Prevalence and risk factors for sexual dysfunction in young women following a cancer diagnosis – a population-based study

Figures & data

Table 1. Socio-demographic characteristics of the women with cancer and the comparison group.

	Women with cancer (n = 694) n (%)	Comparison group (n = 493) n (%)	p Value
Age at survey, years
Mean (SD)^a	34.5 (4.9)	29.7 (6.1)	<.001
Country of birth
Sweden	579 (84)	422 (86)	.322
Outside Sweden	114 (17)	71 (14)
Highest Education^b
University degree	417 (60)	283 (58)	.401
No university degree^c	275 (40)	207 (42)
Occupation^b
Working/studying	530 (77)	440 (89)	<.001
Unemployed, sick-leave, other^d	162 (23)	52 (11)
Relationship status^b
Partnered	585 (85)	394 (81)	.071
Not partnered	106 (15)	95 (19)
Have children^b
Yes	473 (69)	230 (47)	<.001
No	214 (31)	261 (53)
Sexual orientation^b
Heterosexual	633 (93)	454 (93)	.726
Non-heterosexual^e	45 (7)	35 (7)

Numbers do not sum up to total due to missing data.

^aDifference tested by Student’s t-test.

^bDifferences tested by Chi-square test.

^cIncludes elementary school, upper secondary school, folk high school.

^dParental leave, retired.

^eNonheterosexual includes homosexual, bisexual, polysexual.

Table 2. Clinical characteristics of the women with cancer (n = 694).

	Breast	Cervical	CNS	Lymphoma	Ovarian	All women
	n = 349	n = 190	n = 66	n = 57	n = 32	n = 694
	No. (%)	No. (%)	No. (%)	No. (%)	No. (%)	No. (%)
Treatment intensity^a
Least intensive/extensive	11 (3)	128 (73.6)	5 (7.7)	3 (5.3)	16 (51.6)	163 (24)
Moderately intensive/extensive	73 (21)	7 (4.0)	44 (67.7)	17 (29.8)	10 (32.3)	151 (22)
Very intensive/extensive	256 (74)	37 (21.3)	15 (23.1)	33 (57.9)	4 (12.9)	345 (51)
Most intense/extensive	6 (2)	2 (1.1)	1 (1.5)	4 (7.0)	1 (3.2)	14 (2)
Type of treatment
Surgery	340 (97)	153 (80)	61 (92)	0	31 (97)	585 (84)
(Immuno-)^b Chemotherapy	305 (87)	39 (21)	13 (20)	55 (96)	10 (31)	422 (61)
Radiotherapy	260 (74)	36 (19)	12 (18)	23 (40)	0	331 (48)
Chemotherapy and radiotherapy	233 (67)	36 (19)	10 (15)	23 (40)	0	302 (43)
Endocrine treatment	217 (62)	0	0	0	0	217 (31)
Antibody treatment	98 (28)	1 (1)	0	0	2 (6)	101 (15)
Stem cell transplantation	0	0	0	1	0	1 (<1)

^aPatients classified according to an adapted version of the Intensity of Treatment Rating Scale (ITR) 3.0.

^bNine women treated for lymphoma received immunotherapy in addition to chemotherapy.

Numbers do not sum up to total due to missing data (n = 21).

Table 3. Differences in prevalence of sexual dysfunction^a between women with cancer and a comparison group.

Dysfunction related to domains	Brain tumor n (%)	Breast cancer n (%)	Cervical cancer n (%)	Lymphoma n (%)	Ovarian cancer n (%)	All diagnoses n (%)	Comparison group n (%)	OR (95% CI)	^Adjp Value
	n = 66	n = 349	n = 190	n = 57	n = 32	n = 694	n = 493
Satisfaction with Sex Life	9 (16)	71 (26)	33 (20)	6 (13)	9 (33)	128 (22)	51 (12)	1.93 (1.31–2.85)	.001
Interest in Sexual Activity	24 (37)	181 (53)	78 (41)	15 (27)	12 (38)	310 (45)	156 (32)	1.41 (1.08–1.84)	.012
Orgasm – Ability	12 (23)	103 (40)	50 (32)	11 (24)	8 (31)	184 (34)	117 (28)	1.44 (1.05–1.96)	.022
Orgasm – Pleasure	1 (2)	29 (11)	9 (6)	2 (5)	1 (4)	42 (8)	21 (5)	1.30 (0.72–2.36)	.387
Vaginal Lubrication	3 (6)	65 (24)	37 (23)	5 (11)	6 (22)	116 (21)	30 (7)	3.10 (1.96–4.91)	<.001
Vaginal Discomfort	3 (6)	52 (20)	39 (24)	4 (8)	4 (15)	102 (18)	35 (8)	3.02 (1.92–4.76)	<.001
Vulvar Discomfort-Clitoral	7 (13)	72 (26)	32 (20)	7 (15)	4 (17)	122 (22)	66 (16)	1.83 (1.26–2.76)	.002
Vulvar Discomfort-Labial	9 (17)	96 (36)	32(20)	14 (29)	6 (23)	157 (28)	80 (19)	1.55 (1.11–2.18)	.010
Dysfunction ≥ 1 domain^b	37 (56)	240 (69)	116 (61)	24 (42)	21 (66)	438 (63)	263 (53)	1.37 (1.06–1.78)	.017
Dysfunction ≥ 2 domains^b	9 (16)	110 (40)	54 (33)	9 (19)	9 (33)	191 (33)	77 (18)	1.97 (1.42–2.74)	<.001

CI: Confidence interval.

