of peer counseling on reproductive health in African American breast cancer survivors. J Clin Oncol. 2006 Apr 1;24(10):1620–6. doi: 10.1200/JCO.2005.04.7159. [DOI] [PubMed] [Google Scholar]
- 61.Speer JJ, Hillenberg B, Sugrue DP, Blacker C, Kresge CL, Decker VB, et al. Study of sexual functioning determinants in breast cancer survivors. Breast J. 2005 Nov-Dec;11(6):440–7. doi: 10.1111/j.1075-122X.2005.00131.x. [DOI] [PubMed] [Google Scholar]
- 62.Hendren SK, O’Connor BI, Liu M, Asano T, Cohen Z, Swallow CJ, et al. Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann Surg. 2005 Aug;242(2):212–23. doi: 10.1097/01.sla.0000171299.43954.ce. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 63.Jayne DG, Brown JM, Thorpe H, Walker J, Quirke P, Guillou PJ. Bladder and sexual function following resection for rectal cancer in a randomized clinical trial of laparoscopic versus open technique. Br J Surg. 2005 Sep;92(9):1124–32. doi: 10.1002/bjs.4989. [DOI] [PubMed] [Google Scholar]
- 64.Likes WM, Stegbauer C, Hathaway D, Brown C, Tillmanns T. Use of the Female Sexual Function Index in women with vulvar intraepithelial neoplasia. J Sex Marital Ther. 2006 May-Jun;32(3):255–66. doi: 10.1080/00926230600575348. [DOI] [PubMed] [Google Scholar]
- 65.Heiman JR, Talley DR, Bailen JL, Oskin TA, Rosenberg SJ, Pace CR, et al. Sexual function and satisfaction in heterosexual couples when men are administered sildenafil citrate (Viagra) for erectile dysfunction: A multicentre, randomised, double-blind, placebo-controlled trial. Br Obstet Gynaecol. 2007;114:437–447. doi: 10.1111/j.1471-0528.2006.01228.x. [DOI] [PubMed] [Google Scholar]
- 66.Cayan S, Bozlu M, Canpolat B, Akbay E. The assessment of sexual functions in women with male partners complaining of erectile dysfunction: does treatment of male sexual dysfunction improve female partner’s sexual functions? J Sex Marital Ther. 2004;30:333–341. doi: 10.1080/00926230490465091. [DOI] [PubMed] [Google Scholar]
- 67.Rosen RC, Fisher WA, Beneke M, Homering M, Evers T. The COUPLES-project: a pooled analysis of patient and partner treatment satisfaction scale (TSS) outcomes following vardenafil treatment. BJUl Int. 2007;99:849–859. doi: 10.1111/j.1464-410X.2006.06737.x. [DOI] [PubMed] [Google Scholar]
- 68.Alder J, Zanetti R, Wight E, Urech C, Fink N, Bitzer J. Sexual Dysfunction after Premenopausal Stage I and II Breast Cancer: Do Androgens Play a Role? J Sex Med. 2008 Jun 11; doi: 10.1111/j.1743-6109.2008.00893.x. Epub ahead of print. [DOI] [PubMed] [Google Scholar]
- 69.Liang JT, Lai HS, Lee PH, Chang KJ. Laparoscopic pelvic autonomic nerve-preserving surgery for sigmoid colon cancer. Ann Surg Oncol. 2008 Jun;15(6):1609–16. doi: 10.1245/s10434-008-9861-x. [DOI] [PMC free article] [PubMed] [Google Scholar]