Feeling well and talking about sex: psycho-social predictors of sexual functioning after cancer

BMC Cancer

The Australian CancerSexuality Study Team¹  Emilee Gilbert¹  Jane M Ussher¹  Janette Perz¹ 

[1]Centre for Health Research, University of Western Sydney, Locked Bag 1797, Penrith South 2751, Australia

关键词: Communication;    Quality of life;    Sexual functioning;    Psycho-social predictors;    Cancer and sexuality;   

Others  :  858929
DOI  :  10.1186/1471-2407-14-228

 received in 2014-01-29, accepted in 2014-03-17,  发布年份 2014

【 摘 要 】

Background

Changes to sexual wellbeing are acknowledged to be a long-term negative consequence of cancer and cancer treatment. These changes can have a negative effect on psychological well-being, quality of life and couple relationships. Whilst previous conclusions are based on univariate analysis, multivariate research can facilitate examination of the complex interaction between sexual function and psycho-social variables such as psychological wellbeing, quality of life, and relationship satisfaction and communication in the context of cancer, the aim of the present study.

Method

Six hundred and fifty seven people with cancer (535 women, 122 men) and 148 partners (87 women, 61 men), across a range of sexual and non-sexual cancers, completed a survey consisting of standardized measures of sexual functioning, depression and anxiety, quality of life, relationship satisfaction, dyadic sexual communication, and self-silencing, as well as ratings of the importance of sex to life and relationships.

Results

Men and women participants, reported reductions in sexual functioning after cancer across cancer type, for both people with cancer and partners. Multiple regression analysis examined psycho-social predictors of sexual functioning. Physical quality of life was a predictor for men and women with cancer, and for male partners. Dyadic sexual communication was a predictor for women with cancer, and for men and women partners. Mental quality of life and depression were also predictors for women with cancer, and the lower self-sacrifice subscale of self-silencing a predictor for men with cancer.

Conclusion

These results suggest that information and supportive interventions developed to alleviate sexual difficulties and facilitate sexual renegotiation should be offered to men and women with both sexual and non-sexual cancers, rather than primarily focused on individuals with sexual and reproductive cancers, as is the case currently. It is also important to include partners in supportive interventions. Interventions aimed at improving sexual functioning should include elements aimed at improving physical quality of life and sexual communication, with a focus on psychological wellbeing also being important for women with cancer.

