title: Sexual morbidity in very long term survivors of vaginal and cervical cancer: a comparison to national norms.
abstract: OBJECTIVE
  To compare sexuality among very long term survivors of vaginal and cervical cancer to national norms and assess quality of care for sexual problems.
  
  
  METHODS
  A survey of survivors in a cancer registry (n=221) provided data comparable to the 1992 National Health and Social Life Survey (NHSLS). The NHSLS sample was individually matched on age and race to survivors at a 2:1 ratio. Responses were compared using conditional logistic regression and two-sample t-tests. Correlates of sexual problems among survivors were analyzed using multivariate logistic regression.
  
  
  RESULTS
  Survivors' mean age was 49 years (SD=6.0); median survivorship was 26.8 years (range 5.5-39.7). Survivors and controls reported similar levels of sexual partnership and activity, but sexual problems were significantly more prevalent among survivors (mean number of problems 2.6 versus 1.1, P<0.001). Satisfaction with care for sexual problems was lower than with cancer care overall (5.5 versus 8.0/10, P<0.001). While 74% believed that physicians should discuss sex, 62% reported never discussing the effect of genital tract cancer on sexuality. In adjusted analysis, survivors reporting no such discussion were significantly more likely to exhibit current complex sexual morbidity (> or =3 concurrent sexual problems) (OR 2.74, 95% CI 1.14-6.58).
  
  
  CONCLUSIONS
  Despite profoundly more sexual problems, survivors' rate of sexual partnership and activity was similar to population controls. Satisfaction with care relating to sexuality was significantly lower than with cancer care overall. Conversation with a physician about the sexual effects of cancer is associated with significantly lower likelihood of complex sexual morbidity among very long term survivors.
authors.affiliation: University of Chicago, Pritzker School of Medicine, Departments of Ob/Gyn and Medicine-Geriatrics, 5841 S. Maryland Ave., MC2050, Chicago, IL 60637, USA. slindau@uchicago.edu
authors.forename: Stacy Tessler
authors.initials: ST
authors.lastname: Lindau
authors.forename: Natalia
authors.initials: N
authors.lastname: Gavrilova
authors.forename: Diane
authors.initials: D
authors.lastname: Anderson
mesh_terms: D015331:Cohort Studies; D003142:Communication; D005260:Female; D006801:Humans; D008875:Middle Aged; D010817:Physician-Patient Relations; D012735:Sexual Dysfunction, Physiological / Q000209:etiology* / Q000523:psychology; D019529:Sexuality; D002583:Uterine Cervical Neoplasms / Q000150:complications* / Q000523:psychology*; D014625:Vaginal Neoplasms / Q000150:complications* / Q000523:psychology*