Background
Disruptions to sexuality after cancer
Pathways to sexual difficulty and distress after cancer
Relationship communication and context
Study aims and research questions
Method
Participants
Measures
Changes in Sexual Functioning Questionnaire (CSFQ-14)
Hospital Anxiety and Depression Scale (HADS)
Medical outcomes study health survey short form (SF-12)
Brief Dyadic Adjustment Scale (DAS)
Dyadic sexual communication scale
The Silencing the Self Scale (STSS)
Ratings of sexual importance and activity
Statistical analysis
Results
Descriptive data
Women | Men | Test for group difference | Significance | Effect size | |||
---|---|---|---|---|---|---|---|
Variable |
n
|
M (SD)
|
n
|
M (SD)
|
F
|
p
|
η2
|
Patient age | 535 | 50.7 (10.9) | 122 | 61.1 (14.3) | 79.01 | <0.001 | 0.108 |
Years since first diagnosis | 533 | 4.9 (5.3) | 122 | 5.3 (5.4) | 0.53 | 0.468 | 0.001 |
Length of current relationship | 515 | 19.8 (13.7) | 118 | 25.7 (16.8) | 16.55 | <0.001 | 0.026 |
n
| % |
n
| % | χ2
|
p
|
φ
| |
Ethnicity: | 0.51 | 0.774 | 0.028 | ||||
Aust/White European | 508 | 95.7 | 114 | 94.2 | |||
Asian | 14 | 2.6 | 4 | 3.3 | |||
Other | 9 | 1.7 | 3 | 2.5 | |||
Cancer type: | 519.19 | <0.001 | 0.364 | ||||
Breast | 425 | 80 | - | - | |||
Gynecologic | 45 | 8.5 | - | - | |||
Prostate | - | - | 87 | 72.5 | |||
Genitourinary (other) | 4 | 0.8 | 7 | 5.8 | |||
Hematological/Blood | 23 | 4.3 | 14 | 11.7 | |||
Digestive/Gastrointestinal | 11 | 2.1 | 4 | 3.3 | |||
Neurologic | 6 | 1.1 | 4 | 3.3 | |||
Skin | 8 | 1.5 | 2 | 1.7 | |||
Othera
| 9 | 1.7 | 2 | 1.7 | |||
Cancer classification: | 10.52 | .001 | 0.127 | ||||
Sexual cancer type | 474 | 89.3 | 94 | 78.3 | |||
Non-sexual cancer type | 57 | 10.7 | 26 | 21.7 | |||
Stage of disease: | 27.19 | <0.001 | 0.188 | ||||
No longer detectable/In remission | 430 | 80.8 | 71 | 58.7 | |||
Receiving treatment | 16 | 3.0 | 7 | 5.8 | |||
Otherb
| 86 | 16.2 | 43 | 35.5 | |||
Relationship status: | 3.12 | 0.374 | 0.032 | ||||
Partnered – Living together | 414 | 77.4 | 96 | 78.7 | |||
Partnered – Not living together | 34 | 6.4 | 10 | 8.2 | |||
Not in a relationship | 76 | 14.2 | 16 | 13.1 | |||
Other/Not specified | 11 | 2.1 | - | - | |||
Sexual identity: | 405.16 | <0.001 | 0.858 | ||||
Heterosexual | 434 | 96.7 | 92 | 91.1 | |||
Non heterosexual | 15 | 3.3 | 9 | 8.9 | |||
Current sexual relationship: | 0.99 | 0.319 | 0.039 | ||||
Yes | 404 | 76.2 | 87 | 71.9 | |||
No | 126 | 23.8 | 34 | 18.6 |
Women | Men | Test for group difference | Significance | Effect size | |||
---|---|---|---|---|---|---|---|
Variable |
n
|
M (SD)
|
n
|
M (SD)
|
F
|
p
|
η2
|
Partner age | 87 | 54.1 (13.5) | 61 | 54.8 (11.1) | 0.11 | 0.738 | 0.001 |