【 授权许可】

   
2014 Perz et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Hodges LJ, Humphris GM, Macfarlane G: A meta-analytic investigation of the relationship between the psychological distress of cancer patients and their carers. Soc Sci Med 2005, 60(1):1-12.
• [2]World Health Organisation: The world health organisation quality of life assessment (whoqol) position paper. Soc Sci Med 1995, 41:1403-1409.
• [3]Arrington R, Cofrancesco J, Wu AW: Questionnaires to measure sexual quality of life. Qual Life Res 2004, 13(10):1643-1658.
• [4]Anderson BL, Golden-Kreutz DM, Baider L, Cooper CL, De-Nour AK: Sexual self-concept for the women with cancer. In Cancer and the Family. England: John Wiley and Sons; 2000.
• [5]De Groot JM, Mah K, Fyles A, Winton S, Greenwood S, De Petrillo AD, Devins S: The psychosocial impact of cervical cancer among affected women and their partners. Int J Gynecol Cancer 2005, 15:918-925.
• [6]Bertero C, Wilmoth MC: Breast cancer diagnosis and its treatment affecting the self. Cancer Nurs 2007, 30(3):194-202.
• [7]Andersen BL: In sickness and in health: Maintaining intimacy after breast cancer recurrence. Cancer J 2009, 15(1):70-73.
• [8]Gilbert E, Ussher JM, Perz J: Sexuality after breast cancer: a review. Maturitas 2010, 66:397-407.
• [9]Gilbert E, Ussher JM, Perz J: Sexuality after gynaecological cancer: a review of the material, intrapsychic, and discursive aspects of treatment on women’s sexual-wellbeing. Maturitas 2011, 70(1):42-57.
• [10]Howlett K, Koetters T, Edrington J, West C, Paul S, Lee K, Aouizerat BE, Wara W, Swift P, Miaskowski C: Changes in sexual function on mood and quality of life in patients undergoing radiation therapy for prostate cancer. Oncol Nurs Forum 2010, 37(1):E58-E66.
• [11]Ascencio M, Blank T, Descartes L, Crawford A: The prospect of prostate cancer: a challenge for gay men’s sexuality as they age. Sex Res Soc Pol 2009, 6(4):38-51.
• [12]Carter J, Stabile C, Gunn A, Sonoda Y: The physical consequences of gynecologic cancer surgery and their impact on sexual, emotional, and quality of life issues. J Sex Med 2013, 10:21-34.
• [13]Basson R: Sexual function of women with chronic illness and cancer. Womens Health 2010, 6(3):407-429.
• [14]Holmes L: Sexuality in gynaecological cancer patients. Canc Nurs Pract 2005, 4(6):35-39.
• [15]Ussher JM, Perz J, Gilbert E: Changes to sexual well-being and intimacy after breast cancer. Cancer Nurs 2012, 35(6):456-464.
• [16]Bergmark K, Avall-Lundqvist E, Dickman PW, Henningsohn L, Steineck G: Vaginal changes and sexuality in women with a history of cervical cancer. N Engl J Med 1999, 340(18):1383-1389.
• [17]Safarinejad MR, Shafiei N, Safarinejad S: Quality of life and sexual functioning in young women with early stage breast cancer 1 year after lumpectomy. Psycho Oncol 2013, 22(6):1242-1248.
• [18]Stead ML, Fallowfield L, Selby P, Brown JM: Psychosexual function and impact of gynaecological cancer. Best Pract Res Clin Obstet Gynaecol 2007, 21(2):309-320.
• [19]Lamb MA, Sheldon TA: The sexual adaptation of women treated for endometrial cancer. Cancer Pract 1994, 2(2):103-113.
• [20]Plotti F, Sansone M, Di Donato V, Antonelli E, Altavilla T, Angioli R, Panici PB: Quality of life and sexual function after type C2/type III radical hysterectomy for locally advanced cervical cancer: a prospective study. J Sex Med 2011, 8(3):894-904.
• [21]Fobair P, Stewart SL, Chang S, D’Onofrio C, Banks PJ, Bloom JR: Body image and sexual problems in young women with breast cancer. Psychooncology 2006, 15(7):579-594.
• [22]Archibald S, Lemieux S, Byers ES, Tamlyn K, Worth J: Chemically-induced menopause and the sexual functioning of breast cancer survivors. Women Ther 2006, 29(1/2):83-106.
• [23]Wilmoth MC: The aftermath of breast cancer: an altered sexual self. Cancer Nurs 2001, 24(4):278-286.
• [24]Sekse RJT, Raaheim M, Blaaka G, Gjengedal E: Life beyond cancer: women’s experiences 5 years after treatment for gynaecological cancer. Scand J Caring Sci 2010, 24(4):799-807.
• [25]Bal MD, Yilmaz SD, Beji NK: Sexual health in patients with gynecological cancer: a qualitative study. Sex Disabil 2013, 31(1):83-92.
