Oveisi Niki, Khan Zeba, Brotto Lori A
Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada.
Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver, British Columbia, V6T 1Z4, Canada.
Sex Med. 2023 Mar 1;11(2):qfac002. doi: 10.1093/sexmed/qfac002. eCollection 2023 Apr.
Pelvic cancers are among the most common cancers, impacting millions of individuals worldwide annually. However, little is known about the impact of more rare pelvic cancers on the sexual health of females.
In this study we explored sexual health experiences of female pelvic cancer survivors (FPCS) and their healthcare providers (HCP) in order to identify the most salient impacts of pelvic cancer on sexual function.
In this qualitative study, semi-structured online interviews were conducted with 15 female patients with vulvar, vaginal, uterine, ovarian, endometrial, cervical, bladder, and/or colorectal cancers. Additionally, semi-structured online interviews were conducted with HCPs who treat pelvic cancers ( = 9). For data analysis, qualitative framework analysis was used.
We used the collected data and analysis of findings to establish recommendations including ways to improve sexual health and function in female survivors of pelvic cancer.
Most FPCS experienced negative impacts on their sexual health and function through increased pain and dryness, bleeding due to atrophy, decreased libido, and psychosocial issues such as body dysmorphia. Females with the rarer vulvar and vaginal cancers faced additional challenges to their sexual health such as shortening of vaginal canals, high levels of neuropathy, lack of sexual activity with their partners, and suicidal ideation. FPCS had unmet sexual health needs, which can be attributed to lack of appropriate training by HCPs and lack of resources and availability of services. Although HCPs recognized the importance of providing sexual healthcare, they lacked confidence in their ability to facilitate a conversation on sexual health with their patients, and often avoided this topic.
The sexual health outcomes of FPCS can be improved by providing targeted training for HCPs, developing standard resources for sexual health, and integrating tiers of support, including group interventions and counseling.
The main strength of this study is that data were collected from HCPs as well as FPCS, thus providing a more in-depth overall picture of the current strengths and weaknesses of the resources for sexual health support available for this patient population. A limitation of this study is that the experiences of transgender men were not captured.
Sexual difficulties are very common in all FPCS, particularly survivors of vulvar and vaginal cancers. Improvement of sexual health outcomes is needed in this patient population, which can be achieved by providing more training for HCPs, developing robust resources for FPCS and their sexual health, and providing more opportunities for tiered support.
盆腔癌是最常见的癌症之一，每年影响全球数百万人。然而，对于较为罕见的盆腔癌对女性性健康的影响却知之甚少。
在本研究中，我们探讨了女性盆腔癌幸存者（FPCS）及其医疗服务提供者（HCP）的性健康经历，以确定盆腔癌对性功能最显著的影响。
在这项定性研究中，我们对15名患有外阴、阴道、子宫、卵巢、子宫内膜、宫颈、膀胱和/或结直肠癌的女性患者进行了半结构化在线访谈。此外，还对治疗盆腔癌的HCP进行了半结构化在线访谈（n = 9）。数据分析采用定性框架分析法。
我们利用收集到的数据和研究结果制定了相关建议，包括改善盆腔癌女性幸存者性健康和性功能的方法。
大多数FPCS的性健康和性功能受到负面影响，表现为疼痛加剧、阴道干燥、萎缩性出血、性欲减退以及身体变形等心理社会问题。患有较为罕见的外阴和阴道癌的女性在性健康方面面临更多挑战，如阴道缩短、神经病变严重、与伴侣缺乏性活动以及有自杀念头。FPCS的性健康需求未得到满足，这可归因于HCP缺乏适当培训以及资源和服务的可及性不足。尽管HCP认识到提供性健康护理的重要性，但他们对与患者就性健康展开对话缺乏信心，且常常回避这个话题。
通过为HCP提供针对性培训、开发性健康标准资源以及整合包括团体干预和咨询在内的多层次支持，可以改善FPCS的性健康结果。
本研究的主要优点是数据收集自HCP以及FPCS，从而更深入地全面了解了该患者群体性健康支持资源目前的优势和不足。本研究的一个局限性是未涵盖跨性别男性的经历。
性方面的困难在所有FPCS中都很常见，尤其是外阴和阴道癌的幸存者。这一患者群体需要改善性健康结果，可通过为HCP提供更多培训、为FPCS及其性健康开发强大的资源以及提供更多多层次支持的机会来实现。
