Abstract
Background & Research Aim: Pelvic radiotherapy creates both physical effects and psychological responses that negatively affect the sexual health of women and their partners. However, the clinical assessment and management of female sexual difficulties does not receive equivalent professional focus as that of male sexual dysfunction after cancer treatment. The overall aim of this study was to explore the factors that influence the clinical assessment of treatment-induced female sexual difficulties within routine medical follow-up. The purpose of this exploration was to identify the key components of a clinical assessment methodology that could be developed to improve the evaluation of psychosexual morbidity associated with radiotherapy for women with pelvic malignancy. Methodology: This focused ethnography used participant observation of follow-up clinics (n = 69) and in-depth interviews (n = 49) with women, partners and health professionals to collect data. Observation data were analysed using SPSS and interview transcripts subjected to thematic analysis using NVIVO. Findings: Psychosocial issues were discussed in only 42% of consultations, suggesting that these elements of women’s recovery may not be considered a priority in oncology follow-up practice. Vaginal toxicity (42%) was discussed less frequently than bowel (81%) or bladder (70%) toxicity and sexual issues were discussed in only 25% of consultations. Interview data revealed unmet need in relation to women and couple’s sexual recovery including a lack of knowledge and distress caused by fear of resuming sex, loss of sexual desire, dyspareunia, altered orgasm and reduced sexual satisfaction. Partners felt marginal to what was happening to the women in their lives and were not actively engaged in the follow-up process. Oncology follow-up was considered an inappropriate context for the assessment and management of female sexual morbidity because of the priority to detect disease recurrence and manage acute side effects. Conclusion: Assessment and management of sexual difficulties in women following pelvic radiotherapy remains a neglected aspect of rehabilitation after cancer and will require developments at both an individual practitioner and organisational level if care is to be improved.