• [26]Weijmar Schultz WCM, Van De Wiel HBM, Bouma J: Psychosexual functioning after treatment for cancer of the cervix: a comparative and longitudinal study. Int J Gynecol Cancer 1991, 1(1):37-46.
• [27]Andersen BL, Hacker NF: Psychosexual adjustment after vulvar surgery. Obstet Gynecol 1983, 62(4):457-462.
• [28]Green MS, Naumann RW, Elliot M, Hall JB, Higgins RV, Grigsby JH: Sexual dysfunction following vulvectomy. Gynecol Oncol 2000, 77(1):73-77.
• [29]Meyerowitz B, Desmond K, Rowland J, Wyatt G, Ganz P: Sexuality following breast cancer. 1999, 25:237-250. [Journal of Sex and Marital Therapy]
• [30]Juraskova I, Butow P, Bonner C, Robertson R, Sharpe L: Sexual adjustment following early stage cervical and endometrial cancer: prospective controlled multi-centre study. Psycho Oncol 2013, 22(1):153-159.
• [31]Daniel A, Haddovv S: Erectile dysfunction after prostate cancer. Clinical Advisor 2011, 14(3):64-68.
• [32]Jankowska M: Sexual functioning of testicular cancer survivors and their partners: a review of the literature. Rep Pract Oncol Radiother 2012, 17:54-62.
• [33]Higano CS: Sexuality and intimacy after definitive treatment and subsequent androgen deprivation therapy for prostate cancer. J Clin Oncol 2012, 30(30):3720-3725.
• [34]Sanders S, Pedro LW, Bantum E, Galbraith M: Couples surviving prostate cancer: long-term intimacy needs and concerns following treatment. Clin J Oncol Nurs 2006, 10(4):503-508.
• [35]Arrington MI: Prostate cancer and the social construction of masculine sexual identity. Int J Mens Health 2008, 7(3):299-306.
• [36]Galbraith ME, Arechiga A, Ramirez J, Pedro LW: Prostate cancer survivors’ and partners’ self-reports of health-related quality of life, treatment symptoms, and marital satisfaction 2.5-5.5 years after treatment. Oncol Nurs Forum 2005, 32(2):E30-E41.
• [37]Navon L, Morag M: Advanced prostate cancer patients’ ways of coping with the hormone therapy’s affect on body, sexuality, and spousal ties. Qual Health Res 2003, 13:1378-1391.
• [38]Bokhour BG, Clark JA, Inui TS, Silliman RA, Talcott JA: Sexuality after treatment for early prostate cancer: exploring the meanings of “erectile dysfunction”. J Gen Intern Med 2001, 16:649-655.
• [39]Badr H, Carmack Taylor CL: Sexual dysfunction and spousal communication in couples coping with prostate cancer. Psycho Oncol 2009, 18(7):735-746.
• [40]Dahn JR, Penedo FJ, Gonzalez JS, Esquiabro M, Antoni MH, Roos BA, Schneiderman N: Sexual functioning and quality of life after prostate cancer treatment: considering sexual desire. Urology 2004, 63(2):273-277.
• [41]Carpentier MY, Fortenberry JD: Romantic and sexual relationships, body image, and fertility in adolescent and young adult testicular cancer survivors: a review of the literature. J Adolesc Health 2010, 47(2):115-125.
• [42]Tuinman MA, Hoekstra HJ, Vidrine DJ, Gritz ER, Sleijfer DT, Fleer J, Hoekstra-Weebers J: Sexual function, depressive symptoms and marital status in nonseminoma testicular cancer patients: a longitudinal study. Psycho Oncol 2010, 19(3):238-247.
• [43]Gurevich M, Bishop S, Bower J, Malka M, Nyhof-Young J: (Dis)embodying gender and sexuality in testicular cancer. Soc Sci Med 2004, 58(9):1597-1607.
• [44]Rossen P, Pedersen AF, Zachariae R, von der Maase H: Sexuality and body image in long-term survivors of testicular cancer. Eur J Cancer 2012, 48(4):571-578.
• [45]Tsay-Yi A, Zauszniewski JA, King TM: Demographics, cancer-related factors, and sexual function in rectal cancer patients in taiwan: preliminary findings. Cancer Nurs 2012, 35(5):E17-E22.
• [46]Panjari M, Bell RJ, Burney S, Bell S, McMurrick PJ, Davis SR: Sexual function, incontinence, and wellbeing in women after rectal cancer—a review of the evidence. J Sex Med 2012, 9(11):2749-2758.
• [47]Milbury K, Cohen L, Jenkins R, Skibber JM, Schover LR: The association between psychosocial and medical factors with long-term sexual dysfunction after treatment for colorectal cancer. Support Care Cancer 2013, 21(3):793-802.
• [48]Traa MJ, De Vries J, Roukema JA, Den Oudsten BL: Sexual (dys)function and the quality of sexual life in patients with colorectal cancer: a systematic review. Ann Oncol 2012, 23(1):19-27.
