Ovarian cancer is the most lethal form of gynecologic cancer. For the 750,000 US women at significantly high risk for ovarian cancer due to either BRCA1 or BRCA2 mutation or family history, the standard recommendation is to undergo prophylactic bilateral salpingo-oophorectomy (PBSO) after age 35 or after completion of childbearing. Although surgical removal of ovaries dramatically reduces risk of ovarian cancer, this potentially life-saving surgery also causes sudden, premature menopause and women are often left with severe and distressing sexual problems. Common sexual side effects include severe vaginal dryness, pain with sexual activity and loss of desire. Sexual dysfunction due to surgical menopause has been related to a sense of lowered self-efficacy and powerlessness, factors that are also linked to anxiety, depression and lower quality of life. Despite the fact that these profound sexual side effects are long lasting and decrease quality of life, sexual health interventions have not yet been developed for women after PBSO. This study will develop and test the first psychoeducational intervention for managing sexual dysfunction in women after PBSO. We hypothesize that sexual dysfunction can be improved by providing a state-of-the-art sexual health intervention that brings together cognitive-behavioral therapy (CBT) and educational innovations in treating sexual dysfunction. Components of the intervention include targeted sexual health education for managing sexual problems such as vaginal dryness, CBT strategies for recognizing and coping with automatic negative thoughts, strategies for increasing self-efficacy and developing an individualized action plan. Using a multi- modal approach that combines a group psychoeducational session with tailored telephone counseling, the intervention offers women the combination of education, group support and individualized behavioral counseling that is brief, flexible, easily accessible and easy to replicate and disseminate to other settings.
The aims of this pilot study are to assess the intervention's acceptability and feasibility, and investigate the intervention's impact on sexual function, sexual health knowledge, and self-efficacy to manage sexual dysfunction at 2 months post-intervention. This intervention has the potential to make a significant and lasting impact on the lives of high-risk women who are affected every day by the distressing and disruptive sexual side effects caused by PBSO, and the study findings will lead directly to development of a full-scale randomized controlled trial to test the efficacy of the intervention. Results from this study will also have broad implications for creating effective interventions for a wide range of women who suffer from sexual side effects after cancer treatment.

Public Health Relevance

Oophorectomy, the surgical removal of the ovaries, is a potentially life saving procedure for women at high risk of ovarian cancer-but it places these same women at risk for severe and distressing sexual dysfunction. By developing a brief, effective intervention to manage sexual symptoms, this study will ameliorate the negative impact of oophorectomy on the lives of these high-risk women, and help to encourage more women to consider prophylactic surgery to avoid ovarian cancer, the most lethal gynecological malignancy.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Small Research Grants (R03)
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Special Emphasis Panel (ZCA1-SRLB-Y (J1))
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Rowland, Julia
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Dana-Farber Cancer Institute
United States
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Bober, Sharon L; Recklitis, Christopher J; Michaud, Alexis L et al. (2018) Improvement in sexual function after ovarian cancer: Effects of sexual therapy and rehabilitation after treatment for ovarian cancer. Cancer 124:176-182
Bober, Sharon L; Recklitis, Christopher J; Bakan, Jennifer et al. (2015) Addressing sexual dysfunction after risk-reducing salpingo-oophorectomy: effects of a brief, psychosexual intervention. J Sex Med 12:189-97