Years since partner’s first diagnosis | 87 | 2.9 (2.0) | 61 | 2.9 (2.0) | 0.01 | 0.932 | 0.000 |
Length of current relationship | 87 | 25.0 (16.2) | 61 | 23.8 (13.2) | 0.24 | 0.629 | 0.002 |
n
| % |
n
| % | χ2
|
p
|
φ
| |
Ethnicity: | 0.85 | 0.653 | 0.056 | ||||
Aust/White European | 82 | 97.6 | 57 | 95.0 | |||
Asian | 1 | 1.2 | 2 | 3.3 | |||
Other | 1 | 1.2 | 1 | 1.7 | |||
Cancer type: | 60.10 | <0.001 | 0.297 | ||||
Breast | 4 | 4.6 | 29 | 48.3 | |||
Gynecologic | 4 | 4.6 | 9 | 15 | |||
Prostate | 35 | 40.2 | 2 | 3.3 | |||
Genitourinary (other) | 6 | 6.9 | - | - | |||
Hematological/Blood | 15 | 17.2 | 10 | 16.7 | |||
Digestive/Gastrointestinal | 11 | 12.6 | 6 | 10.0 | |||
Neurologic | 2 | 2.3 | 1 | 1.7 | |||
Skin | 2 | 2.3 | 1 | 1.7 | |||
Othera
| 8 | 9.2 | 2 | 3.3 | |||
Cancer classification: | 1.60 | 0.207 | 0.104 | ||||
Sexual cancer type | 49 | 56.3 | 40 | 66.7 | |||
Non-sexual cancer type | 38 | 43.7 | 20 | 33.3 | |||
Stage of disease: | 3.11 | 0.375 | 0.095 | ||||
No longer detectable/In remission | 52 | 59.8 | 41 | 67.2 | |||
Receiving treatment | 2 | 2.3 | 3 | 4.9 | |||
Otherb
| 33 | 37.9 | 17 | 27.9 | |||
Relationship status: | 0.12 | 0.896 | 0.011 | ||||
Partnered – Living together | 79 | 90.8 | 55 | 90.2 | |||
Partnered – Not living together | 8 | 9.2 | 6 | 9.8 | |||
Sexual orientation: | 36.16 | 0.525 | 0.086 | ||||
Heterosexual | 79 | 90.8 | 55 | 90.2 | |||
Non heterosexual | 8 | 9.2 | 6 | 9.8 | |||
Current sexual relationship: | 0.12 | 0.729 | 0.039 | ||||
Yes | 70 | 81.4 | 51 | 83.6 | |||
No | 16 | 18.6 | 10 | 16.4 |
Women | Men | Test for group difference | Sexual cancer | Non-sexual cancer | Test for group difference | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Item/Variable |
n
| % |
n
| % | χ2
|
p
|
φ
|
n
| % |
N
| % | χ2
|
p
|
φ
|
Sex important part of the relationship: | 13.17 | 0.001 | 0.158 | 2.715 | 0.257 | 0.072 | ||||||||
Very important | 148 | 34.3 | 45 | 48.4 | 162 | 35.7 | 30 | 46.2 | ||||||
Somewhat important | 224 | 51.9 | 46 | 49.5 | 238 | 52.4 | 28 | 43.1 | ||||||
Not important | 60 | 13.9 | 2 | 2.2 | 54 | 11.9 | 7 | 10.8 | ||||||
Sex important part of life: | 39.59 | <0.001 | 0.248 | 9.965 | 0.007 | 0.125 | ||||||||
Very important | 125 | 23.7 | 57 | 48.7 | 146 | 26.2 | 35 | 42.7 | ||||||
Somewhat important | 288 | 54.5 | 56 | 47.9 | 304 | 54.6 | 37 | 45.1 | ||||||
Not important | 115 | 21.8 | 4 | 3.4 | 107 | 19.2 | 10 | 12.2 | ||||||
Change in sexual activities since onset of cancer: | 3.417 | 0.065 | 0.074 | 2.951 | 0.086 | 0.069 | ||||||||
Yes | 394 | 76.8 | 99 | 84.6 | 432 | 79.1 | 55 | 70.5 | ||||||
No | 119 | 23.2 | 18 | 15.4 | 114 | 20.9 | 23 | 29.5 |
Women | Men | Test for group difference | Sexual cancer | Non-sexual cancer | Test for group difference | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Item/Variable |