• [49]Donovan KA, Thompson LM, Hoffe SM: Sexual function in colorectal cancer survivors. Cancer Control 2010, 17(1):44-51.
• [50]van der Horst-Schrivers ANA, Ieperen EV, Wymenga ANM, Boezen HM, Weijmar-Schultz W, Kema IP, Meijer WG, Herder WWD, Willemse PHB, Links TP, De Vries E: Sexual function in patients with metastatic midgut carcinoid tumours. Neuroendocrinology 2009, 89(2):231-236.
• [51]Low C, Fullarton M, Parkinson E, O’Brien K, Jackson SR, Lowe D, Rogers SN: Issues of intimacy and sexual dysfunction following major head and neck cancer treatment. Oral Oncol 2009, 45(10):898-903.
• [52]Monga U, Tan G, Ostermann HJ, Monga TN: Sexuality in head and neck cancer patients. Arch Phys Med Rehabil 1997, 78(3):298-304.
• [53]Salem HK: Radical cystectomy with preservation of sexual function and fertility in patients with transitional cell carcinoma of the bladder: new technique. Int J Urol 2007, 14:294-298.
• [54]Jonker-Pool G, Hoekstra HJ, van Imhoff GW, Sonneveld DJA, Sleijfer DT, van Driel MF, Koops HS, van de Wiel HBM: Male sexuality after cancer treatment-needs for information and support: testicular cancer compared to malignant lymphoma. Patient Educ Couns 2004, 52(2):143-150.
• [55]Jarden M, Schjodt I, Thygesen KH: The impact of hematopoietic stem cell transplantation on sexuality: a systematic review of the literature. Bone Marrow Transplant 2012, 47:716+.
• [56]Shell JA, Carolan M, Zhang Y, Meneses KD: The longitudinal effects of cancer treatment on sexuality in individuals with lung cancer. Oncol Nurs Forum 2008, 35(1):73-79.
• [57]Galbraith ME, Crighton F: Alterations of sexual function in men with cancer. Semin Oncol Nurs 2008, 24(2):102-114.
• [58]Greenfield DM, Walters SJ, Coleman RE, Hancock BW, Snowden JA, Shalet SM, DeRogatis LR, Ross RJM: Quality of life, self-esteem, fatigue, and sexual function in young men after cancer: a controlled cross-sectional study. Cancer 2010, 116(6):1592-1601.
• [59]Bober SL, Zhou ES, Chen B, Manley PE, Kenney LB, Recklitis CJ: Sexual function in childhood cancer survivors: a report from project REACH. J Sex Med 2013, 10(8):2084-2093.
• [60]Zebrack BJ, Foley S, Wittmann D, Leonard M: Sexual functioning in young adult survivors of childhood cancer. Psycho Oncol 2010, 19(8):814-822.
• [61]Frumovitz M, Sun CC, Schover LR, Munsell MF, Jhingran A, Wharton JT, Eifel P, Bevers TB, Levenback CF, Gershenson DM, Bodurka DC: Quality of life and sexual functioning in cervical cancer survivors. J Clin Oncol 2005, 23(30):7428-7436.
• [62]Punnen S, Cowan JE, Dunn LB, Shumay DM, Carroll PR, Cooperberg MR: A longitudinal study of anxiety, depression and distress as predictors of sexual and urinary quality of life in men with prostate cancer. BJU Int 2013, 112(2):E67-E75.
• [63]Namiki S, Ishidoya S, Nakagawa H, Ito A, Kaiho Y, Tochigi T, Takegami M, Arai Y: The relationships between preoperative sexual desire and quality of life following radical prostatectomy: a 5-year follow-Up study. J Sex Med 2012, 9(9):2448-2456.
• [64]Kimura M, Bañez LL, Schroeck FR, Gerber L, Qi J, Satoh T, Baba S, Robertson CN, Walther PJ, Donatucci CF, Moul JW, Polascik TJ: Factors predicting early and late phase decline of sexual health-related quality of life following radical prostatectomy. J Sex Med 2011, 8(10):2935-2943.
• [65]Kiserud CE, Schover LR, Dahl AA, Fosså A, Bjøro T, Loge JH, Holte H, Yuan Y, Fosså SD: Do male lymphoma survivors have impaired sexual function? J Clin Oncol 2009, 27(35):6019-6026.
• [66]Arden-Close E, Eiser C, Pacey A: Sexual functioning in male survivors of lymphoma: a systematic review (CME). J Sex Med 2011, 8(7):1833-1840.
• [67]Kim KR, Chung HC, Lee E, Kim SJ, Namkoong K: Body image, sexual function and depression in Korean patients with breast cancer: modification by 5-HTT polymorphism. Support Care Cancer 2012, 20(9):2177-2182.
• [68]Den Oudsten BL, Van Heck GL, Van der Steeg AFW, Roukema JA, De Vries J: Clinical factors are not the best predictors of quality of sexual life and sexual functioning in women with early stage breast cancer. In Psycho-Oncology. Volume 19. US: John Wiley & Sons; 2010::646-656.
