Bober Sharon L, Recklitis Christopher J, Bakan Jennifer, Garber Judy E, Patenaude Andrea F
Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
J Sex Med. 2015 Jan;12(1):189-97. doi: 10.1111/jsm.12713. Epub 2014 Oct 14.
Women at high risk for ovarian cancer due to BRCA1 or BRCA2 mutation or family history are recommended to undergo risk-reducing salpingo-oophorectomy (RRSO) after age 35 or completion of childbearing. This potentially life-saving surgery leads to premature menopause, frequently resulting in distressing and unaddressed sexual dysfunction.
To pilot a novel sexual health intervention for women with BRCA1/2 mutations who previously underwent RRSO a using a single-arm trial. Feasibility and primary outcomes including sexual dysfunction and psychological distress were assessed.
This single-arm trial included a one-time, half-day educational session comprised of targeted sexual health education, body awareness and relaxation training, and mindfulness-based cognitive therapy strategies, followed by two sessions of tailored telephone counseling. Assessments were completed at baseline and 2 months postintervention.
Study end points include feasibility and effectiveness as reported by the participant.
Thirty-seven women completed baseline and postintervention assessments. At baseline, participants had a mean age of 44.4 (standard deviation [SD] = 3.9) years and mean duration of 3.8 (SD = 2.7) years since RRSO. Overall sexual functioning (P = 0.018), as well as desire (P = 0.003), arousal (P = 0.003), satisfaction (P = 0.028), and pain (P = 0.018), improved significantly. There were significant reductions in somatization (P = 0.029) and anxiety scores (P < 0.001), and, overall, for the Global Severity Index (P < 0.001) of the Brief Symptom Inventory. Sexual self-efficacy and sexual knowledge also improved significantly from baseline to postintervention (both P < 0.001). Women were highly satisfied with the intervention content and reported utilizing new skills to manage sexual dysfunction.
This intervention integrates elements of cognitive behavioral therapy with sexual health education to address a much-neglected problem after RRSO. Results from this promising single-arm study provide preliminary data to move toward conducting a randomized, controlled trial.
因BRCA1或BRCA2基因突变或家族病史而患卵巢癌风险较高的女性，建议在35岁或完成生育后接受降低风险的输卵管卵巢切除术（RRSO）。这种可能挽救生命的手术会导致过早绝经，常常引发令人苦恼且未得到解决的性功能障碍。
采用单臂试验，为先前接受RRSO的携带BRCA1/2基因突变的女性试行一种新型性健康干预措施。评估可行性以及包括性功能障碍和心理困扰在内的主要结局。
该单臂试验包括一次为时半天的教育课程，内容有针对性的性健康教育、身体意识和放松训练以及基于正念的认知疗法策略，随后进行两次量身定制的电话咨询。在基线和干预后2个月完成评估。
研究终点包括参与者报告的可行性和有效性。
37名女性完成了基线和干预后评估。基线时，参与者的平均年龄为44.4岁（标准差[SD]=3.9），自RRSO以来的平均时长为3.8年（SD=2.7）。总体性功能（P=0.018）以及性欲（P=0.003）、性唤起（P=0.003）、性满意度（P=0.028）和性交疼痛（P=0.018）均有显著改善。躯体化症状（P=0.029）和焦虑评分（P<0.001）显著降低，总体而言，简明症状量表的总体严重程度指数（P<0.001）也显著降低。从基线到干预后，性自我效能感和性知识也显著提高（均为P<0.001）。女性对干预内容高度满意，并报告运用新技能来管理性功能障碍。
这种干预将认知行为疗法的要素与性健康教育相结合，以解决RRSO后一个长期被忽视的问题。这项有前景的单臂研究结果为开展随机对照试验提供了初步数据。