n
| % |
n
| % | χ2
|
p
|
φ
|
n
| % |
n
| % | χ2
|
p
|
φ
|
Sex important part of the relationship: | 5.24 | 0.073 | 0.202 | 0.80 | 0.672 | 0.079 | ||||||||
Very important | 24 | 31.6 | 27 | 50.9 | 33 | 42.9 | 18 | 35.3 | ||||||
Somewhat important | 41 | 53.9 | 22 | 41.5 | 35 | 45.5 | 27 | 43.5 | ||||||
Not important | 11 | 14.5 | 4 | 7.5 | 9 | 11.7 | 6 | 11.8 | ||||||
Sex important part of life: | 9.43 | 0.009 | 0.254 | 2.11 | 0.348 | 0.121 | ||||||||
Very important | 20 | 23.5 | 29 | 47.5 | 31 | 35.6 | 18 | 31.0 | ||||||
Somewhat important | 52 | 61.2 | 27 | 44.3 | 43 | 49.4 | 35 | 60.3 | ||||||
Not important | 13 | 15.3 | 5 | 8.2 | 13 | 14.9 | 5 | 8.7 | ||||||
Change in sexual activities since onset of cancer: | 1.37 | 0.163 | 0.098 | 0.68 | 0.411 | 0.035 | ||||||||
Yes | 62 | 75.6 | 40 | 66.7 | 64 | 73.6 | 38 | 70.4 | ||||||
No | 20 | 24.4 | 20 | 33.3 | 23 | 26.4 | 16 | 29.6 |
Sexual functioning according to gender
Women | Test for group difference | Sign. | Effect size | Men | Test for group difference | Sign. | Effect size | |||
---|---|---|---|---|---|---|---|---|---|---|
Subscale |
n
|
M(SD)
|
t
|
p
|
d
|
n
|
M(SD)
|
t
|
p
|
d
|
Sexual desire/frequency | 21.28 | <0.001 | 1.403 | 8.73 | <0.001 | 1.388 | ||||
Before cancer | 520 | 6.85 (1.64) | 117 | 7.40 (1.33) | ||||||
After cancer | 520 | 4.92 (1.86) | 117 | 5.86 (1.97) | ||||||
Sexual desire/interest | 16.63 | <0.001 | 1.228 | 6.75 | <0.001 | 1.285 | ||||
Before cancer | 516 | 8.82 (2.51) | 115 | 10.74 (2.12) | ||||||
After cancer | 516 | 6.77 (2.62) | 115 | 9.17 (2.44) | ||||||
Sexual arousal | 21.01 | <0.001 | 1.459 | 16.96 | <0.001 | 1.807 | ||||
Before cancer | 509 | 11.17 (3.01) | 114 | 13.69 (1.42) | ||||||
After cancer | 509 | 7.27 (3.12) | 114 | 9.26 (2.52) | ||||||
Sexual orgasm | 18.13 | <0.001 | 1.342 | 16.32 | <0.001 | 1.924 | ||||
Before cancer | 504 | 12.04 (2.95) | 109 | 12.29 (1.90) | ||||||
After cancer | 504 | 8.72 (3.97) | 109 | 6.88 (3.32) | ||||||
Total sexual functioning | 13.67 | <0.001 | 1.359 | 10.49 | <0.001 | 1.547 | ||||
Before cancer | 446 | 42.22 (7.37) | 104 | 46.55 (5.36) | ||||||
After cancer | 446 | 34.73(10.45) | 104 | 36.48 (9.30) |
Women | Test for group difference | Sign. | Effect size | Men | Test for group difference | Sign. | Effect size | |||
---|---|---|---|---|---|---|---|---|---|---|
Subscale |
n
|
M(SD)
|
t
|
p
|
d
|
n
|
M(SD)
|
t
|
p
|
d
|
Sexual desire/frequency | 9.75 | <0.001 | 1.125 | 6.38 | <0.001 | 1.327 | ||||
Before cancer | 80 | 6.96 (1.44) | 58 | 7.28 (1.47) | ||||||
After cancer | 80 | 5.24 (1.62) | 58 | 5.98 (1.57) | ||||||
Sexual desire/interest | 3.93 | <0.001 | 1.031 | 1.45 | 0.152 | 0.711 | ||||
