Sexual Health Problems and Their Association with Psychological Distress: Investigating the Role of Dyadic Coping Behaviors among Young Adult Breast Cancer Survivors and Partners

Abstract

ABSTRACT Introduction Cancer-related sexual health problems are among the most prevalent and distressing consequences of breast cancer. Representative studies have shown almost one-half of adult U.S. women reporting sexual dysfunction; among female young adult breast cancer survivors (YABCS) this figure approaches an estimated 75%. When untreated, sexual problems can persist throughout survivorship and negatively affect physical and psychological health. Despite the prevalence of sexual health concerns among this population and the negative impact on intimate relationships, the extant literature has marginally considered the role of interpersonal factors. Objective The present work utilized a dyadic perspective assessing emotional distress, satisfaction with sexual relationship, sexual functioning, and relationship satisfaction among YABCS and their partners in the first-year post-diagnosis. Using the Systemic-Transactional Model of Dyadic Coping theoretical framework, it was additionally assessed whether dyadic coping behaviors moderated the relationship between sexual health and distress. Methods YABCS (n=83) and partners (n=40) from an NCI-designated cancer center completed a cross-sectional survey. Validated questionnaires of psychological distress (PHQ-9), relationship functioning (DAS-7), satisfaction with sexual relationship (GMSEX), sexual function (IIEF, FSFI), and dyadic coping [Dyadic Coping Inventory, (DCI)] were administered. Descriptive statistics and independent sample t-tests were used to assess mean differences between survivors and partners’ measures. In addition, the moderating role of dyadic coping on the relationship between sexual health measures and psychological distress was assessed using the PROCESS macro. Results In the present sample, more than one-half of YABCS scored above the cut-off for clinically significant sexual dysfunction (51.6%), compared to 20% of the partners. Both patients and partners reported elevated scores for relationship satisfaction, positive dyadic coping behaviors and low distress. Significant differences were detected in satisfaction with sexual relationship and stress communication, with YABCS reporting lower satisfaction (p<.05), higher self- reported stress communication (p<.01) and male partners rating higher women's engagement in stress communication behaviors (p<.05). Common dyadic coping moderated the relationship between sexual functioning subscales and distress in male partners, with higher distress for those reporting low levels of shared coping behaviors. Similarly, stress communication by the partner moderated the relationship between desire and distress. Among YABCS partner-reported dyadic coping behaviors moderated the relationship between vaginal lubrication and distress, with lower rates of distress for YABCS reporting elevated partner stress communication. Conclusions Despite elevated relationship satisfaction, a substantial subgroup of YABCS and partners experience impaired sexual functioning. Our study provides emerging evidence about the role of interpersonal factors on the relationship between sexual health and distress among YABCS and partners. Specifically, the study reveals that perceived partner stress communication and common dyadic coping behaviors could be clinical intervention targets. Additional research is needed to confirm these findings in larger dyadic samples, including cancer types that are not sex-based. Healthcare providers serving YABCS and their partners should utilize standardized sexual health tools and screening protocols to identify and address survivor, partner, and couple-based factors that can alleviate the impact of sexual health problems on psychological well-being during cancer survivorship. Disclosure No