Abstract
Cancer may impair sexual function in women. We provide an overview of studies that address Female Sexual Dysfunction (FSD) in women with cancer with a meta-analysis of observational studies that used a validated diagnostic tool. Searches included MEDLINE, Scopus, and Google Scholar for studies published from January 2000 to 31 December 2014. Every included study had to involve at least 30 cancer patients, to investigate FSD based on the Female Sexual Function Index (FSFI), and to have been published in peer-review journals. Duplicate independent data extraction and quality assessment were performed. Data were pooled using a random effects model if statistical heterogeneity was present. The main outcomes were FSFI total score and FSD prevalence. FSFI is a 19-item self-report instrument for assessing key dimensions of female sexual function. A value less than 26.55 is consistent with FSD. Thirty-five studies met the inclusion criteria. Among these, 27 reported FSFI scores, and 16 FSD prevalence. Most studies (56 %) had low to moderate quality. The mean value of FSFI was lower than 20 at all cancer sites: 16.25 (pooled random effect, 95 % CI 14.91–17.58, I 2 = 14.5 %) for colorectal cancer, 18.11 (95 % CI 14.45–21.77, I 2 = 97.8 %) for gynecological cancer, and 19.58 (95 % CI 17.64–21.53, I 2 = 90.9 %) for breast cancer. FSD prevalence was higher than 60 % at all cancer sites, with the highest value for gynecological cancer (78.44 %, 95 % CI 68.36–88.52 %, I 2 = 94.1 %). Women with cancer showed low FSFI scores with a high prevalence of FSD.
Similar content being viewed by others
References
American Cancer Society, Cancer Facts & Figures 2015 (American Cancer Society, Atlanta, 2015)
Z.A. Alicikus, I.B. Gorken, R.C. Sen, S. Kentli, M. Kinay, H. Alanyali, O. Harmancioglu, Psychosexual and body image aspects of quality of life in Turkish breast cancer patients: a comparison of breast conserving treatment and mastectomy. Tumori 95, 212–218 (2009)
American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 5th edn. (American Psychiatric Association, Arlington, 2013)
D.D. Jeffery, J.P. Tzeng, F.J. Keefe, L.S. Porter, E.A. Hahn, K.E. Flynn, B.B. Reeve, K.P. Weinfurt, Initial report of the cancer Patient-Reported Outcomes Measurement Information System (PROMIS) sexual function committee: review of sexual function measures and domains used in oncology. Cancer 115, 1142–1153 (2009)
C.S. Denlinger, R.W. Carlson, M. Are, K.S. Baker, E. Davis, S.B. Edge, D.L. Friedman, M. Goldman, L. Jones, A. King, E. Kvale, T.S. Langbaum, J.A. Ligibel, M.S. McCabe, K.T. McVary, M. Melisko, J.G. Montoya, K. Mooney, M.A. Morgan, T. O’Connor, E.D. Paskett, M. Raza, K.L. Syrjala, S.G. Urba, M.T. Wakabayashi, P. Zee, N. McMillian, D. Freedman-Cass, National Compresensive Cancer Network, Survivorship: sexual dysfunction (female) version. J. Natl. Compr. Cancer Netw. 12, 184–192 (2014)
R. Rosen, C. Brown, J. Heiman, S. Leiblum, C. Meston, R. Shabsigh, D. Ferguson, R. D’Agostino Jr, The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J. Sex Marital Ther. 26, 191–208 (2000)
R.E. Baser, Y. Li, J. Carter, Psychometric validation of the Female Sexual Function Index (FSFI) in cancer survivors. Cancer 118, 4606–4618 (2012)
