Interventions for psychosexual dysfunction in women treated for gynaecological malignancy

 

Abstract

Background

Psychosexual dysfunction (sexual difficulties not directly due to physical factors) is known to be a common complication of treatment for gynaecological cancer. It has a considerable impact on quality of life (QoL) for the increasing number of women who are survivors of gynaecological cancer.

Objectives

To determine the effectiveness of interventions for psychosexual dysfunction in women who have been treated for gynaecological malignancy (cancer of uterine cervix, uterine corpus, ovary, vulva).

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL, up to October 2008), MEDLINE (1950 to October 2008), EMBASE (1982 to October 2008), CINAHL (1980 to October 2008) and PsycINFO (1806 to October 2008). We hand searched reference lists from eligible trials.

Selection criteria

We selected all randomized controlled trials (RCTs) of a medical or psychological intervention to prevent or treat psychosexual dysfunction in adult women previously treated for gynaecological cancer.

Data collection and analysis

We selected five studies for inclusion in this review and analysed any outcome data relating to resumption of sexual intercourse, DSM-IV diagnoses or validated scales of sexual functioning. Sensitivity analysis was performed where possible.

Main results

The review included data from 5 studies, comprising a total of 413 patients, examining 5 different interventions. One trial suggested a short-term benefit for the use of vaginal Dienoestrol in women after pelvic radiotherapy (NNT = 4). Another trial suggested a short-term benefit for one regime of low dose-rate brachytherapy over another but this modality is not in widespread use. Studies of a Clinical Nurse Specialist intervention, Psychoeducational Group Therapy and a Couple-Coping intervention, did not show any significant benefit. All the studies were of poor methodological quality.

Authors' conclusions

There is no convincing evidence to support the use of any interventions for psychosexual dysfunction in women treated for gynaecological cancer. There is a need for more studies of high methodological quality.

 

Plain language summary

Interventions for psychosexual dysfunction in women treated for gynaecological malignancy

This systematic review found very few good quality trials of interventions to treat or prevent psychosexual problems occurring in women after treatment for gynaecological cancer. They were mostly small studies and all examined different types of interventions. This review found only weak evidence to support the use of vaginal oestrogen, some low dose-rate brachytherapy regimes and a number of psychological interventions.

 

摘要

背景

接受婦科惡性腫瘤治療的女性之性心理性功能障礙治療

性心理性功能障礙 (非因生理因素直接引起的性功能障礙) 是婦科癌症治療常見的併發症。對於越來越多罹患婦科癌症後存活的女性之生活水準 (QoL) ，會造成可觀的影響。

目標

評估曾接受婦科惡性腫瘤 (子宮頸、子宮體、卵巢、陰戶癌) 治療的女性，對於其性心理性功能障礙進行治療干預的功效。

搜尋策略

我們搜尋了Cochrane Central Register of Controlled Trials (CENTRAL,直到2008年10月) 、MEDLINE (1950年到2008年10月) 、EMBASE (1982年到2008年10月) 、CINAHL (1980年到2008年10月) 及PsycINFO (1806年到2008年10月) 等資料庫。同時也從符合資格的試驗中，以人工方式搜尋參考文獻。

選擇標準

我們選擇所有利用一種醫療或心理之治療干預，來防止或治療之前曾接受婦科癌症治療女性之性心理性功能障礙的隨機對照試驗 (randomised controlled trials；RCTs) 。

資料收集與分析

在本篇回顧中，我們選擇了5項研究，並分析所有與「重新恢復性生活」、「精神疾病診斷與統計手冊第四版 (DSMIV) 之診斷」或「性功能實用量表」有關的結果。如有可能，也進行敏感度分析。

主要結論

本回顧包含5項研究的數據，總共包含413名病人，檢測5種不同的治療干預。其中一項試驗建議，病人接受骨盆放射療法後 (NNT = 4) ，於陰道使用Dienoestrol藥膏，具有短期的功效。另一項試驗建議，使用一種低劑量率的近接療法 (low doserate brachytherapy) 之短期效果，更甚於其他治療，但是這種治療形式並不普遍。一項「臨床專科護理師治療干預」、一項「心理教育分組治療」及一項「夫婦同時接受治療干預」的研究，並未證實這些治療方式有顯著的功效。所有文獻的方法學品質都不佳。

作者結論

從這些文獻中，並無令人信服的證據支持使用任何治療干預，治療接受婦科癌症治療之女性的性心理性功能障礙。還需要更多方法學(研究方法)品質高的研究。

翻譯人

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

接受婦科惡性腫瘤治療的女性之性心理性功能障礙治療。這篇系統性的回顧，只找到很少篇品質良好的試驗，研究女性接受婦科癌症治療後，治療或防止性心理性問題之治療干預。這些研究大多為小型研究，而且全都調查不同類型的治療方式。本回顧發現，只有微弱的證據支持使用陰道雌激素、某些低劑量率的近接療法和一些心理治療。