Survivors of endometrial cancer: who is at risk for sexual dysfunction?

Our goal was to determine the prevalence of sexual dysfunction and identify risk factors associated with sexual morbidity in patients with early stage endometrial cancer.

This prospective trial included patients with stage I-IIIa endometrial cancer, without evidence of disease, and one to five years out from primary surgical treatment. Patients who received chemotherapy were excluded. The Female Sexual Function Index (FSFI) was used to measure our primary endpoint of sexual function. Other patient reported outcome indices included: Functional Assessment of Cancer Therapy-Endometrial (FACT-En), Center for Epidemiology Studies Depression scale (CES-D), and Menopausal Rating Scale (MRS).

Of the 72 women treated for early stage endometrial cancer, 65% were married, 69% had a sexual partner, the mean age was 60, 86% had stage I disease, and 18% received radiation therapy. The median score for the FSFI was 16.6 (0-32.8; scores below 26 are diagnostic for sexual dysfunction). Eighty nine percent of the patients had a score below 26. There was a moderate correlation between the total FSFI score and FACT-En scores but not with CES-D or MRS. Histologic grade, relationship status, mental health, and diabetes significantly correlated with total FSFI scores in multivariate analysis.

This patient population commonly thought to be at low risk actually suffers from severe sexual dysfunction. The four risk factors revealed by multivariate analysis need to be studied in greater detail in order to appropriately target patients and develop meaningful interventions.