Before cancer | 77 | 8.26 (2.58) | 55 | 11.13(5.94) | ||||||
After cancer | 77 | 7.38 (2.49) | 55 | 10.04 (2.46) | ||||||
Sexual arousal | 4.62 | <0.001 | 0.939 | 3.85 | <0.001 | 1.192 | ||||
Before cancer | 79 | 11.51 (5.18) | 56 | 8.39 (1.63) | ||||||
After cancer | 79 | 9.03 (3.05) | 56 | 7.82 (1.82) | ||||||
Sexual orgasm | 3.73 | <0.001 | 0.946 | 2.54 | 0.014 | 1.029 | ||||
Before cancer | 77 | 12.45 (5.45) | 52 | 17.54 (6.10) | ||||||
After cancer | 77 | 9.60 (5.21) | 52 | 15.48 (2.69) | ||||||
Total sexual functioning | 3.39 | 0.001 | 1.244 | 1.057 | .296 | 1.046 | ||||
Before cancer | 70 | 41.01 (7.28) | 50 | 46.74(13.21) | ||||||
After cancer | 70 | 37.13(9.61) | 50 | 44.78 (7.14) |
Health related QoL, psychological distress and relationship measures according to gender
Women | Men | |||||
---|---|---|---|---|---|---|
Variable |
M (SD)
|
M (SD)
|
t(655) |
p
| 95% CI |
η2
|
SF12-Physical component summary | 46.33 (10.88) | 46.88 (10.23) | -0.51 | .609 | [-2.67, 1.57] | .000 |
SF12-Mental component summary | 45.25 (11.42) | 48.37 (10.42) | -2.77 | .006 | [-5.34, -0.91] | .012 |
HADS-Anxiety | 9.75 (2.41) | 8.68 (3.12) | 4.19 | <.001 | [0.57, 1.58] | .026 |
HADS-Depression | 8.12 (2.15) | 7.78 (3.05) | 1.65 | .099 | [-0.73, 0.85] | .004 |
Dyadic Adjustment Scale (DAS) | 27.73 (4.09) | 28.57 (3.83) | -1.99 | .047 | [-1.65, -0.01] | .006 |
Dyadic Sexual Communication (DSCS) | 46.06 (11.63) | 48.47 (11.04) | -2.03 | .043 | [-4.74, -0.73] | .007 |
Silencing the Self Scale (STSS) | ||||||
Externalized self perception | 17.34 (5.48) | 15.69 (5.21) | 3.01 | .003 | [0.57, 2.73] | 0.14 |
Silencing the self | 23.55 (7.74) | 26.78 (6.77) | -4.16 | <.001 | [-4.76, 1.71] | .027 |
Care as self sacrifice | 24.78 (5.93) | 31.49 (5.58) | -11.16 | <.001 | [-7.89, -5.53] | .165 |
Divided self | 16.38 (6.45) | 16.58 (6.45) | -0.30 | .767 | [-1.51, 1.11] | .000 |
Women | Men | |||||
---|---|---|---|---|---|---|
Variable |
M (SD)
|
M (SD)
|
t(655) |
p
| 95% CI |
η2
|
SF12-Physical component summary | 51.05 (9.12) | 51.28 (8.24) | -0.16 | .873 | [-3.13, 2.66] | .000 |
SF12-Mental component summary | 45.55 (12.01) | 48.32 (12.01) | -1.38 | .169 | [-6.74, -1.19] | .013 |
HADS-Anxiety | 11.10 (2.49) | 11.59 (2.93) | -1.10 | .275 | [-1.39, 0.40] | .008 |
HADS-Depression | 8.80 (2.02) | 8.78 (2.35) | 0.06 | .956 | [-0.73, 0.74] | .000 |
Dyadic Adjustment Scale (DAS) | 28.33 (3.91) | 29.29 (3.46) | -1.52 | .130 | [-2.21, 0.29] | .016 |
Dyadic Sexual Communication (DSCS) | 46.43 (13.04) | 48.65 (10.20) | -1.10 | .275 | [-6.22, 1.78] | .008 |
Silencing the Self Scale (STSS) | ||||||
Externalized self perception | 17.76 (8.90) | 14.97 (5.78) | 2.13 | .035 | [0.20, 5.39] | .031 |