D.F. Stroup, J.A. Berlin, S.C. Morton, I. Olkin, G.D. Williamson, D. Rennie, D. Moher, B.J. Becker, T.A. Sipe, S.B. Thacker, Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA 283, 2008–2012 (2000)
R. Herzog, M.J. Álvarez-Pasquin, C. Díaz, J.L. Del Barrio, J.M. Estrada, Á. Gil, Are healthcare workers’ intentions to vaccinate related to their knowledge, beliefs and attitudes? A systematic review. BMC Public Health 13, 154 (2013)
S.P. Hozo, B. Djulbegovic, I. Hozo, Estimating the mean and variance from the median, range, and the size of a sample. BMC Med. Res. Methodol. 5, 13 (2005)
J.P. Higgins, S.G. Thompson, Quantifying heterogeneity in a meta-analysis. Stat. Med. 21, 1539–1558 (2002)
J.J.A.D. Deeks, M.J. Bradburn, Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis, in Systematic Reviews in Health Care, ed. by D.G. Altman, M.D.-S.G. Egger (BML, London, 2001)
S. Damast, K. Alektiar, A. Eaton, N.K. Gerber, S. Goldfarb, S. Patil, R. Jia, M. Leitao, J. Carter, E. Basch, Comparative patient-centered outcomes (health state and adverse sexual symptoms) between adjuvant brachytherapy versus no adjuvant brachytherapy in early stage endometrial cancer. Ann. Surg. Oncol. 21, 2750–2754 (2014)
S. Damast, K.M. Alektiar, S. Goldfarb, A. Eaton, S. Patil, J. Mosenkis, A. Bennett, T. Atkinson, E. Jewell, M. Leitao, R. Barakat, J. Carter, E. Basch, Sexual functioning among endometrial cancer patients treated with adjuvant high-dose-rate intra-vaginal radiation therapy. Int. J. Radiat. Oncol. Biol. Phys. 84, e187–e193 (2012)
N. Onujiogu, T. Johnson, S. Seo, K. Mijal, J. Rash, L. Seaborne, S. Rose, D.M. Kushner, Survivors of endometrial cancer: who is at risk for sexual dysfunction? Gynecol. Oncol. 123, 356–369 (2011)
G. Bogani, M. Serati, R. Nappi, A. Cromi, E. di Naro, F. Ghezzi, Nerve-sparing approach reduces sexual dysfunction in patients undergoing laparoscopic radical hysterectomy. J. Sex. Med. 11, 3012–3020 (2014)
Y. Harding, T. Ooyama, T. Nakamoto, A. Wakayama, W. Kudaka, M. Inamine, Y. Nagai, S. Ueda, Y. Aoki, Radiotherapy- or radical surgery-induced female sexual morbidity in stages IB and II cervical cancer. Int. J. Gynecol. Cancer 24, 800–805 (2014)
T. Song, C.H. Choi, Y.Y. Lee, T.J. Kim, J.W. Lee, B.G. Kim, D.S. Bae, Sexual function after surgery for early-stage cervical cancer: is there a difference in it according to the extent of surgical radicality? J. Sex. Med. 9, 1697–1704 (2012)
T.Y. Tsai, S.Y. Chen, M.H. Tsai, Y.L. Su, C.M. Ho, H.F. Su, Prevalence and associated factors of sexual dysfunction in cervical cancer patients. J. Sex. Med. 8, 1789–1796 (2011)
J. Carter, Y. Sonoda, R.E. Baser, L. Raviv, D.S. Chi, R.R. Barakat, A. Iasonos, C.L. Brown, N.R. Abu-Rustum, A 2-year prospective study assessing the emotional, sexual, and quality of life concerns of women undergoing radical trachelectomy versus radical hysterectomy for treatment of early-stage cervical cancer. Gynecol. Oncol. 119, 358–365 (2010)
M. Serati, S. Salvatore, E. Cattoni, M. Zanirato, S. Mauri, G. Siesto, A. Cromi, F. Ghezzi, P. Bolis, The impact of the loop electrosurgical excisional procedure for cervical intraepithelial lesions on female sexual function. J. Sex. Med. 7, 2267–2272 (2010)
