Sexual (dys-)function in female childhood cancer survivors

Since advances in treatment increased survival rates of children with cancer,
more attention is drawn to long term effects of treatment and quality of life
after cancer. Sexuality is an important determinant of experienced quality of
life. Cancer and its treatment can cause damage to one of the physiological
systems required for a normal sexual response including hormonal, vascular
neurological and psychological elements of sexual function.1 In addition
treatment of cancer during childhood and adolescence may put the patient at
risk for an impaired psychosexual development with a negative impact on issues
needed for a normal sexual function like self-image, sexual identity and
psychosocial competences. Studies assessing sexuality in adult childhood cancer
survivors are scarce in men but even more so in women. One study among 31
Finnish female childhood leukemia survivors found that sexual behaviour of the
surviving women did not differ from apparent sexual functioning of the
controls. Their inner sexuality however was more restrictive and less
positive.2 Van Dijk et al. described a subjective limitation in sexual life due
to the illness in 20% of 60 Dutch childhood cancer survivors of both sexes.
Treatment in adolescence was a risk factor for a delay in psychosexual
development. 3 In a survey among 217 American young cancer survivors 57%
indicated that they had a desire for counseling related to sexuality or
intimacy. In 82% this need was not met during treatment and afterwards.4 These
data highlight the need to study sexuality in a large cohort of (female)
childhood cancer survivors in order to gain more insight into the extend of the
problem and the effects of different types of treatment and different ages of
treatment on sexual function. With this information proper counseling and
secondary prevention can be offered to future patients and survivors.
References
1. Schover RS. Sexuality and fertility after cancer. Hematology Am Soc Hematol
Educ Program 2005:523-7.
2. Puukko L, Hirvonen E, Aalberg V et al. Sexuality of young women surviving
leukaemia. Arch Dis Child 1997;76:197-202.
3. Van Dijk EM, van Dulmen-den Broeder E, Kaspers GJL et al. Psychosexual
functioning of childhood cancer survivors. Psycho-oncology 2007.
4. Zebrack B. Information and service needs for young adult cancer patients.
Support Care Cancer 2008;16:1353-1360.

Objectives
1. To assess the prevalence of sexual dysfunction in a Dutch cohort of female
childhood cancer survivors.
2. To assess the disease-associated risk factors for sexual dysfunction (type
of treatment, age at treatment) in female childhood cancer survivors.

Methods
Study groups:
- Survivor group
All female 5-year survivors of childhood cancer above the age of 18 years
treated in the University Medical Center St. Radboud Nijmegen, the Netherlands,
between 1965 and 2003 and who participate in VEVO, a study of fertility and
endocrine function among Dutch female childhood cancer survivors (n= about
250).
- Control group
An age-matched control group of female siblings of the survivors.
Exclusion criteria:
- Being unable to read and write
- Not being familiar with the Dutch language
- Mental retardation
For the VEVO-study female survivors and their female siblings are asked to fill
in a questionnaire and to visit the hospital for a physical examination and a
blood sample. We will ask these women for this research project to fill in an
additional validated questionnaire; the Female Sexual Function Index, assessing
the following items: sexual desire, arousal, lubrication, orgasm, satisfaction,
relationship and pain or other discomfort during sexual activity. Data
concerning type of cancer, treatment and age at diagnosis as well as current
ovarian function will be extracted from the medical records and from the
VEVO-database. Sexual function according to the FSFI of the surviving women
will be compared with sexual function of the control group and will be related
to disease dependent factors.

10 minutes to read the information about the study and the informed consent.
10 minutes to fill in the FSFI.