Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW, Australia.
J Sex Med. 2013 Oct;10(10):2549-58. doi: 10.1111/jsm.12156. Epub 2013 May 1.
Almost half of breast cancer survivors experience chronic sexual problems. Despite the negative effects of dyspareunia on physical and overall quality of life, sexual dysfunction remains underreported and undertreated in clinical practice. This is likely due to the paucity of evidence-based interventions to improve sexual functioning.
The study aims to prospectively evaluate the acceptability, feasibility, and efficacy of a novel intervention (Olive Oil, Vaginal Exercise, and MoisturizeR [OVERcome]) to improve sexual problems following breast cancer treatment.
Dyspareunia, sexual functioning, quality of life, distress, and pelvic floor muscles (PFMs) functioning were evaluated.
Twenty-five women with dyspareunia were instructed to perform pelvic floor muscle (PFM) relaxation exercises twice/day to prevent/manage PFM overactivity, apply a polycarbophil-based vaginal moisturizer three times/week to alleviate vaginal dryness, use olive oil as a lubricant during intercourse, and complete a weekly compliance diary. PFM relaxation training was administered by a physiotherapist at weeks 0 and 4, with follow-up at weeks 12 and 26. At each visit, women completed validated self-report questionnaires and the physiotherapist recorded objective measures of PFM functioning.
OVERcome resulted in significant improvements in dyspareunia, sexual function, and quality of life over time (all P<0.001). PFM relaxation training was reported to be effective (P≤0.001). Maximum benefits were observed at week 12. Most women rated PFM relaxation exercises (92%), vaginal moisturizer (88%), and olive oil (73%) as helpful, indicating that the intervention was acceptable. Unexpectedly, six cases (11%) of vaginal stenosis were noted during initial screening.
This novel intervention is acceptable to patients with demonstrated efficacy in improving dyspareunia and sexual function following breast cancer. Delivery of the OVERcome intervention appears feasible in a clinical setting, providing a potential treatment for this important clinical issue. The unexpected number of observed cases of stenosis further highlights the underreporting of sexual problems in this population, deserving further exploration.
近半数乳腺癌幸存者会经历慢性性问题。尽管性交困难会对身体和整体生活质量产生负面影响，但在临床实践中，性功能障碍的报告和治疗仍不足。这可能是因为缺乏改善性功能的循证干预措施。
本研究旨在前瞻性评估一种新干预措施（橄榄油、阴道锻炼和保湿剂 [OVERcome]）治疗乳腺癌治疗后性问题的可接受性、可行性和疗效。
评估性交困难、性功能、生活质量、苦恼和盆底肌肉（PFMs）功能。
25 名性交困难的女性被指导每天进行两次盆底肌肉（PFM）放松练习，以预防/管理 PFM 过度活动，每周三次使用基于聚卡波非的阴道保湿剂以缓解阴道干燥，在性交时使用橄榄油作为润滑剂，并每周填写一份依从性日记。在第 0 周和第 4 周，由物理治疗师进行 PFM 放松训练，第 12 周和第 26 周进行随访。每次就诊时，女性都会填写经过验证的自我报告问卷，物理治疗师会记录 PFM 功能的客观测量结果。
OVERcome 随着时间的推移，在性交困难、性功能和生活质量方面均有显著改善（均 P<0.001）。PFM 放松训练被认为是有效的（P≤0.001）。最大的益处出现在第 12 周。大多数女性（92%）认为 PFM 放松练习、阴道保湿剂（88%）和橄榄油（73%）有帮助，表明干预措施是可以接受的。出乎意料的是，在最初的筛查中发现了 6 例（11%）阴道狭窄病例。
这种新的干预措施对于改善乳腺癌后性交困难和性功能是可以接受的，并证明是有效的。在临床环境中，OVERcome 干预措施的实施似乎是可行的，为这一重要的临床问题提供了一种潜在的治疗方法。观察到的狭窄病例数量之多进一步凸显了该人群中性问题报告不足的问题，值得进一步探讨。