M. Serati, S. Salvatore, S. Uccella, R.M. Laterza, A. Cromi, F. Ghezzi, P. Bolis, Sexual function after radical hysterectomy for early-stage cervical cancer: is there a difference between laparoscopy and laparotomy? J. Sex. Med. 6, 2516–2522 (2009)
W.M. Likes, C. Stegbauer, D. Hathaway, C. Brown, T. Tillmanns, Use of the female sexual function index in women with vulvar intraepithelial neoplasia. J. Sex Marital Ther. 32, 255–256 (2006)
U. Boehmer, A. Ozonoff, A. Timm, M. Winter, J. Potter, After breast cancer: sexual functioning of sexual minority survivors. J. Sex. Res. 51, 681–689 (2014)
G.A. Raggio, M.L. Butryn, D. Arigo, R. Mikorski, S.C. Palmer, Prevalence and correlates of sexual morbidity in long-term breast cancer survivors. Psychol. Health 29, 632–650 (2014)
L.R. Schover, G.P. Baum, L.A. Fuson, A. Brewster, A. Melhem-Bertrandt, Sexual problems during the first 2 years of adjuvant treatment with aromatase inhibitors. J. Sex. Med. 11, 3102–3111 (2014)
M.S. Neto, M.V. de Aguiar Menezes, J.R. Moreira, E.B. Garcia, L.E. Abla, L.M. Ferreira, Sexuality after breast reconstruction post mastectomy. Aesthet. Plast. Surg. 37, 643–647 (2013)
M.R. Safarinejad, N. Shafiei, S. Safarinejad, Quality of life and sexual functioning in young women with early-stage breast cancer 1 year after lumpectomy. Psychooncology 22, 1242–1248 (2013)
I. Harirchi, A. Montazeri, F. Zamani Bidokhti, N. Mamishi, K. Zendehdel, Sexual function in breast cancer patients: a prospective study from Iran. J. Exp. Clin. Cancer. Res. 31, 20 (2012)
V. Pumo, G. Milone, M. Iacono, S.R. Giuliano, A. Di Mari, C. Lopiano, S. Bordonaro, P. Tralongo, Psychological and sexual disorders in long-term breast cancer survivors. Cancer Manag. Res. 4, 61–65 (2012)
Y. Sbitti, H. Kadiri, I. Essaidi, Z. Fadoukhair, S. Kharmoun, K. Slimani, N. Ismaili, M. Ichou, H. Errihani, Breast cancer treatment and sexual dysfunction: Moroccan women’s perception. BMC Womens Health 11, 29 (2011)
L.R. Schover, M.M. Rhodes, G. Baum, J.H. Adams, R. Jenkins, P. Lewis, K.E. Jackson, Sisters Peer Counseling in Reproductive Issues After Treatment (SPIRIT): a peer counseling program to improve reproductive health among African American breast cancer survivors. Cancer 117, 4983–4992 (2011)
L.R. Schover, R. Jenkins, D. Sui, J.H. Adams, M.S. Marion, K.E. Jackson, Randomized trial of peer counseling on reproductive health in African American breast cancer survivors. J. Clin. Oncol. 24, 1620–1626 (2006)
J.J. Speer, B. Hillenberg, D.P. Sugrue, C. Blacker, C.L. Kresge, V.B. Decker, D. Zakalik, D.A. Decker, Study of sexual functioning determinants in breast cancer survivors. Breast J. 11, 440–447 (2005)
P. Contin, Y. Kulu, T. Bruckner, M. Sturm, T. Welsch, B.P. Müller-Stich, J. Huber, M.W. Büchler, A. Ulrich, Comparative analysis of late functional outcome following preoperative radiation therapy or chemoradiotherapy and surgery or surgery alone in rectal cancer. Int. J. Colorectal Dis. 29, 165–175 (2014)
J.B. Reese, P.H. Finan, J.A. Haythornthwaite, M. Kadan, K.R. Regan, J.M. Herman, J. Efron, L.A. Diaz Jr, N.S. Azad, Gastrointestinal ostomies and sexual outcomes: a comparison of colorectal cancer patients by ostomy status. Support. Care Cancer 22, 461–468 (2014)