• [69]Greimel ER, Winter R, Kapp KS, Haas J: Quality of life and sexual functioning after cervical cancer treatment: a long-term follow-up study. Psycho Oncol 2009, 18(5):476-482.
• [70]Fernandes W, Kimura M: Health related quality of life of women with cervical cancer. Rev Lat-Am Enferm 2010, 18(3):360-367.
• [71]Matthews AK, Aikens JE, Helmrich SP, Anderson DD, Herbst AL, Waggoner SE: Sexual functioning and mood among long-term survivors of clear-cell adenocarcinoma of the vagina or cervix. J Psychosoc Oncol 2000, 17(3–4):27-45.
• [72]Rouanne M, Massard C, Hollebecque A, Rousseau V, Varga A, Gazzah A, Neuzillet Y, Lebret T, Soria J-C: Evaluation of sexuality, health-related quality-of-life and depression in advanced cancer patients: a prospective study in a Phase I clinical trial unit of predominantly targeted anticancer drugs. Eur J Cancer 2013, 49(2):431-438.
• [73]Biglia N, Moggio G, Peano E, Sgandurra P, Ponzone R, Nappi RE, Sismondi P: Effects of surgical and adjuvant therapies for breast cancer on sexuality, cognitive functions, and body weight. J Sex Med 2010, 7(5):1891-1900.
• [74]Orsini RG, Thong MSY, van de Poll-Franse LV, Slooter GD, Nieuwenhuijzen GAP, Rutten HJT, de Hingh IHJT: Quality of life of older rectal cancer patients is not impaired by a permanent stoma. Eur J Surg Oncol 2013, 39(2):164-170.
• [75]Grant M, McMullen CK, Altschuler A, Mohler MJ, Hornbrook MC, Herrinton LJ, Wendel CS, Baldwin CM, Krouse RS: Gender differences in quality of life among long-term colorectal cancer survivors with ostomies. Oncol Nurs Forum 2011, 38(5):587-596.
• [76]Zeng YC, Li D, Loke AY: Life after cervical cancer: quality of life among chinese women. Nurs Health Sci 2011, 13(3):296-302.
• [77]Jenkins R, Schover LR, Fouladi RT, Warneke C, Neese L, Klein EA, Zippe C, Kupelian P: Sexuality and health-related quality of life after prostate cancer in African-American and white men treated for localized disease. J Sex Marital Ther 2004, 30(2):79-93.
• [78]Manganiello A, Hoga LAK, Reberte LM, Miranda CM, Rocha CAM: Sexuality and quality of life of breast cancer patients post mastectomy. Eur J Oncol Nurs 2011, 15(2):167-172.
• [79]Traa MJ, Orsini RG, Oudsten BLD, Vries JD, Roukema JA, Bosman SJ, Dudink RL, Rutten HJT: Measuring the health-related quality of life and sexual functioning of patients with rectal cancer: Does type of treatment matter? Int J Cancer 2014, 134(4):979-987.
• [80]Kleinplatz PJ (Ed): New directions in sex therapy: Innovations and alternatives. 2nd edition. Philadelphia, PA, US: Brunner-Routledge; 2012.
• [81]Alder J, Zanetti R, Wight E, Urech C, Fink N, Bitzer J: Sexual dysfunction after premenopausal stage I and II breast cancer: Do androgens play a role? J Sex Med 2008, 5:1898-1906.
• [82]Hawkins Y, Ussher JM, Gilbert E, Perz J, Sandoval M, Sundquist K: Changes in sexuality and intimacy after the diagnosis of cancer. The experience of partners in a sexual relationship with a person with cancer. Cancer Nurs 2009, 34(4):271-280.
• [83]Gilbert E, Ussher JM, Perz J: Renegotiating sexuality and intimacy in the context of cancer: the experiences of carers. Arch Sex Behav 2010, 39(4):998-1009.
• [84]Aerts L, Enzlin P, Vergote I, Verhaeghe J, Poppe W, Amant F: Sexual, psychological, and relational functioning in women after surgical treatment for vulvar malignancy: a literature review. J Sex Med 2012, 9(2):361-371.
• [85]Manne S, Ostroff J, Norton T, Fox K, Goldstein L, Grana G: Cancer-related relationship communication in couples with early stage breast cancer. Psycho Oncol 2006, 15(3):234-247.
• [86]Badr H, Acitelli L, Carmack Taylor CL: Does talking about their relationship affect couples’ marital and psychological adjustment to lung cancer? J Cancer Surviv 2008, 2(1):53-64.
• [87]Zunkel G: Relational coping processes: couples’ response to a diagnosis of early stage breast cancer. J Psychosoc Oncol 2002, 20(4):39-55.
• [88]Kayser K, Watson LE, Andrade JT: Cancer as a “we-disease”: examining the process of coping from a relational perspective. Fam Syst Health 2007, 25(4):404-418.
