Gynaecological cancers refer to cancers that start in a woman reproductive system. Their treatment varies with their source or where they started. Gynaecological cancers can be the cancer of the ovary, cancer of the womb, cancer of the external genitals, cancer of the ovary and cancer of the birth canal. A close evaluation of changes that are taking place in the quality of life after gynaecologic cancer shows that sexuality issues are the ones which undergoes the greatest disruption.
Sexual problems always start with the signs and symptoms of the disease and even continue as attempts are made to ensure that the women are able to resume with their sexual activity after the treatment. For most women, the emotional sequelae or the physical difficulty that they encounter are usually so disruptive to an extent that all their sexual activity and feeling ceases. Many researches that have been conducted show that these sexual difficulties can have ripple effects that can result into negative feelings regarding self esteem, self confidence and the perception of herself as a woman.
The extent of disruption of sexual activity depends on many factors such as the extent of the disease, and other risk factors. Intervention will play a vital role especially for a Gynaecological cancer patient who has a more negative perception on her sexuality. Despite the fact that it will give him specific strategies for managing her sexual problems, an intervention will challenge the typical view of a woman by providing some strategies for enriching her sexual schema. There are different types of interventions which are usually applied to improve post-treatment sexual adjustment of women with gynaecological cancer.
Some of the examples of intervention that are normally used include psychological intervention and pharmacologic agents. This paper is going to describe the interventions applied to improve post-treatment sexual adjustment of women with gynaecological cancer. The paper will also give examples of cases critically evaluate the effectiveness of such interventions to improve post-treatment sexual adjustment of women with either breast or gynaecological Psychological intervention Psychological intervention have been widely used for post treatment of sexual adjustment of women either breast or gynaecological cancer.
Psychological intervention includes imagery, systematic desensitization and hypnosis. Researchers have found out that this is helpful when it comes to sexual adjustment of a gynaecological cancer patient. According to Marteau (1993) counselling is a generally accepted as one of the best intervention when it comes to post treatment for sexual adjustment of women with gynaecological cancer. A study that was recently done looks at the benefits of counselling found out, despite the fact that the subjects indicated that they perceived counselling to be very important (Berek et al 2004)
Post treatment sexual adjustment of women with either breast or gynaecological cancer can be improved by psychological intervention. Intervention can hasten resumption of sexual activities, reduce distress and even improves the social outcomes. Components of Effective therapy includes an emotional supportive context that addresses anxieties and fears concerning the disease, information concerning the disease and its treatment, strategies, behavioural coping, relaxation and cognitive coping strategies training to lower sexual arousal or to enhance sexual activity.
Despite the fact that there is insufficient data to choose from, the literature that is currently available suggests an emphasis on coping, relaxation, the specific components of the disease and the social support (Berek et al 2004). In 1993 Andersen, came up with a model that was to be used in predicting risk for behavioural and psychological morbidity, which take into consideration some pre disease factors like prior health status, current stressors with some of the events that are relevant to disease such as recovery, diagnosis, treatment and diagnosis.
This model was widely used in classification of patients into high, medium and low risk. Effectiveness of Psychological intervention – While there is no psychology interventions studies that focus on sexuality, there are some three studies that have incorporated some small elements of the effectiveness of psychological intervention According to Berek J, two studies (one has been done by Houts et al) have been conducted using non-equivalent control group design to establish the effectiveness of brief psychological intervention to improve post-treatment sexual adjustment of women with gynaecological cancer.
The structured counselling helped patients to show their fears and feelings that is directly related to their up coming treatment or diagnosis any upcoming treatment provided information on treatment sequale and tried to enrich femininity and interpersonal relationships. For those women who were sexually active, additional sexual therapy component involve information on how anxiety can be reduced when resuming intercourse. This format involved more than four individual sessions during the surgical hospitalization, the duration of the total therapy was not specified.
A thorough analysis of the result showed differences between the three groups or within the intervention group on the measures of self concept or emotional distress. A trend in the number of women who were going back to work was in favour of the intervention participants. However, there was substantial difference between the group to the return to and frequency of intercourse in all post treatment assessments. (Sixteen percent of the intervention group vs. fifty seven percent of the control women registered no or less sexual activity after twelve months of post treatment) (Capone et al 1990)
Houts et al also examined the efficiency of peer counselling model. His structured intervention involved an encouragement of maintaining interpersonal relationships, making positive plans for the future and questioning medical staff with regard to treatment, any side effects and sexual outcome and maintenance of normal routines. Analysis of the results obtained by Houts et al showed no difference between the two groups at point in any given time. (Houts et al (2008)
In summary, these two quasi experimental designs (by Capone et al and Houts et al) suggested that psychological intervention for gynaecologic patients who had cancer produced limited gains, except in areas of sexual functioning. These two findings are consistent with Gynaecological cancer patients’ the longitudinal descriptive data. With the disease showing low morbidity in areas of marital adjustment, social adjustment and emotional distress but soft when it comes to severe problems of sexual activities. (Williamson 2002) Psycho educational group interventions
Robinson et al evaluated the effectiveness of psycho educational group in improving post-treatment sexual adjustment of women with gynaecological cancer. According to Robinson et al, gynaecological cancer patients are usually at a higher risk for sexual morbidity due to changes in the Vagina which are associated with radiation treatment, all of which brings pain, during sexual intercourse. In their study they recommend the use of sexual vaginal dilators which breaks the fibrous adhesions. In their study, a total of thirty two gynaecological cancer patients participated.