L. Yu-Hua, Sexual dysfunction in women after low anterior resection. Clin. Nurs. Res. 23, 216–226 (2014)
J. Segelman, A. Martling, M. Machado, T. Holm, K. Bergmark, A. Flöter Rådestad, Preoperative sexual function in women with rectal cancer. Eur. J. Surg. Oncol. 39, 1079–1086 (2013)
T.Y. Au, J.A. Zauszniewski, T.M. King, Demographics, cancer-related factors, and sexual function in rectal cancer patients in Taiwan: preliminary findings. Cancer Nurs. 35, E17–E25 (2012)
M.J. Traa, J. De Vries, J.A. Roukema, B.L. Den Oudsten, The preoperative sexual functioning and quality of sexual life in colorectal cancer: a study among patients and their partners. J. Sex. Med. 9, 3247–3254 (2012)
S.K. Hendren, B.I. O’Connor, M. Liu, T. Asano, Z. Cohen, C.J. Swallow, H.M. Macrae, R. Gryfe, R.S. McLeod, Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann. Surg. 242, 212–223 (2005)
M.S. El-Bahnasawy, Y. Osman, A. El-Hefnawy, A. Hafez, M. Abdel-Latif, A. Mosbah, B. Ali-Eldin, A.A. Shaaban, Radical cystectomy and urinary diversion in women: impact on sexual function. Scand. J. Urol. Nephrol. 45, 332–338 (2011)
J. Carter, C. Stabile, B. Seidel, R.E. Baser, A.R. Gunn, S. Chi, R.F. Steed, S. Goldfarb, D.J. Goldfrank, Baseline characteristics and concerns of female cancer patients/survivors seeking treatment at a Female Sexual Medicine Program. Support. Care Cancer 23, 2255–2265 (2015)
A. Pilger, R. Richter, C. Fotopoulou, C. Beteta, C. Klapp, J. Sehouli, Quality of life and sexuality of patients after treatment for gynaecological malignancies: results of a prospective study in 55 patients. Anticancer Res. 32, 5045–5049 (2012)
A.C. Rodrigues, R. Teixeira, T. Teixeira, S. Conde, P. Soares, I. Torgal, Impact of pelvic radiotherapy on female sexuality. Arch. Gynecol. Obstet. 285, 505–514 (2012)
D. Vomvas, G. Iconomou, E. Soubasi, M. Leotsinidis, H.P. Kalofonos, S. Beratis, D. Kardamakis, K. Assimakopoulos, Assessment of sexual function in patients with cancer undergoing radiotherapy—a single centre prospective study. Anticancer Res. 32, 657–664 (2012)
J. Carter, L. Raviv, L. Applegarth, J.S. Ford, L. Josephs, E. Grill, C. Sklar, Y. Sonoda, R.E. Baser, R.R. Barakat, A cross-sectional study of the psychosexual impact of cancer-related infertility in women: third-party reproductive assistance. J. Cancer Surviv. 4, 236–246 (2010)
E.Z. Latif, M.P. Diamond, Arriving at the diagnosis of female sexual dysfunction. Fertil. Steril. 100, 898–904 (2013)
R.M. Turner, S.M. Bird, J.P. Higgins, The impact of study size on meta-analyses: examination of underpowered studies in Cochrane reviews. PLoS ONE 8, e59202 (2013)
J.A. Sterne, D. Gavaghan, M. Egger, Publication and related bias in meta-analysis: power of statistical tests and prevalence in the literature. J. Clin. Epidemiol. 53, 1119–1129 (2000)
J.E. Blümel, P. Chedraui, G. Baron, E. Belzares, A. Bencosme, A. Calle, M.T. Espinoza, D. Flores, H. Izaguirre, P. Leon-Leon, S. Lima, E. Mezones-Holguin, A. Monterrosa, D. Mostajo, D. Navarro, E. Ojeda, W. Onatra, M. Royer, E. Soto, S. Vallejo, K. Tserotas, Collaborative Group for Research of the Climacteric in Latin America (REDLINC), Sexual dysfunction in middle-aged women: a multicenter Latin American study using the Female Sexual Function Index. Menopause 16, 1139–1148 (2009)
