title: Sexual distress and associated factors among cervical cancer survivors: A cross-sectional multicenter observational study.
abstract: BACKGROUND
  To assess whether sexual distress among cervical cancer (CC) survivors is associated with frequently reported vaginal sexual symptoms, other proposed biopsychosocial factors and whether worries about painful intercourse mediate the relation between vaginal sexual symptoms and sexual distress.
  
  
  METHODS
  A cross-sectional study was conducted among 194 sexually active partnered CC survivors aged 25 to 69 years. Sexual distress, vaginal sexual symptoms, sexual pain worry, anxiety, depression, body image concerns, and relationship dissatisfaction and the sociodemographic variables age, time since treatment, and relationship duration were assessed by using validated self-administrated questionnaires.
  
  
  RESULTS
  In total, 33% (n = 64) of the survivors scored above the cut-off score for sexual distress. Higher levels of sexual distress were shown to be associated with higher levels of vaginal sexual symptoms, sexual pain worry, relationship dissatisfaction, and body image concerns. Furthermore, the results showed that sexual pain worry partly mediated the association between vaginal sexual symptoms and sexual distress, when controlling for relationship dissatisfaction and body image concerns.
  
  
  CONCLUSIONS
  Appropriate rehabilitation programs should be developed for CC survivors to prevent and reduce not only vaginal sexual symptoms but also sexual pain worry, relationship dissatisfaction, and body image concerns to reduce sexual distress.
authors.affiliation: Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: R M
authors.initials: RM
authors.lastname: Bakker
authors.affiliation: Center of Gynecological Oncology Amsterdam, Amsterdam, The Netherlands.
authors.forename: G G
authors.initials: GG
authors.lastname: Kenter
authors.affiliation: Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: C L
authors.initials: CL
authors.lastname: Creutzberg
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: A M
authors.initials: AM
authors.lastname: Stiggelbout
authors.affiliation: Center of Gynecological Oncology Amsterdam, Amsterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Derks
authors.affiliation: Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Mingelen
authors.affiliation: Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: C D
authors.initials: CD
authors.lastname: Kroon
authors.affiliation: Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: W M
authors.initials: WM
authors.lastname: Vermeer
authors.affiliation: Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: M M
authors.initials: MM
authors.lastname: Ter Kuile
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology*; D001828:Body Image; D000073116:Cancer Survivors / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology*; D004414:Dyspareunia / Q000523:psychology; D005260:Female; D006801:Humans; D008875:Middle Aged; D010146:Pain / Q000523:psychology; D012725:Sexual Behavior; D012747:Sexual Partners; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000523:psychology*
keywords: biopsychosocial model; cervical cancer; mediation analysis; psychosocial oncology; sexual distress; sexual functioning