Women’s Sexual Functioning as a Health Outcome and a New Approach to Engaging the Public in Health Intervention Development

Abstract

Sexual functioning is a critical aspect of quality of life and a health outcome in its own right. Difficulties with sexual functioning are common population-wide, but even more prevalent among women than men. Chapters 1 and 2 examine predictors of sexual dysfunction symptoms among two understudied sub-populations of women: middle-aged women as well as young women with breast cancer. Chapter 1 examines the prevalence and predictors of sexual activity and sexual function in midlife among 68,906 women from the Nurses’ Health Study II (NHSII). Three quarters of middle-aged women in NHSII reported being sexually active and half experienced symptoms of sexual dysfunction. Multivariable regression analysis was used to assess independent associations between potential risk factors and women’s self-report of potentially clinically relevant symptoms of sexual dysfunction. Evidence of effect modification by partner status was found such that relative risk estimates associated with being post-menopausal and other health-status factors were greater for unpartnered women than partnered women. Chapter 2 aims to remedy the current paucity longitudinal literature on how sexual functioning changes over time among the youngest breast cancer survivors who are at greatest risk for treatment-induced sexual dysfunction. A series of latent growth trajectory-based models were fit to the first five years of post-diagnosis follow-up data on sexual functioning from approximately 1,000 members of the Helping Ourselves, Helping Others: the Young Women’s Breast Cancer Study cohort. Five trajectories were found to underlie the data, each characterized by a unique form of change in sexual dysfunction symptoms over time (one increasing, one decreasing, three stable trajectories) and each with distinct member characteristics. Overall, half of young survivors experienced minimal burden of sexual dysfunction and half struggled. Finally, in Chapter 3 I propose an important complementary approach to traditional public health intervention design, one where solutions to persistent health problems such as sexual dysfunction are innovated by members of the public to meet their own needs. These solutions can be systematically identified and evaluated by public health experts, who then design improvements and diffusion strategies as appropriate. I describe assets-based next steps in this approach using methods informed by the field of User Innovation.