M.I. Maiorino, G. Bellastella, K. Esposito, Sexual activity in midlife women and beyond. JAMA Intern. Med. 174, 1203–1204 (2014)
D.D. Bransfield, J.C. Horiot, A. Nabid, Development of a scale for assessing sexual function after treatment for gynecologic cancer. J. Psychosoc. Oncol. 2, 3–19 (1984)
P.T. Jensen, M.C. Klee, I. Thranov, M. Groenvold, Validation of a questionnaire for self-assessment of sexual function and vaginal changes after gynaecological cancer. Psychooncology 13, 577–592 (2004)
L.R. Derogatis, The Derogatis Interview for Sexual Functioning (DISF/DISF-SR): an introductory report. J. Sex Marital Ther. 23, 291–304 (1997)
A.H. Clayton, E.L. McGarvey, G.J. Clavet, The Changes in Sexual Functioning Questionnaire (CSFQ): development, reliability, and validity. Psychopharmacol. Bull. 33, 731–745 (1997)
European Organization for Research and Treatment of Cancer (EORTC). EORTC quality-of-life questionnaires. http://groups.eortc.be/qol/questionnaires_modules.htm. Accessed January 31, 2015
I. Bartula, K.A. Sherman, The Female Sexual Functioning Index (FSFI): evaluation of acceptability, reliability, and validity in women with breast cancer. Support. Care Cancer (2015). doi:10.1007/s00520-015-2623-y
V. SanchezVarela, E.S. Zhou, S.L. Bober, Management of sexual problems in cancer patients and survivors. Curr. Probl. Cancer 37, 319–352 (2013)
M. Krychman, L.S. Millheiser, Sexual health issues in women with cancer. J. Sex. Med. 10(Suppl 1), 5–15 (2013)
H.N. Thomas, C.C. Chang, S. Dillon, R. Hess, Sexual activity in midlife women: importance of sex matters. JAMA Intern. Med. 174, 631–633 (2014)
A.M. Isidori, C. Pozza, K. Esposito, D. Giugliano, S. Morano, L. Vignozzi, G. Corona, A. Lenzi, E.A. Jannini, Development and validation of a 6-item version of the female sexual function index (FSFI) as a diagnostic tool for female sexual dysfunction. J. Sex. Med. 7, 1139–1146 (2010)
P. Chedraui, F.R. Perez-Lopez, G. San Miguel, C. Avila, Assessment of sexuality among middle-aged women using the Female Sexual Function Index. Climacteric 12, 213–221 (2009)
S.T. Lindau, N. Gavrilova, D. Anderson, Sexual morbidity in very long term survivors of vaginal and cervical cancer: a comparison to national norms. Gynecol. Oncol. 106, 413–418 (2007)
J. Carter, C. Stabile, A. Gunn, Y. Sonoda, The physical consequences of gynecologic cancer surgery and their impact on sexual, emotional, and quality of life issues. J. Sex. Med. 10(Suppl 1), 21–34 (2013)
J. Tian, Sexual well-being of cervical cancer survivors under 50 years old and the factors affecting their libido. Gynecol. Obstet. Invest. 76, 177–181 (2013)
V. Günther, B. Malchow, M. Schubert, L. Andresen, A. Jochens, W. Jonat, C. Mundhenke, I. Alkatout, Impact of radical operative treatment on the quality of life in women with vulvar cancer—a retrospective study. Eur. J. Surg. Oncol. 40, 875–882 (2014)
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Maiorino, M.I., Chiodini, P., Bellastella, G. et al. Sexual dysfunction in women with cancer: a systematic review with meta-analysis of studies using the Female Sexual Function Index. Endocrine 54, 329–341 (2016). https://doi.org/10.1007/s12020-015-0812-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12020-015-0812-6