• [89]Manne S, Ostroff J, Winkel G, Goldstein L, Fox K, Grana G: Posttraumatic growth after breast cancer: patient, partner, and couple perspectives. Psychosom Med 2004, 66(3):442-454.
• [90]Kuijer RG, Ybema JF, Buunk BP, de Jong GM, Thijs-boer F, Sanderman R: Active engagement, protective buffering and overprotection: three ways of giving support by intimate partners of patients with cancer. J Soc Clin Psychol 2000, 19(2):256-275.
• [91]Badr H, Carmack Taylor CL: Social constraints and spousal communication in lung cancer. Psycho Oncol 2006, 15(8):673-683.
• [92]Jack DC: Silencing the self: Women and depression. Cambridge MA: Harvard University Press; 1991.
• [93]Carr JG, Gilroy FD, Sherman MF: Silencing the self and depression among women. Psychol Women Q 1996, 20:375-392.
• [94]Cowan G, Bommersbach M, Curtis S: Codependency, loss of self and power. Psychol Women Q 1995, 19:221-236.
• [95]Jack DC, Dill D: The silencing the self scale: schemas of intimacy with depression in women. Psychol Women Q 1992, 16:97-106.
• [96]Whiffen VE, Foot ML, Thompson JM: Self-silencing mediates the link between marital conflict and depression. J Soc Pers Relat 2007, 24(6):993-1006.
• [97]Cramer KM, Thoms N: Factor structure of the silencing the self scale in women and men. pers Indiv Differ 2003, 35:525-535.
• [98]Ussher JM, Perz J: Gender differences in self-silencing and psychological distress in informal cancer carers. Psychol Women Q 2010, 34(2):228-242.
• [99]Remen AL, Chambless DL, Rodebaugh TL: Gender differences in the construct validity of the silencing the self scale. Psychol Women Q 2002, 26:151-159.
• [100]Duarte LM, Thompson JM: Sex-differences in self-silencing. Psychol Rep 1999, 85:145-161.
• [101]Reichers EA: Including partners into the diagnosis of prostate cancer: a review of the literature to provide a model of care. Urol Nurs 2004, 24(1):22-38.
• [102]Harden J, Schafenacker A, Northouse L, Mood D, Pienta K, Hussain M, Baranowski K: Couples’ experience with prostate cancer: a focus group. Oncol Nurs Forum 2002, 29(4):701-709.
• [103]O'Shaughnessy PK, Ireland C, Pelentsov LT, Laws A, Esterman AJ: Impaired sexual function and prostate cancer: a mixed method investigation into the experiences of men and their partners. J Clin Nurs 2013, 22(23-24):3492-3502.
• [104]Maltaris T, Weigel M, Dittrich R: Cancer and fertility preservation in females: where we stand and where we are heading. Exp Rev Endocrinol Metab 2009, 4(1):79-89.
• [105]Soothill K, Morris SM, Thomas C, Harman JC, Francis B, McIllmurray MB: The universal, situational, and personal needs of cancer patients and their main carers. Eur J Oncol Nurs 2003, 7(1):5-16.
• [106]Maughan K, Heyman B, Matthews M: In the shadow of risk: how men cope with a partners gynaecological cancer. Int J Nurs Stud 2002, 39:27-34.
• [107]Gilbert E, Ussher JM, Hawkins Y: Accounts of disruptions to sexuality following cancer: the perspective of informal carers who are partners of a person with cancer. Health 2009, 13(5):523-541.
• [108]Hannah P, Adams D, Lee A, Glover V: Links between early post-partum mood and post-natal depression. Br J Psychiatry Suppl 1992, 160:777-780.
• [109]Yiou R, Ebrahiminia V, Mouracade P, Lingombet O, Abbou C: Sexual quality of life in women partnered with men using intracavernous alprostadil injections after radical prostatectomy. J Sex Med 2013, 10(5):1355-1362.
• [110]Perz J, Ussher JM, Gilbert E: Constructions of sex and intimacy after cancer: Q methodology study of people with cancer, their partners, and health professionals. BMC Cancer 2013, 13:270. BioMed Central Full Text
• [111]Gilbert E, Ussher JM, Perz J: Embodying sexual subjectivity after cancer: A qualitative study of people with cancer and intimate partners. Psychol Health 2013, 28(6):603-619.
• [112]Gilbert E, Ussher JM, Perz J, Wong WKT, Hobbs K, Mason C: Men’s experiences of sexuality after cancer: a material discursive intra-psychic approach. Cult Health Sex 2013, 15(8):881-895.
• [113]Ussher JM, Perz J, Gilbert E, Wong WKT, Hobbs K: Renegotiating sex after cancer: resisting the coital imperative. Cancer Nurs 2013, 36(6):454-462.
• [114]Ussher JM, Perz J, Gilbert E: Women’s sexuality after cancer: a qualitative analysis of sexual changes and renegotiation. Women Therin press