Silencing the self | 26.05 (8.13) | 25.93 (9.54) | 0.83 | .934 | [-2.79, 3.03] | .000 |
Care as self sacrifice | 28.71 (8.39) | 30.15 (6.10) | -1.12 | .267 | [-3.99, 1.11] | .009 |
Divided self | 15.70 (6.49) | 15.31 (6.61) | 0.35 | .724 | [-1.80, 2.59] | .001 |
Women | ||||||
---|---|---|---|---|---|---|
Variable | Sexual desire/frequency | Sexual desire/interest | Sexual arousal | Sexual orgasm | Sexual pleasure | Total sexual functioning |
SF12-Physical component summary | .14** | .15** | .13** | .14** | .17** | .15** |
SF12-Mental component summary | .20** | .07 | .21** | .21** | .31** | .22** |
HADS-Anxiety | -.11* | -.02 | -.12** | -.10* | -.18** | -.16** |
HADS-Depression | -.10* | -.05 | -.14** | -.13** | -.18** | -.20** |
Dyadic Adjustment Scale (DAS) | .28** | .04 | .21** | .13** | .37** | .22** |
Dyadic Sexual Communication (DSCS) | .35** | .18** | .31** | .31** | .46** | .34** |
Silencing the Self Scale (STSS) | ||||||
Externalized self perception | -.20** | -.23** | -.26** | -.21** | -.27** | -.20** |
Silencing the self | -.24** | -.17** | -.15** | -.26** | -.25** | -.28** |
Care as self sacrifice | -.10* | -.18** | -.21** | -.21** | -.08 | -.18** |
Divided self | -.34** | -15** | -.25** | -.28** | -.40** | -3.32** |
Men
| ||||||
SF12-Physical component summary | .42** | .16 | .16 | .23* | .36** | .33** |
SF12-Mental component summary | .16* | .11 | .10 | .10 | .16* | .17* |
HADS-Anxiety | .04 | .02 | -23** | -20* | -.04 | -.11 |
HADS-Depression | .02 | .03 | -.19* | -.20* | -.06 | -.09 |
Dyadic Adjustment Scale (DAS) | .21* | .09 | .07 | .12 | .30** | .19* |
Dyadic Sexual Communication (DSCS) | .17* | -.10 | .06 | .13 | .43** | .11 |
Silencing the Self Scale (STSS) | ||||||
Externalized self perception | -.08 | -.19* | -.03 | -.06 | -.07 | -.15 |
Silencing the self | -.25** | -.01 | -.21* | -.24** | -.25** | -.24** |
Care as self sacrifice | -.28** | -.04 | -.27** | -.25** | -.13 | -.27** |
Divided self | -.12 | -.03 | -.09 | -.10 | -.29** | -.12 |
Women | ||||||
---|---|---|---|---|---|---|
Variable | Sexual desire/frequency | Sexual desire/interest | Sexual arousal | Sexual orgasm | Sexual pleasure | Total sexual functioning |
SF12-Physical component summary | .22* | .24* | .28** | -.14 | .15 | .12 |
SF12-Mental component summary | .13 | .01 | .13 | .07 | .32** | .13 |
HADS-Anxiety | .14 | .17 | .15 | .01 | .20* | .13 |
HADS-Depression | -.07 | -.03 | -.08 | -.18 | -.15 | -.18 |
Dyadic Adjustment Scale (DAS) | .39** | .17 | .24* | .11 | .51** | .26** |
Dyadic Sexual Communication (DSCS) | .49** | .30** | .37** | .04 | .53** | .33** |
Silencing the Self Scale (STSS) | ||||||
Externalized self perception | -.19* | -.14 | .08 | -.11 | -.23* | -.13 |