Their control condition included guidance and counselling session in which they were given some questions in book let to answer. This intervention had two (2) ninety minutes group session that involve the following three component information, motivation and behavioural skills. Analysis of their finding showed that women who were getting intervention did not fear about their sexual life. Sixty six percent of those who were interviewed were of the opinion that psycho education group therapy should be encouraged so as to motivate the patients (Smith et al 1995).
Psycho educational group intervention has also been found to be effective. According to Robinson et al eighty two percent of all those women who participated in the study where of the opinion that discussing their issues affecting their sexual life was one of the best ways of some of the sexual problems that they were going through (Smith et al 1995). Medicinal intervention For gynaecological cancer patients whose therapy cannot be identified, risk reducing medicinal intervention is usually used.
In the event that the patient has an extensive disease and treatment availability risk reducing medicinal intervention might bring down the level of risk from high to moderate. Example of some rehabilitative medical efforts includes labia preservation for vulva cancer patients and reconstruction of vagina for pelvic exoneration patients. Despite not being panaceas, these interventions help in improving the sexual activities of the gynecological cancer patient. For that gynecological cancer patient with limited treatment and disease, medical interventions could help to improve a patient sexual life.
For example a patient suffering from a localized cervical cancer can undergo a medical intervention to improve his sexual life by replacing the sexual hormones, in the same way as it is done for healthy women. (Greenwald et al 1995) Medicinal intervention has been found to be effective when it comes to improving the sexual life of gynaecological cancers patients. According to a research that was recently done by Kessler, women who underwent medicinal intervention have ended having the sexual life improved.
However medicinal intervention is mostly effective when it comes to labia preservation for vulva cancer patients and reconstruction of vagina for pelvic exoneration patients. Medicinal intervention is also applied during hormone replacement therapy (Greenwald et al 1995). Conclusion It is hard to make a concrete (viable) conclusion from the scarce literature on the efficiency of some intervention Treating sexual problems after they have developed is usually a common strategy for provision of psychosocial services for Gynaecological cancer patients.
However, some previous research that have been conducted shows that preventive intervention after one has been diagnosed with Gynaecological cancer but prior to the resumption of sexual activity post treatment are usually more effective as compared to the rehabilitation intervention during the recovery process or after, because sexual problems occurs as soon as the intercourse resume.
Intensive intervention at the time of post treatment duration would give women an educated perspective for having a clear understanding of the sexual changes and the knowledge that is required to modify her activities of reducing the likelihood of some sexual problems. Conversely, intervention after the process of complete recovery process might be facilitated by some other factors like lowering emotional distress rather than the emotional liability that is associated with the diagnosis/treatment duration and stabilization of some of the side treatment effects
According to the data that have been shown and analysed by the writer, their should be a cautious optimism that sexual and psychological outcomes can be effectively improved by using a general psychological interventions, however, chances are high that greater gains can be achieved in the event that sexuality specific intervention for a specific intervention was the central part of the therapeutic effort.
The writer of this paper is of the opinion that the intervention to improve post-treatment sexual adjustment of women with either breast or gynaecological cancers should be improved. Andersen finding suggested that psychology intervention is used. Reference: Andersen B: (1992) Psychological interventions Dian publisher pp. 21 – 36 Berek J & Hacker N (2004) Practical gynecologic oncology Lippincott Williams and Wilkins associates
Capone M, Good RS, Westie KS, et al (1990) psychosocial rehabilitation of gynecologic oncology patients Arch Phys Med Rehab Publisher pp 128 -152 Coyne C, & Gaba G (2000) Distress & psychiatric morbidity among women suffering from gynecologic cancer Greenwald P & Kramer B (1995) Cancer Prevention & Control New York Houts J, Mullan B & Price M (2008)Psychological intervention & quality of life University of Sydney publisher Smith M & Schwartz E (1995) gynecologic cancer Thomson publisher pp. 71 – 76 Williamson G (2002) Psychological intervention Dian publisher