An intervention that incorporates cognitive behavioral therapy and sex education may be helpful for women’s sexual function after risk-reducing salpingo-oophorectomy (RRSO), American researchers report.
RRSO involves removing the fallopian tubes and ovaries in women who have BRCA 1 and BRCA 2 gene mutations, which significantly raise their risk for gynecological and breast cancers. Women who choose to have surgery typically have the procedure in their late thirties (or when they are finished with childbearing) in order to reduce their risk.
Unfortunately, removing the ovaries causes estrogen levels to drop sharply, inducing surgical menopause. Sexual issues, such as lower desire, decreased satisfaction, and vaginal dryness are common. Hormone replacement therapy is usually not helpful.
With this study, researchers from the Dana-Farber Cancer Institute and Harvard Medical School, both in Boston, designed an intervention using mindfulness concepts of cognitive behavioral therapy along with education to help women after RRSO.
The program had three components:
• A 3.5 hour educational session led by a clinical psychologist. Participants learned about the sexual problems that can result from RRSO and were taught relaxation training and body awareness techniques. They were also given guidance on improving their sexual self-esteem. At the close of the session, each woman developed an action plan focused on concrete steps she could take to apply what she had learned.
• About two weeks after the educational session, each woman had a telephone counseling session with the same psychologist. This session built on the action plan.
• Four weeks following the educational session, a “booster” telephone call was made, focusing again on the action plan along with steps for the future.
Thirty-seven women with a mean age of 44 completed the program. Each woman had had RRSO and reported at least one distressing sexual symptom.
The women completed several questionnaires at the start of the study and two months after the close of the program. Assessments included the Female Sexual Function Index (FSFI), along with tools addressing psychological distress, sexual self-efficacy, and sexual knowledge.
Overall, the women saw improvement on all measures. When compared to baseline, they had improved sexual function, less anxiety, and better self-efficacy. All of the women said they had enjoyed the program and that they were “certain” or “very certain” that they could manage sexual issues caused by RRSO.
“Results from this intervention suggest that when women are given information, skill-based education, and practical strategies for addressing these issues, it is likely that that impact can enhance not only sexual health but quality of life more broadly,” the authors wrote.
Their findings cannot be applied to other groups of women, they noted, as the women in the study group were mainly white and college-educated. Also, it was unclear whether the intervention would still be effective after the two-month post-program assessment.
Also, not all of the women who were interested in the program were able to attend because of timing or logistics. Future versions could make it more accessible to more women, the researchers said.
Still, from a clinical standpoint, the results suggest that women may be more likely to consider RRSO if they know that any sexual problems can be managed. The availability of an effective treatment may also make clinicians more likely to discuss sexual dysfunction for women undergoing RRSO.
The study was first published online in October in The Journal of Sexual Medicine.
Resources
The Journal of Sexual Medicine
Bober, Sharon L., PhD, et al.
“Addressing Sexual Dysfunction After Risk-Reducing Salpingo-Oophorectomy: Effects of a Brief, Psychosexual Intervention”
(Full-text. First published online: October 14, 2014)
http://onlinelibrary.wiley.com/doi/10.1111/jsm.12713/full