Communication about sexual problems and sexual concerns in ovarian cancer: qualitative study

Participants, methods, and results

Detailed interviews were conducted with 15 women with ovarian cancer (median age 56 (range 42-71) years, median time since diagnosis 18 (8-120) months) who were identified from a sampling survey as sexually active or as inactive for reasons related to the condition. Topics included pre-diagnostic and current sexual behaviour and response, satisfaction with sex life, and importance of sex. Interviews were audiotaped, transcribed verbatim, and analysed using grounded theory methods,5 starting after the first interview. Each author read the transcript, noting themes and issues, and concepts pertaining to similar issues were grouped into categories. As more interviews were conducted, a thematic framework of the categories and their associated themes was produced, and this was systematically applied to each transcript, searching for evidence of the categories and themes. Semistructured interviews were conducted with the women and 43 clinicians and nurses in Leeds to determine their attitudes about, and experiences of, written or verbal communication about sex. Local research ethics committee approval was granted.

The condition affected women's sexual desire and raised fears about sexual activity (for example, fear of recurrence) and relationship concerns (for example, fear of rejection). The couple's ability to discuss sex, and the woman's perception that sex maintained normality or control, contributed to whether or not sex was resumed. The experience of physical problems (for example, dyspareunia or vaginal dryness) or psychological distress affected the continuation of sex, and the frequency of sexual activity was often reduced. Over time, physical problems reduced in severity, but the psychological distress persisted. For some women, sex never occurred again—the impact on their self esteem and relationship was devastating. Loss of fertility also caused distress.

Most women thought that a healthcare professional should have provided written information or discussed sexual issues with them. No patient received written information and only two received brief verbal information—a medical oncologist told one woman that the hospital had creams to help if intercourse proved difficult, and another woman vaguely recalled a surgeon saying something, but she still felt unsure about the safety of sexual activity.

The table shows women's attitudes towards communication about sexual issues compared with the reality that they faced. Some women felt uncomfortable discussing sex, but they felt that the benefits would outweigh any embarrassment. Women felt that time available to discuss psychosexual concerns was limited, but they did not seek extensive information—reassurance of the safety of sex, reassurance that their problems were not unique, and permission to discuss concerns was often all that was needed.

The table also shows the attitudes and behaviours of healthcare professionals. All but one thought that medical staff should discuss psychosexual issues; however, only four clinicians (25%) and five nurses (19%) did so. Knowledge about the impact of ovarian cancer on sexual functioning was lacking, with few healthcare professionals being aware of the problems that can occur.

Comment

Ovarian cancer affects sexual functioning, but healthcare professionals' knowledge about this is inadequate, as is their communication with patients about sexual issues. A larger prospective study starting from the time of diagnosis is planned to identify the prevalence, duration, and severity of sexual problems in patients with ovarian cancer.

Healthcare professionals need training to help them communicate more comfortably about sexual issues. Detailed discussion may be unnecessary—just a few reassuring words may be enough to relieve some of the fears and problems provoked by ovarian cancer and its treatment.