Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Science, The Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden.
Centre for Sexology and Sexuality Studies, Malmö University, Malmö, Sweden.
Support Care Cancer. 2021 Nov;29(11):6851-6861. doi: 10.1007/s00520-021-06263-0. Epub 2021 May 18.
Sexual abuse is a women's health concern globally. Although experience of sexual abuse and cancer may constitute risk factors for sexual dysfunction and low wellbeing, the effects of sexual abuse have received little attention in oncology care. This study aims to explore sexual health and wellbeing in women after pelvic radiotherapy and to determine the relationship between sexual abuse and sexual dysfunction, and decreased wellbeing.
Using a study-specific questionnaire, data were collected during 2011-2017 from women with gynaecological, anal, or rectal cancer treated with curative pelvic radiotherapy in a population-based cohort and a referred patient group. Subgroup analyses of data from women with a reported history of sexual abuse were conducted, comparing socio-demographics, diagnosis, aspects of sexual health and wellbeing.
In the total sample of 570 women, 11% reported a history of sexual abuse and among these women the most common diagnosis was cervical cancer. More women with than without a history of sexual abuse reported feeling depressed (19.4% vs. 9%, p = 0.007) or anxious (22.6% vs. 11.8%, p = 0.007) and suffering genital pain during sexual activity (52% vs. 25.1%, p = 0.011, RR 2.07, CI 1.24-3.16). In the total study cohort, genital pain during sexual activity was associated with vaginal shortness (68.5% vs. 31.4% p ≤ 0.001) and inelasticity (66.6% vs. 33.3%, p ≤ 0.001).
Our findings suggest that a history of both sexual abuse and pelvic radiotherapy in women are associated with increased psychological distress and sexual impairment, challenging healthcare professionals to take action to prevent retraumatisation and provide appropriate interventions and support.
性虐待是一个全球性的女性健康问题。尽管性虐待经历和癌症可能构成性功能障碍和幸福感降低的风险因素，但性虐待对肿瘤学护理的影响却很少受到关注。本研究旨在探讨盆腔放疗后女性的性健康和幸福感，并确定性虐待与性功能障碍和幸福感降低之间的关系。
使用特定于研究的问卷，于 2011 年至 2017 年期间，从接受根治性盆腔放疗的妇科、肛门或直肠癌症的女性中收集数据，这些女性来自基于人群的队列和转诊患者组。对报告有性虐待史的女性数据进行了亚组分析，比较了社会人口统计学、诊断、性健康和幸福感方面的情况。
在 570 名女性的总样本中，11%报告有性虐待史，其中最常见的诊断是宫颈癌。与没有性虐待史的女性相比，更多有性虐待史的女性报告感到抑郁（19.4%比 9%，p=0.007）或焦虑（22.6%比 11.8%，p=0.007），并且在性活动时感到生殖器疼痛（52%比 25.1%，p=0.011，RR 2.07，CI 1.24-3.16）。在整个研究队列中，性活动时生殖器疼痛与阴道短缩（68.5%比 31.4%，p≤0.001）和无弹性（66.6%比 33.3%，p≤0.001）相关。
我们的研究结果表明，女性的性虐待史和盆腔放疗史都与心理困扰和性障碍增加有关，这对医疗保健专业人员提出了挑战，需要采取行动预防再创伤，并提供适当的干预和支持。
