Abstract
AimsSexual abuse is a women’s health concern globally. Although experience of sexual abuse and cancer may constitute risk factors for sexual dysfunction and low wellbeing, the effects of sexual abuse have received little attention in oncology care. This study aims to explore sexual health and wellbeing in women after pelvic radiotherapy and to determine the relationship between sexual abuse and sexual dysfunction, and decreased wellbeing.MethodsUsing a study-specific questionnaire, data were collected during 2011–2017 from women with gynaecological, anal, or rectal cancer treated with curative pelvic radiotherapy in a population-based cohort and a referred patient group. Subgroup analyses of data from women with a reported history of sexual abuse were conducted, comparing socio-demographics, diagnosis, aspects of sexual health and wellbeing.ResultsIn the total sample of 570 women, 11% reported a history of sexual abuse and among these women the most common diagnosis was cervical cancer. More women with than without a history of sexual abuse reported feeling depressed (19.4% vs. 9%, p = 0.007) or anxious (22.6% vs. 11.8%, p = 0.007) and suffering genital pain during sexual activity (52% vs. 25.1%, p = 0.011, RR 2.07, CI 1.24–3.16). In the total study cohort, genital pain during sexual activity was associated with vaginal shortness (68.5% vs. 31.4% p ≤ 0.001) and inelasticity (66.6% vs. 33.3%, p ≤ 0.001).ConclusionsOur findings suggest that a history of both sexual abuse and pelvic radiotherapy in women are associated with increased psychological distress and sexual impairment, challenging healthcare professionals to take action to prevent retraumatisation and provide appropriate interventions and support.
Highlights
Sexual abuse and intimate partner violence are problems faced by women worldwide, often causing life-long physiological and psychological consequences, and sexual dysfunctions such as impaired sexual desire, sexual pain, reduced1 3 Vol.:(0123456789)Supportive Care in Cancer (2021) 29:6851–6861 intimate partner violence, including sexual abuse, was ten times higher among cervical cancer patients compared to the general population [10]
Women with a reported history of sexual abuse were on average younger than those with no reported history of sexual abuse (57.2 years vs. 64.9 years, p < 0.001), a higher proportion stated that they had a partner but lived alone (16.1% vs. 3.7%, p < 0.001), and they were more likely to be on sick leave (16.7% vs. 8.5%, p = 0.024)
Our results are consistent with the study by Bergmark et al [20], which shows a statistically significant higher risk and a synergistic effect for genital pain during vaginal sex among cervical cancer survivors with a history of both pelvic radiotherapy and sexual abuse compared to healthy controls
Summary
Sexual abuse and intimate partner violence are problems faced by women worldwide, often causing life-long physiological and psychological consequences, and sexual dysfunctions such as impaired sexual desire, sexual pain, reduced. Supportive Care in Cancer (2021) 29:6851–6861 intimate partner violence, including sexual abuse, was ten times higher among cervical cancer patients compared to the general population [10]. There is limited research about the associations between radiotherapy-induced sexual dysfunctions and earlier sexual abuse among female cancer survivors. Bergmark et al [20] previously found that, compared to healthy controls with no reported history of sexual abuse, the risk of pain during sexual activity in women who have had both cervical cancer and reported a history of sexual abuse was up to 30 times higher; their overall sexual health and wellbeing were more negatively affected. The potential interplay of previous trauma may be reactivated by the cancer treatment experience, which rise the importance of increased knowledge in this field
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