Because loss of desire often is multifactorial, an approach that includes psychological assessment and treatment is usually optimal. An experienced mental health professional can rule out a mood disorder as a factor in loss of desire and can explore the interactions of factors such as changes in relationship dynamics, loss of physical well-being, changes in sexual self-concept, and negative body image. The effects of prescription medications, chemical dependency, or hormonal abnormalities can be recognized and targeted for change. Unfortunately, there is no true aphrodisiac medication that can restore sexual desire in the presence of a normal hormonal environment.
In general, a variety of treatment modalities are available for sexual dysfunction after cancer. For many problems, providing information and suggestions for behavior change in a self-help format may be sufficient. Education can be provided via books, pamphlets,[3,4] CD-ROMs, videos, peer counselors,[Level of evidence: I] or Internet interactions. For men and women with more complex and severe problems, professional intervention will be more effective. Future research needs to explore which treatment components are most effective with particular groups of patients. A psychoeducational intervention was evaluated in women with a history of breast cancer.[Level of evidence: I] The intervention content addressed the following:
- Sexual anatomy.
- Body image.
- Attitudes and behavior.
- Ways to enhance sexual function.
The intervention was delivered in person, in groups, at 2-hour sessions over a 6-week period. The primary outcome was the Mental Health Index, providing a measure of anxiety, depression, loneliness, distress, well-being, and positive affect. Other outcomes included sexual satisfaction, self-image, and functioning, such as dyspareunia. Women were identified through a mailed survey and randomly assigned ahead of time either to the intervention or to the control group (written material only). Women randomly assigned to the intervention were then invited to participate. Of 284 women assigned to the intervention, only 83 agreed to participate; of those, only 72 attended any of the sessions. The most common reasons for declining participation were inconvenient time and/or location, being too busy, or feeling that the intervention was not needed. One hundred twenty-seven women were randomly assigned to the control group, and follow-up was reported for 98 of them.
Results from this study are presented for three groups:
- Control group.
- Intervention nonparticipants.
- Intervention participants.
An intent-to-treat analysis showed no significant differences between groups for the Mental Health Index. However, there was an intervention effect for general satisfaction with sex. An as-treated analysis did suggest improvement on the Mental Health Index, with women who reported more distress at baseline experiencing more benefit. This study provides data to support the idea that interventions focusing on psychosocial and cognitive factors may be an important component of interventions to improve emotional and sexual outcomes. However, more research is needed to develop psychoeducational interventions that are less time intensive, can be disseminated easily, and are more readily accepted by cancer survivors.