title: A controlled study of sexual activity and functioning in epithelial ovarian cancer survivors. A therapeutic approach.
abstract: OBJECTIVE
  To explore sexual activity and functioning in epithelial ovarian cancer survivors (EOCSs) compared to age-adjusted controls from the general population (NORM) with focus on findings that should be given therapeutic considerations.
  
  
  METHODS
  A cross-sectional study of 189/287 (66%) EOCSs treated at The Norwegian Radiumhospital 1979-2003 using a mailed questionnaire including demographic and somatic issues, and schedules concerning sexuality, fatigue, mental distress and quality of life. Blood tests for sex hormone determination were taken at their GPs.
  
  
  RESULTS
  Among EOCSs 47% (95% CI 40-54%) were sexually active compared to 53% (95% CI 48-58%) in NORM. The sexually active EOCSs reported lower levels sexual pleasure (p<0.001) and higher levels of sexual discomfort than NORM (p<0.001). In sexually active EOCSs an association between higher level of sexual discomfort and both lower serum levels of estradiol (p=0.02) and higher levels of SHBG (p=0.04) was observed. Sexually active EOCSs were significantly more often in a paired relation and showed lower levels of fatigue and better quality of life compared to inactive EOCSs. Lack of interest (36%) and physical problems (23%) were significantly more common in sexually inactive EOCSs compared to NORM. In multivariable analyses of sexually active EOCSs premenopausal oophorectomy, having had chemotherapy, age at survey, mental health and body image were significantly associated with sexual functioning.
  
  
  CONCLUSIONS
  Our findings on sexual inactivity and poorer sexual functioning among EOCSs point to issues in need of consideration. We present therapeutic strategies for evaluation and treatment for sexual problems in EOCSs.
authors.affiliation: Department of Gynecology, Sorlandet Hospital, Arendal, Norway. astrid.liavaag@sshf.no
authors.forename: Astrid H
authors.initials: AH
authors.lastname: Liavaag
authors.forename: Anne
authors.initials: A
authors.lastname: Dørum
authors.forename: Trine
authors.initials: T
authors.lastname: Bjøro
authors.forename: Halldis
authors.initials: H
authors.lastname: Oksefjell
authors.forename: Sophie D
authors.initials: SD
authors.lastname: Fosså
authors.forename: Claes
authors.initials: C
authors.lastname: Tropé
authors.forename: Alv A
authors.initials: AA
authors.lastname: Dahl
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000503:physiopathology* / Q000523:psychology*; D011788:Quality of Life; D012725:Sexual Behavior; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D020018:Sexual Dysfunctions, Psychological / Q000209:etiology