子宮頸癌治療後病患之性功能障礙－－著重在性交疼痛及文獻探討

Sexual Dysfunction Focusing on Sexual Pain Disorder in Cervical Cancer Patients after Treatment-A Review Article

子宮頸癌是婦女常見的癌症之一，治療過程包括放射線治療、放射線合併化學治療、化學治療，而這些治療會造成婦女性生活巨大的影響。在保守的文化當中，源自於性交疼痛的性功能障礙是一個重要的課題。本篇將過去文獻（1980-2014）的探討子宮頸癌的文章作為分析，找出子宮頸癌治療後的病人產生性交疼痛的危險因子。性交疼痛的原因包括生理、心理及社會因素、手術後或電療後的骨盆腔器官解剖位置改變、後續的賀爾蒙補充與否、年紀、社經地位、教育水準、子宮頸癌期別、治療後的陰道擴張器使用及諮商系統支持。性交疼痛會同時引起性慾相關疾病（sexual desire disorders, sexual arousal disorders）造成性功能障礙，雖然目前文獻對於子宮頸癌治療後病患合併性交疼痛及性功能障礙之危險因子及預防仍尚未定論，但多數文獻認為良好的諮商支持及陰道擴張器使用可以預防性交疼痛及後續的性功能障礙。

Objective: Cervical cancer (CC) is one of most common gynecological cancers, and treatment including radical hysterectomy or radiotherapy (RT), concurrent (Chinese J. Pain chemotherapy and radiotherapy (CCRT), chemotherapy (CT) is major treatment of cervical cancer. Those treatments have critical implications for women's sexual lives. Sexual dysfunction (SD) from sexual pain disorder is an important issue especially in a conservative culture. Aim: Literatures review and associated factors among CC patients for more effective prevention and recommendation to SD. Methods: A literatures review was performed to summarize studies about quality of sexual life, risk factors, outcomes and recommendations in women with cervical cancer after treatment. Results: Sexual dysfunction in cervical cancer patients is complicated and may result from biological, psychological, and social factors. Anatomy changes following surgery, with or without radiotherapy, and hormone replacement therapy which may determine the sexual function including sexual desire disorders, sexual arousal disorders, orgasmic disorders, and sexual pain disorders is intact. Lower level of education, older, no sexual-counseling services prior to therapy or later, higher cancer stage are reasons leading to sexual dysfunction. Which risk factors are critical to sexual dysfunction is still controversial and recommendations to these patients are not fully established. Some studies suggest treatment of female sexual pain following radiotherapy with hormone replacement therapy or using vaginal dilator in combination with psycho-educational support. Conclusion: Quality of sexual life should be more concerned in patients with cervical cancer after treatment. Educational, pharmacological, mechanical device, complementary medicine interventions may be useful to prevent sexual dysfunction.