Psychological interventions for the sexual sequelae of cancer: a review of the literature

Abstract

Introduction: Despite the frequency of sexual side effects of cancer, treatment outcome studies focus almost exclusively on pharmacologic agents, most of which are completely ineffective for women. We conducted a systematic review of the literature on psychological interventions for sexual difficulties following cancer.

Methods: We searched eight research databases using the terms "sexual dysfunction," "cancer," and "psychological therapy" for empirical studies (not case illustrations). Three independent raters evaluated studies using a modified version of the Oxford Centre for Evidence-Based Medicine System to rate the level of evidence for every retrieved study.

Results: We identified 27 papers ranging in level of evidence from 1b (randomized controlled trial) to 4 (expert committee report or clinical experience). Youth showed positive outcomes on sexual knowledge, body image, and sexual functioning, and treatments administered by paraprofessionals were equally effective. Thematic counseling, addressing mental health, social functioning, and sexual functioning, significantly improved quality of sexual relationships, independent partner presence, whereas other studies revealed more pronounced benefits if the partner participated. Despite the importance of talking to a cancer care provider about sexual difficulties, interventions designed to empower patients to do so were ineffective. Treatments addressing sex education were more effective if they also addressed motivation and self-efficacy. Only three treatment outcome studies focused on ethnic minority (African-American or Hispanic) sexual concerns and one focused on sexual minority (Lesbian) issues.

Discussion: There was moderate support for the effectiveness and feasibility of psychological interventions targeting sexual dysfunction following cancer but attrition rates are high, placebo response is notable, and there are often barriers impeding survivors from seeking out psychological interventions for sexual concerns.

Implications for cancer survivors: Despite the prevalence of sexual difficulties following cancer treatment, psychological interventions are a viable, but not often sought after option to help improve sexual functioning, intimacy, and quality of life for cancer survivors and their partners.