Silencing the self | -.17 | -.10 | -.18 | -.09 | -.22* | -.16 |
Care as self sacrifice | .02 | .07 | -.15 | -.26** | .00 | -.19* |
Divided self | -.23* | -.08 | -.14 | -.01 | -.42** | -.17 |
Men
| ||||||
SF12-Physical component summary | .06 | .26* | .27* | .37** | .12 | .33** |
SF12-Mental component summary | .40** | -.28* | -.14 | -.04 | .45** | .06 |
HADS-Anxiety | .29* | -.13 | -.15 | -.03 | .33** | -.03 |
HADS-Depression | -.04 | .17 | .05 | -.02 | -.09 | .12 |
Dyadic Adjustment Scale (DAS) | .11 | -.10 | .01 | .11 | .31** | .11 |
Dyadic Sexual Communication (DSCS) | .49** | -.08 | .18 | .18 | .64** | .34** |
Silencing the Self Scale (STSS) | ||||||
Externalized self perception | -.22* | .40** | .12 | -.04 | -.26* | .07 |
Silencing the self | -.25* | -.09 | -.09 | -.26* | -.25* | -.23* |
Care as self sacrifice | -.14 | -.21 | .00 | -.11 | -.06 | -.08 |
Divided self | -.31** | .30* | -.06 | -.20 | -.48** | -.13 |
Prediction of sexual functioning
Women | |||
---|---|---|---|
Variable | B | β | sr2(unique) |
SF12-Physical component summary | .16*** | .17 | .03 |
SF12-Mental component summary | .11* | .12 | .01 |
HADS-Anxiety | .26 | .06 | |
HADS-Depression | -.59* | -.12 | .01 |
Dyadic Adjustment Scale (DAS) | .23 | .09 | |
Dyadic Sexual Communication (DSCS) | .23*** | .25 | .04 |
Silencing the Self Scale (STSS) | |||
Externalized self perception | .01 | .00 | |
Silencing the self | -.13 | -.09 | |
Care as self sacrifice | -.11 | -.06 | |
Divided self | .01 | .01 | |
(Intercept) | 12.20 | ||
R
2
| .21a
| ||
Total Adj. R
2
| .22 | ||
R
| .46*** | ||
95% Confidence limits from 0.14 to 0.28 | |||
Men
| |||
SF12-Physical component summary | .24* | .24 | .05 |
SF12-Mental component summary | .09 | .09 | |
Dyadic Adjustment Scale (DAS) | .20 | .08 | |
Silencing the Self Scale (STSS) | |||
Silencing the self | -.04 | -.03 | |
Care as self sacrifice | -.42* | -.24 | .05 |
(Intercept) | 29.98 | ||
R
2
| .10b
| ||
Total Adj. R
2
| .12 | ||
R
| .41** | ||
95% Confidence limits from 0.04 to 0.30 |
Women | |||
---|---|---|---|
Variable | B | β | sr2(unique) |
Dyadic Adjustment Scale (DAS) | .20 | .08 | |
Dyadic Sexual Communication (DSCS) | .20* | .27 | .05 |
Silencing the Self Scale (STSS) | |||
Care as self sacrifice | -.15 | -.14 | |
(Intercept) | 28.00 | ||
R
2
| .13a
| ||
Total Adj. R
2
| .09 | ||
R
| .36* | ||
95% Confidence limits from 0.14 to 0.28 | |||
Men
| |||
SF12-Physical component summary | .30* | .35 | .11 |
Dyadic Sexual Communication (DSCS) | .25* | .36 | .11 |
Silencing the Self Scale (STSS) | |||
Silencing the self | .03 | .04 | |
(Intercept) | 16.33 | ||
R
2
| .23b
| ||
Total Adj. R
2
| .18 | ||
R
| .48** | ||
95% Confidence limits from 0.04 to 0.42 |