Valid percentages for women having had sexual activity (partner/solo sex) during the past 30 days.

Statistically significant (p < 0.05) differences in the logistic regression multivariable models indicated in bold; regression models adjusted for socio-demographics (age at study, education, relationship status, having children and country of birth).

^aSexual dysfunction defined as cut‐off = 1 SD above/below the t-score mean of the norm population.

^bBased on reports for the domains: Satisfaction with Sex Life, Interest in Sexual Activity, Orgasm – Ability, Orgasm – Pleasure, Vaginal Lubrication.

Table 4. Differences in prevalence of sexual dysfunction^a between women with reproductive cancers (breast, cervical, ovarian) and non-reproductive cancers (brain tumor, lymphoma) and a comparison group, respectively.

Dysfunction related to domains	Reproductive cancers n = 571 n (%)	Comparison group n = 493 n (%)	OR (95% CI)	Non-reproductive cancers n = 123 n (%)	Comparison group n = 493 n (%)	OR (95% CI)
Satisfaction with Sex Life	113 (24)	51 (12)	2.47 (1.62–3.77)	15 (15)	51 (12)	1.26 (0.67–2.38)
Interest in Sexual Activity	271 (48)	156 (32)	1.62 (1.22–2.16)	39 (32)	156 (32)	0.92 (0.59–1.43)
Orgasm – Ability	161 (36)	117 (28)	1.74 (1.24–2.44)	23 (23)	117 (28)	0.81 (0.48–1.36)
Orgasm – Pleasure	39 (9)	21 (5)	1.72 (0.91–3.28)	3 (3)	21 (5)	0.61 (0.17–2.16)
Vaginal Lubrication	108 (23)	30 (7)	4.25 (2.60–6.96)	8 (8)	30 (7)	1.18 (0.51–2.70)
Vaginal Discomfort	95 (21)	35 (8)	4.27 (2.60–7.01)	7 (7)	35 (8)	0.91 (0.39–2.15)
Vulvar Discomfort-Clitoral	108 (23)	66 (16)	2.43 (1.60–3.68)	14 (14)	66 (16)	0.92 (0.54–1.97)
Vulvar Discomfort-Labial	134 (29)	80 (19)	1.72 (1.19–2.46)	23 (22)	80 (19)	1.32 (0.77–2.25)
Dysfunction ≥1 domain^b	377 (66)	263 (53)	1.69 (1.27–2.24)	61 (50)	263 (53)	0.81 (0.54–1.22)
Dysfunction ≥2 domains^b	173 (37)	77 (18)	2.50 (1.76–3.54)	18 (18)	77 (18)	0.87 (0.54–1.69)

CI: Confidence interval.

Valid percentages for those women having had sexual activity (partner/solo sex) the past 30 days.

Statistically significant (p < 0.05) differences in the logistic regression multivariable models indicated in bold; regression models adjusted for socio-demographics (age at study, education, relationship status, having children and country of birth).

^aSexual dysfunction defined as cut‐off = 1 SD above/below the t-score mean of the norm population.

^bBased on reports for the domains: Satisfaction with Sex life, Interest in Sexual Activity, Orgasm – Ability, Orgasm – Pleasure, Vaginal Lubrication.

Table 5. Factors associated with sexual dysfunction in 5 domains among 694 women with cancer.

Factors	Satisfaction with Sex life		Interest in Sexual Activity		Orgasm – Ability		Orgasm – Pleasure		Vaginal Lubrication		≥2 domains above cutoff
	OR	95% CI	OR	95% CI	OR	95% CI	OR	95% CI	OR	95% CI	OR	95% CI
Age at study^a	1.07	1.02–1.14	1.04	1.00–1.08					1.06	1.01–1.11	1.08	1.03–1.13
Country of birth
Other vs. Sweden (ref)			1.35	0.85–2.12
Relationship status
No partner vs. partnered (ref)	2.23	1.16–4.27
Treatment intensity
Very/most vs. least/moderately (ref)	1.50	0.88–2.57	1.78	1.20–2.64					1.22	0.77–1.93	2.13	1.33–3.93
Type of cancer
Lymphoma (ref)
Breast cancer	2.31	0.85–6.25	2.62	1.31–5.26	2.80	1.32–5.92					2.62	1.10–6.20
Cervical cancer	3.08	1.06–8.92	2.99	1.41–6.35	1.98	0.88–4.42					4.15	1.64–10.50
Ovarian cancer	4.84	1.24–18.98	2.79	1.00–7.78	1.69	0.54–5.23					3.55	1.03–12.28
Brain tumors	2.37	0.70–8.09	2.14	0.91–5.03	1.19	0.44–3.21					1.57	0.51–4.80
Emotional distress	1.07	1.03–1.10	1.04	1.01–1.07	1.07	1.03–1.10	1.09	1.03–1.14	1.04	1.00–1.04	1.07	1.04–1.11
Body image disturbance	1.06	1.02–1.10	1.04	1.01–1.07	1.02	0.99–1.05	1.03	0.99–1.05	1.05	1.02–1.08	1.05	1.02–1.08

OR: Odds Ratio.

CI: Confidence Interval.

^aAge is treated as a continuous variable in the models.

Statistically significant (p < .05) factors in the multivariable models indicated in bold; models only include the factors associated with sexual dysfunction in the specific domain in bivariate analyses.

All models were adjusted for self-reported assessment of satisfaction with sex life prediagnosis.

Data availability statement

The data that support the findings of this study are available from the corresponding author [LW], upon reasonable request.