Assessment of sexual dysfunction in women diagnosed with breast cancer

Women with breast cancer frequently report sexual functioning difficulties that are directly or indirectly related to breast cancer and treatment. There are promising treatments for sexual dysfunction in women diagnosed with breast cancer, however, women who could benefit may not be identified as both practitioners and women find it difficult to initiate converstaions about sexual functioning. One way to identify these women is to routinely administer a self-report scale to screen for sexual dysfunction. Unfortunately, there are numerous scales that have been used in research, with no one scale identified as a 'gold standard'. This thesis addresses this issue by developing a sexual dysfunction measure suitable for use with breast cancer populations. An initial systematic review was conducted to identify potential scales for this purpose. Scales measuring sexual functioning in the breast cancer context were systematically evaluated to determine (1) evidence for acceptable psychometric properties; and, (2) the extent to which these scales cover the areas of sexual dysfunction defined by internationally-recognised diagnostic systems DSM-5 and ICD-10. The Female Sexual Function Index (FSFI) was identified as a promising measure. The FSFI has been used extensively in breast cancer research, but never validated in this population. The first empirical study entailed a validation of the FSFI within the breast cancer context. Sexually active women diagnosed with breast cancer (N=399) completed an on-line questionnaire containing the FSFI and measures of related constructs necessary for validity studies. Overall, the FSFI demonstrated excellent internal consistency and test-retest reliability. The confirmatory factor analysis provided evidence for six factors – Desire, Arousal, Lubrication, Orgasm, Pain and Satisfaction. Convergent, divergent and discriminant validities were also evident. Women with breast cancer provided positive feedback about the FSFI and they noted that the FSFI could be further improved by including questions that measure (1) reasons for sexual dysfunction; (2) the contributions of the partner’s difficulties; (3) the use of artificial lubricants; and, (4) pre-cancer sexual functioning. Following suggestions for improvements to the FSFI for use with women with breast cancer, the second empirical study reports on the development and validation of the breast cancer adaptation of the FSFI – the FSFI-BC. This new measure aims to overcome the commonly-cited limitations of the original scale regarding applicability to non-sexually active women and measuring distress. Women diagnosed with breast cancer, both sexually active and non-active (N=596) completed the FSFI-BC and other measures of related constructs used for validity studies. An exploratory factor analysis provided evidence for seven factors - Changes after cancer, Desire/arousal, Lubrication, Orgasm, Pain, Satisfaction and Distress. Acceptable internal consistency and test-retest reliability of the subscales were evident. The pattern of correlations with related constructs provided evidence for convergent and divergent validities. The participants provided positive feedback about the FSFI-BC. appropriate for this population. Overall, the systematic review and two empirical studies of this thesis contributed to the understanding of the assessment of sexual dysfunction in breast cancer populations. The resulting scale, the FSFI-BC can be used in routine clinical care and research to screen for sexual dysfunction in women diagnosed with breast cancer, as it is psychometrically sound and appropriate for this population.