Cara R. Dunkley

Risk-Reducing Bilateral Salpingo-Oophorectomy and Sexual Health: A Qualitative Study

OBJECTIVE To examine the impact of risk-reducing bilateral salpingo-oophorectomy (RRBSO) on sexual function in BRCA gene mutation carriers, compared with the effect on women undergoing BSO (bilateral salpingo-oophorectomy) for benign indications from a qualitative perspective. METHODS Our study included 25 women who had undergone either a RRBSO because of BRCA carrier status or a BSO for a benign gynaecologic indication. Women were invited to participate if they were at least six months post-BSO. They took part in an individual, private interview during which they were asked open-ended questions about their sexual health in the context of undergoing BSO. They also completed self-report measures of sexual response, sexual distress, sexual self-image, and mood. RESULTS Using content analysis of interviews, saturation in themes was reached after 15 interviews and four main themes were identified: (1) preoperative knowledge of sexual side effects, (2) preoperative drive to educate oneself on BSO side effects, (3) partner support, and (4) treatment for sexual side effects. Preoperative awareness of post-BSO sexual side effects was highly correlated with patient satisfaction and inversely correlated with postoperative sexual distress. A majority of participants reported that they did not discuss post-BSO sexual functioning with their physicians, and had to seek out information independently. Satisfaction with RRBSO remained high regardless of whether or not participants reported post-BSO sexual distress. Self-report questionnaires did not reveal any differences between the two groups on measures of sexual function. CONCLUSION This study provided a nuanced view of sexual health in women following RRBSO that was not captured by self-report questionnaires. Women with preoperative knowledge of post-BSO sexual side effects report being more prepared for surgery, and experience less sexual distress following their BSO.

Sexual Functioning in Young Women and Men: Role of Attachment Orientation

Prior research has documented various ways in which adult attachment styles are characteristic of differential behavioral and cognitive patterns within romantic relationships and sexuality. However, few studies have examined the direct influence of anxious or avoidant attachment orientation on sexual function. The aim of the present study was to assess the impact of insecure attachment on sexual function. Undergraduate students completed questionnaires measuring attachment style and sexual functioning. Among women, attachment avoidance tended to be associated with impairments in all aspects of sexual function, whereas anxious attachment tended to be associated with declines in arousal, satisfaction, and ability to achieve orgasm. A different trend was seen in men: Anxious attachment tended to be associated with multiple facets of sexual dysfunction, while avoidant attachment did not correlate with any sexual function deficits and was associated with superior physiological competence. These results suggest that both anxious and avoidant attachment styles are important yet differential predictors of sexual function in men and women.

Psychological Treatments for Provoked Vestibulodynia: Integration of Mindfulness-Based and Cognitive Behavioral Therapies

Provoked vestibulodynia (PVD) is a chronic and distressing genital pain condition involving sharp pain to the vulvar vestibule with lifetime prevalence as high as 12%. PVD is the most prevalent cause of pain during sexual intercourse (dyspareunia) in premenopausal women, and gives rise to considerable sexual and relational concerns. As intercourse for women with PVD is either painful or impossible, PVD has pronounced negative effects on womens romantic relationship adjustment and sexual intimacy, as well as their emotional well-being and sense of sexual self-efficacy. Given the low efficacy and high side-effect profile of medications for the treatment of PVD, attention has shifted toward psychological interventions over the past decade. Psychological treatments for PVD have the advantage of targeting both the experience of pain and its many psychosexual consequences, such as reduced desire and arousal. Cognitive behavioral therapy (CBT) currently represents one of the most popular first-line psychological interventions for PVD. Mindfulness has been increasingly used alongside, or instead of CBT for a variety of health-related conditions, particularly with respect to chronic pain disorders and more recently in women with PVD. This review provides a detailed overview of CBT and mindfulness-based approaches in treating PVD.

Integrating Quantitative and Qualitative Methods to Evaluate an Online Psychoeducational Program for Sexual Difficulties in Colorectal and Gynecologic Cancer Survivors

Sexual health is an integral component of quality of life for cancer survivors, and is often negatively impacted by treatment. Geographic limitations often prohibit survivors from accessing sexual health programs designed to address their needs. This study examined the efficacy of an online, 12-week psychoeducational program, which included elements of mindfulness meditation, for sexual difficulties in survivors of colorectal or gynecologic cancer. Complete pre- and postintervention data were available for 46 women (mean age 55.0, SD 9.6) and 15 men (mean age 59.7, SD 6.8). Women experienced significant improvements in sex-related distress (p < .001), sexual function (p < .001 and p < .01), and mood (p < .001); these results were maintained at six months follow-up. Mens improvement in desire was not significant (p = .06), whereas intercourse satisfaction was (p < .05) immediately after the program, but not at follow-up. In order to more fully explore womens experiences, interviews were carried out with six participants and analyzed using narrative inquiry. Women shared a feeling of renewed hope for regaining their sex lives, and expressed that they would have valued an interactive component to the program. These findings suggest that an online, unidirectional psychoeducational program is feasible, and may be effective for women survivors of gynecologic and colorectal cancer, but further work is needed to ensure that online interventions address the sexual health needs of male survivors.

Sexuality and romantic relationships: investigating the relation between attachment style and sexual satisfaction

ABSTRACT Attachment theories have recently been applied to adult romantic relationships, and more specifically, sexuality within these relationships. However, few studies have examined the influence of attachment-related avoidance and anxiety on sexual communication, gender role ideology, sexual satisfaction or the relations between these constructs. Men (n = 106) and women (n = 349) undergraduate students and young adults from the community completed an online questionnaire measuring attachment style, sexual communication, gender role ideology, and sexual satisfaction. Multiple mediation and path analyses showed several interrelations between these variables among women. Additionally, gender role ideology and sexual communication together were found to totally mediate the relation between attachment-related anxiety and sexual satisfaction in women. Sexual communication partially mediated the relation between attachment-related avoidance and sexual satisfaction in women. Among men, the only significant finding was that attachment-related anxiety and avoidance were related to lower sexual communication. These results indicate that there is disparity in sexual communication, gender role ideology, and sexual satisfaction among individuals with differing attachment orientations and that these effects may be more prominent in women than men.