Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Department of Psychosocial Counseling, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Family Cancer Clinic, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
J Sex Med. 2017 Oct;14(10):1248-1259. doi: 10.1016/j.jsxm.2017.08.004. Epub 2017 Sep 8.
Many women develop sexual problems after breast cancer (BC) treatment. Little is known about BC survivors with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) sexual dysfunction and their partners, and the factors associated with their sexual functioning.
To evaluate (i) patient-related and clinical factors associated with (a) specific DSM-IV sexual dysfunctions and (b) level of sexual functioning and sexual distress as reported by BC survivors and (ii) the association between the sexual functioning of BC survivors and that of their partners.
We analyzed baseline data from a study of the efficacy of online cognitive-behavioral therapy for sexual dysfunction in BC survivors.
Women completed self-report questionnaires assessing sexual functioning, sexual distress, relationship intimacy, marital functioning, menopausal symptoms, body image, and psychological distress. Their partners completed questionnaires assessing sexual functioning.
The study included 169 BC survivors and 67 partners. The most prevalent female sexual dysfunctions were hypoactive sexual desire disorder (HSDD; 83%), sexual arousal disorder (40%), and dyspareunia (33%). Endocrine therapy was associated with HSDD (P = .003), and immunotherapy was associated with dyspareunia (P = .009). Older age was associated with lower sexual distress (P < .001). Depressive symptoms were highest in women with sexual arousal disorder (P = .004). An indication for erectile disorder was present in two thirds of partners. Lower overall partner sexual satisfaction was associated with lower overall BC survivor sexual functioning (P = .001), lower female arousal (P = .002), and lower female sexual satisfaction (P = .001). Poorer male erectile function was related to higher female sexual pain (P = .006). Partners of women who underwent breast reconstruction reported marginally significantly better orgasmic functioning (P = .012) and overall sexual functioning (P = .015) than partners of women who had undergone breast-conserving treatment.
BC survivors and their partners experience sexual problems after BC treatment. This suggests that not only the BC survivor but also her partner could benefit from sexual counseling.
This is the first study focusing on BC survivors with a DSM-IV sexual dysfunction and their partners. The results cannot necessarily be generalized to women experiencing milder sexual problems or who have no interest in receiving sexual counseling.
Endocrine therapy and immunotherapy are relevant risk factors for HSDD and dyspareunia in BC survivors. The sexual functioning of women and their partners is affected, underscoring the importance of involving both partners in sexual counseling after BC treatment. Hummel SB, Hahn DEE, van Lankveld JJDM, et al. Factors Associated With Specific Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Sexual Dysfunctions in Breast Cancer Survivors: A Study of Patients and Their Partners. J Sex Med 2017;14:1248-1259.
许多女性在乳腺癌（BC）治疗后会出现性功能障碍。关于符合《精神障碍诊断与统计手册》第四版（DSM-IV）性功能障碍的 BC 幸存者及其伴侣的情况知之甚少，以及与他们的性功能相关的因素。
评估（i）患者相关和临床因素与（a）特定的 DSM-IV 性功能障碍和（b）BC 幸存者报告的性功能和性困扰水平之间的关系；（ii）BC 幸存者的性功能与伴侣之间的关系。
我们分析了一项针对 BC 幸存者在线认知行为疗法治疗性功能障碍疗效的研究的基线数据。
女性完成了自我报告问卷，评估了性功能、性困扰、关系亲密、婚姻功能、更年期症状、身体形象和心理困扰。她们的伴侣完成了评估性功能的问卷。
研究包括 169 名 BC 幸存者和 67 名伴侣。女性最常见的性功能障碍包括性欲低下障碍（HSDD；83%）、性唤起障碍（40%）和性交困难（33%）。内分泌治疗与 HSDD 相关（P=0.003），免疫治疗与性交困难相关（P=0.009）。年龄较大与较低的性困扰相关（P<0.001）。性欲障碍患者的抑郁症状最高（P=0.004）。伴侣中有三分之二存在勃起功能障碍的指征。伴侣的整体性满意度较低与 BC 幸存者的整体性功能较低（P=0.001）、女性唤起较低（P=0.002）和女性性满意度较低（P=0.001）相关。男性勃起功能越差，女性性疼痛越高（P=0.006）。接受乳房重建的女性的伴侣报告在性高潮功能（P=0.012）和整体性功能（P=0.015）方面略好于接受保乳治疗的女性的伴侣。
BC 幸存者及其伴侣在 BC 治疗后会出现性功能障碍。这表明不仅 BC 幸存者，而且她的伴侣也可能受益于性咨询。
这是第一项专门针对符合 DSM-IV 性功能障碍的 BC 幸存者及其伴侣的研究。结果不一定可以推广到性功能障碍较轻或对接受性咨询不感兴趣的女性。
内分泌治疗和免疫治疗是 BC 幸存者发生 HSDD 和性交困难的相关危险因素。女性及其伴侣的性功能受到影响，强调了在 BC 治疗后让伴侣双方都参与性咨询的重要性。
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