Assessment of sexual activity and dysfunction in medically underserved women with gynecologic cancers.
BACKGROUND
Sexual dysfunction is a common long-term side effect of treatments for gynecologic cancer. Studies of sexual problems in gynecologic cancer survivors overrepresent White non-Hispanic, highly educated, and married women. Less is known about the sexual health needs of women in medically underserved populations. We therefore conducted a study to characterize sexual activity and sexual function in this population.


METHODS
We recruited patients attending two gynecologic oncology clinics in a large public healthcare system that primarily serves uninsured and low-income patients. Participants were invited to complete a one-time survey to assess sexual function, sexual communication, sexual distress, relationship adjustment, depression, anxiety, prior help-seeking and help-seeking preferences, and reasons for sexual inactivity. Data were analyzed using descriptive statistics and multivariate models to predict sexual activity status and sexual dysfunction.


RESULTS
Among 243 participants, the majority (n=160, 65.8%) were not sexually active in the past 4weeks, most often due to lack of a partner or lack of desire for sex. Just over one-fourth of sexually active participants were identified as likely cases of sexual dysfunction. Greater endorsement of depressive symptoms predicted both sexual inactivity and sexual dysfunction in multivariate analyses. Prior help-seeking for sexual problems was uncommon; however, a significant minority of participants expressed interest in receiving care for sexual problems.


CONCLUSIONS
Gynecologic cancer survivors in our medically underserved population have high rates of sexual inactivity and sexual dysfunction. Future research should identify feasible strategies to address barriers to sexual healthcare in low-resource settings.
Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, United States. Electronic address: abradford@mdanderson.org.
Andrea
A
Bradford
Department of Biostatistics, University of Texas MD Anderson Cancer Center, United States.
Bryan
B
Fellman
Department of Biostatistics, University of Texas MD Anderson Cancer Center, United States.
Diana
D
Urbauer
Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, United States.
Jessica
J
Gallegos
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Baylor College of Medicine, United States.
Kristen
K
Meaders
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Baylor College of Medicine, United States.
Celestine
C
Tung
Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, United States.
Lois
L
Ramondetta
D003430:Cross-Sectional Studies; D003863:Depression / Q000191:economics / Q000453:epidemiology / Q000523:psychology; D005260:Female; D005833:Genital Neoplasms, Female / Q000191:economics / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D008484:Medicaid; D008507:Medically Underserved Area; D017057:Medically Uninsured; D008875:Middle Aged; D011203:Poverty; D012735:Sexual Dysfunction, Physiological / Q000191:economics / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D013781:Texas / Q000453:epidemiology; D014481:United States
Depression; Gynecologic cancer; Sexual activity; Sexual dysfunction; Underserved