• [115]Keller A, McGarvey EL, Clayton AH: Reliability and construct validity of the changes in sexual functioning questionnaire short-form (CSFQ-14). J Sex Marital Ther 2006, 32(1):43-52.
• [116]Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand 1983, 67(6):361-370.
• [117]Bjelland I, Dahl AA, Haug TT, Neckelmann D: The validity of the hospital anxiety and depression scale. An updated literature review. J Psychosom Res 2002, 52:69-77.
• [118]Ware JEJ, Kosinski M, Keller SD: A 12-item short-form health survey. Med Care 1996, 24:220-233.
• [119]Resnick B, Partker R: Simplified scoring and psychometrics of the revised 12-item Short-Form Health Survey. Outcomes Manag Nurs Pract 2001, 5(4):161-166.
• [120]Sabourin S, Valois P, Lussier Y: Development and validation of a brief version of the dyadic adjustment scale with a nonparametric item analysis model. Psychol Assess 2005, 17(1):15-27.
• [121]Sharpley CF, Rogers HJ: Preliminary validation of the abbreviated spanier dyadic adjustment scale: some psychometric data regarding a screening test of marital adjustment. Educ Psychol Meas 1984, 44(4):1045-1049.
• [122]Catania J: Dyadic sexual communication scale. In Handbook of Sexuality-Related Measures. Edited by Davis M. London: Sage; 1998.
• [123]Tabachnick BG, Fidell LS: Using Multivariate Statistics. Boston: Pearson; 2013.
• [124]Hordern AJ, Street AF: Communicating about patient sexuality and intimacy after cancer: mismatched expectations and unmet needs. Med J Aust 2007, 186(5):224-227.
• [125]Miles C, Candy B, Jones L, Williams R, Tookman A, King M: Interventions for sexual dysfunction following treatments for cancer. Cochrane Database Syst Rev 2007, 4:CD005540.
• [126]Rivers BM, August EM, Gwede CK, Hart A, Donovan KA, Pow-Sang JM, Quinn GP: Psychosocial issues related to sexual functioning among African-American prostate cancer survivors and their spouses. Psycho Oncol 2011, 20(1):106-110.
• [127]Mercadante S, Vitrano V, Catania V: Sexual issues in early and late stage cancer: a review. Support Care Cancer 2010, 18(6):659-665.
• [128]Perez MA, Skinner EC, Meyerowtiz BE: Sexuality and intimacy following radical prostatectomy: patient and partner perspectives. Health Psychol 2002, 21(3):288-293.
• [129]Ussher JM, Perz J, Gilbert E: The experience and construction of changes to women’s sexuality after breast cancer. In The essential handbook of women’s sexuality, vol 2. Edited by Castaneda D. Santa Barbara: Praeger; 2013:171-196.
• [130]Koch PB, Mansfield PK: Women’s sexuality as they age: the more things change, the more they stay the same. Siecus Report 2001, 30(2):5-9.
• [131]DeLamater JD, Sill M: Sexual desire in later life. J Sex Res 2005, 42(2):138-149.
• [132]Gott M, Hinchliff S: How important is sex in later life? the views of older people. Soc Sci Med 2003, 56(8):1617-1628.
• [133]Loe M: Sex and the senior woman: pleasure and danger in the viagra era. Sexualities 2004, 7(3):303-326.
• [134]Watters Y, Boyd TV: Sexuality in later life: opportunity for reflections for healthcare providers. Sex Relat Ther 2009, 24(3–4):307-315.
• [135]Ussher JM, Perz J, Gilbert E, Wong WKT, Mason C, Hobbs K, Kirsten L: Talking about sex after cancer: a discourse analytic study of health care professional accounts of sexual communication with patients. Psychol Health 2013, 28(12):1370-1390.
• [136]Kennedy SH, Dickens SE, Eisfeld BS, Bagby RM: Sexual dysfunction before antidepressant therapy in major depression. J Affect Disord 1999, 56(2–3):201-208.
• [137]Laurent SM, Simons AD: Sexual dysfunction in depression and anxiety: conceptualizing sexual dysfunction as part of an internalizing dimension. Clin Psychol Rev 2009, 29(7):573-585.
• [138]Hartmann U: Depression and sexual dysfunction. J Mens Health Gend 2007, 4(1):18-25.
• [139]Australian Institute of Health and Welfare: Australia’s Health 2012. In vol. Australia’s Health series no.13. Cat. no. AUS 156. Canberra: AIHW; 2012.
• [140]Trudel G, Goldfarb MR: Marital and sexual functioning and dysfunctioning, depression and anxiety. Sexologies 2010, 19(3):137-142.
