Significant sexual problems often are an unexpected -- and unwelcome -- side effect of the treatment of early-stage cervical and endometrial cancer for many women following hysterectomy. A targeted therapeutic approach involving mindfulness training has been found to improve desire, orgasm, arousal and other aspects of sexual satisfaction in just three one-hour sessions.
"Often women who have had cancer are interested in being sexual, physical. A lot of these women can be in their 30s," said Julia Heiman, director of the Kinsey Institute for Research in Sex, Gender and Reproduction at Indiana University. "By offering women something that can improve this part of their lives, in a sense you're investing in the hopeful side of their surviving a serious disease like cancer."
Quality of life issues are becoming more important in cancer research as cancer survival rates increase and more people live for years with cancer as a chronic condition. Being close to someone can benefit survivors' overall wellness, just as the absence of a sexual relationship can hurt a relationship. Heiman said it is unusual, however, for post treatment cancer counseling to address sexuality because so many other important issues, such as nutrition and exercise, also need to be addressed.
Heiman and Lori Brotto, professor in the Department of Obstetrics and Gynecology, University of British Columbia, in Vancouver, are co-authors of the study, "A Psychoeducational Intervention for Sexual Dysfunction in Women with Gynecologic Cancer," published online in the Archives of Sexual Behavior. Sexual problems are associated with treatment of early-stage cervical and endometrial cancer in more than half of the women who undergo hysterectomy even though no similar association exists when hysterectomy is performed to treat benign conditions, such as fibroids.
Psychoeducation includes "Mindfulness:" Mindfulness is an ancient Eastern philosophical and spiritual practice that involves focusing on the moment rather than being distracted by unrelated thoughts and worries. Little sexuality research has involved mindfulness techniques. In Heiman and Brotto's study, this practice is part of the psychoeducational approach to help women make emotional and conscious changes in their thoughts about illness and sexuality.
Brotto and Heiman's study involved 19 women who had hysterectomies as part of their treatment for early stage cervical and endometrial cancer. Following the treatment, they experienced serious sexual problems, including lack of lubrication, less actual or perceived genital sensation during sex and in some cases a deterioration of their relationship. In three, one-hour sessions, the women were given information about sexual skills and relaxation techniques, training in mindfulness techniques and home-work assignments that asked them to practice their new skills.
Heiman said the therapy was skills-oriented rather than based on discussing the women's difficulties. She said the therapy used in their pilot study could be offered by social workers and nurses, not just psychologists. "It can be someone who knows something about the conditions the women are experiencing," Heiman said, "someone aware of the fact that it's important and remarkable when people make an effort in this area."
In addition to the improvements in sexual satisfaction, the degree of mild depression significantly decreased among the study participants, who reported an improvement in their overall quality of life. The authors note there are few psychoeducational treatment options for women with sexual problems, especially treatments that also consider the psychological issues arising from a cancer diagnosis. The research was supported by the Social Science Research Council and the Ford Foundation.
"A Psychoeducational Intervention for Sexual Dysfunction in Women with Gynecologic Cancer," Archives of Sexual Behavior, 2008.
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