• [141]Goldfarb MR, Trudel G, Boyer R, Préville M: Marital relationship and psychological distress: its correlates and treatments. Sex Relat Ther 2007, 22(1):109-126.
• [142]Manne S, Badr H: Intimacy processes and psychological distress among couples coping with head and neck or lung cancers. 2010, 19:941-954. [Psycho-Oncology]
• [143]Lindau ST, Surawska H, Paice J, Baron SR: Communication about sexuality and intimacy in couples affected by lung cancer and their clinical-care providers. Psycho Oncol 2011, 20(2):179-185.
• [144]Ptacek JT, Ptacek JJ, Dodge KL: Coping with breast cancer from the perspectives of husbands and wives. J Psychosoc Oncol 1994, 12(3):47-72.
• [145]Ussher JM, Wong WKT, Perz J: A qualitative analysis of changes in relationship dynamics and roles between people with cancer and their primary informal carer. 2011, 15:650-667. [Health: An Interdisciplinary Journal]
• [146]Kayser K, Sormanti M, Strainchamps E: Women coping with cancer. Psychol Women Q 1999, 23(4):725-739.
• [147]Regan TW, Lambert SD, Girgis A, Kelly B, Kayser K, Turner J: Do couple-based interventions make a difference for couples affected by cancer?: a systematic review. BMC Cancer 2012, 12(1):279-292. BioMed Central Full Text
• [148]Emmers-Sommer T, Nebel S, Allison M-L, Cannella M, Cartmill D, Ewing S, Horvath D, Osborne J, Wojtaszek B: Patient–provider communication about sexual health: the relationship with gender, age, gender-stereotypical beliefs, and perceptions of communication inappropriateness. Sex Roles 2009, 60(9–10):669-681.
• [149]Gottman JM, Krokoff LJ: Marital interaction and satisfaction: a longitudinal view. J Consult Clin Psychol 1989, 57(1):47-52.
• [150]Jordan JV: The meaning of mutuality. In Women’s Growth in Connection: Writings from the Stone Center. Edited by Kaplan AG, Miller JB, Stiver IP, Surrey JL. New York: Guilford; 1991:81-96.
• [151]Kaplan A: The “self-in-relation”: implications for depression in women. Psychotherapy 1986, 23:234-242.
• [152]Gratch LB, Bassett ME, Attra SL: The relationship of gender and ethnicity to self silencing and depression among college students. Psychol Women Q 1995, 19:509-519.
• [153]Jensen PT: Gynaecological cancer and sexual functioning: Does treatment modality have an impact? Sexologies 2007, 16:279-285.
• [154]Ussher JM, Perz J, Gilbert E: Information needs associated with changes to sexual well-being after breast cancer. J Adv Nurs 2013, 69(3):327-337.
• [155]Schover LR, Fouladi RT, Warneke CL, Neese L, Klein EA, Zippe C, Kupelian PA: Defining sexual outcomes after treatment for localized prostate carcinoma. Cancer 2002, 95(8):1773-1785.
• [156]Canada AL, Neese LE, Sui D, Schover LR: Pilot intervention to enhance sexual rehabilitation for couples after treatment for localized prostate carcinoma. Cancer 2005, 104(12):2689-2700.
• [157]Schover LR, Jenkins R, Sui D, Adams JH, Marion MS, Jackson KE: Randomized trial of peer counseling on reproductive health in African American breast cancer survivors. J Clin Oncol 2006, 24(10):1620-1626.
• [158]Latini DM, Hart SL, Coon DW, Knight SJ: Sexual rehabilitation after localized prostate cancer: current interventions and future directions. Cancer J 2009, 15:34-40.
• [159]Hordern AJ, Currow DC: A patient-centred approach to sexuality in the face of life-limiting illness. Med J Aust 2003, 179:s8-s11.
• [160]Brandenburg U, Bitzer J: The challenge of talking about sex: the importance of patient–physician interaction. Maturitas 2009, 63(2):124-127.
• [161]Hughes MK: Sexuality and the cancer survivor. A silent coexistence. Cancer Nurs 2000, 23(6):477-482.
• [162]Katz A: Do ask, do tell: why do so many nurses avoid the topic of sexuality? Am J Nurs 2005, 105(7):66-68.
• [163]Annon JS: PLISSIT therapy. In Handbook of Innovative Psychotherapies. Edited by Corsine RJ. New York: Wiley and Sons; 1981:629-639.
• [164]Breast cancer and sexual wellbeing information booklet http://www.bcna.org.au/sites/default/files/bcn_sexual_wellbeing_brochure_v.2.pdf webcite
• [165]Sexuality, intimacy and cancer: a self-help guide for people with cancer and their partner http://www.uws.edu.au/__data/assets/pdf_file/0010/353494/Cancer_sex_no_trims.pdf webcite