Promoting Sexual Function and Pelvic Health in Women's Healthcare (2022-2023)

Background

Sexual health is an integral part of women’s wellbeing that remains understudied and unaddressed in clinical care. Life events, like childbirth and cancer treatment, can have abrupt and profound impacts on sexual function leading to persistent genito-pelvic pain, impaired quality of life, psychological distress and poor relationship functioning. 

Few treatments exist to help women manage pain, improve sexual function and cope with genito-pelvic changes. One novel approach is to develop interventions grounded in the biopsychosocial model of pain, which is based on research that highlights the associations between emotional distress, cognitions and pain processing. 

Women who have undergone intensive cancer treatments, such as pelvic radiation and surgery, experience vaginal changes that require invasive follow-up care. Additionally, women in the postpartum period commonly experience pain and other sexual difficulties related to physical and psychosocial changes that occur during and after birth. Interventions developed from the biopsychosocial model of pain may be particularly effective for reducing pain and promoting sexual function in these groups.

Project Description

Building on the work of the 2021-2022 team, this project team will focus on developing treatments to help women manage pain and changes that occur following cancer treatment and childbirth. The goals of this project are to conduct two intervention development studies grounded in the biopsychosocial model. 

With members from Duke Cancer Institute (DCI), Duke Cancer Symptom Management and Support, Duke Women’s Health Physical Therapy and Duke Perinatal Mental Health programs, this team will collaborate to develop an integrated pelvic floor physical therapy and coping skills intervention for women treated with pelvic radiation to improve sexual function; and a couples coping skills intervention to reduce genito-pelvic pain and improve sexual function in the postpartum period. 

Two intervention development studies guided by the biopsychosocial model and ORBIT Model will be conducted, each in a different phase of development. Study 1 will be in the refinement and preliminary testing phase, and Study 2 will be in the intervention development phase. 

Study 1 investigates an integrated pelvic floor physical therapy and coping skills training intervention. The intervention will be refined based on patient and provider stakeholder interviews and expert feedback on the intervention manual. A pilot study will be conducted with 16 participants undergoing post-pelvic radiation physical therapy at the DCI to assess feasibility and acceptability of the intervention and study procedures. Team members will conduct exploratory analyses examining pre- to post-intervention patterns of change in outcomes. 

Study 2 will provide preliminary information needed for a dissertation study of a couples-based coping skills training intervention for postpartum pain and sexual dysfunction.

A phased research approach will allow findings from the integrated pelvic floor physical therapy and coping skills study to inform the postpartum couples-based coping skills study, as both require managing sexual side effects, genito-pelvic pain and dramatic changes in multiple life domains. The team will collaborate to integrate findings from the first study to inform the development of the second. This approach will allow trainees to participate in intervention development during all stages.

Anticipated Outputs

Manuscripts; reports; results dissemination

Student Opportunities 

Ideally, this team will be comprised of 2 graduate students and 6 undergraduate students from disciplines such as psychology, nursing, neuroscience, biology (prehealth), global health, gender, sexuality and feminist studies and visual studies/graphic design/animation.

Students will have the opportunity to learn about women’s health, sexual health and symptom management from the interdisciplinary team. Undergraduates will gain training in qualitative research methods; learn about translating research findings into intervention content; and collaborate on manuscript writing and discussing reports with healthcare leadership. 

This project offers a significant learning opportunity for graduate students, who will gain leadership experience by organizing team learning opportunities, coordinating with other graduate students and supervising undergraduates. Differentiated roles will promote ownership over tasks and provide graduate students with leadership and supervision opportunities. Additional graduate student opportunities include conducting interviews, intervention development/delivery and leading data collection and analysis. 

Sarah Arthur will serve as the team’s project manager, and she will lead weekly full-team meeting for collaboration across studies involving consultation and didactics on interdisciplinary topics facilitated by team members and outside speakers. All team members will be involved in this translational intervention research. 

To promote learning and shared knowledge, team members at all levels will deliver didactics. Topics will include medical, psychotherapy and physical therapy treatments for these populations, the biopsychosocial model, cognitive behavioral approaches and trauma-informed principles. The project manager will help facilitate each study and will meet weekly with undergraduates on their sub-team for supervision and collaboration. Undergraduates will code qualitative data, assist with writing manuscripts and reports and create study materials.

Graduate students on the team will be expected to work each summer; undergraduate summer participation will be optional.

Timing

Summer 2022 – Summer 2023

  • Summer 2022 (optional): Refine Study 1 intervention; conduct literature review for Study 2; interview stakeholders 
  • Fall 2022: Begin proof of concept pilot study; analyze data; submit conference abstract; create interview guide; select measures for questionnaire packet; submit IRB protocol
  • Spring 2023: Complete proof of concept pilot study; prepare presentations and manuscripts; complete community qualitative and quantitative data collection; draft intervention content
  • Summer 2023 (optional): Continue writing manuscripts for publication; disseminate findings; present at conference

Crediting

Academic credit available for fall and spring semesters; summer funding available

See earlier related team, Promoting Psychological Adjustment and Pelvic Health Among Female Cancer Survivors (2021-2022).

Pelvic diagram.

Team Leaders

  • Sarah Arthur, Arts and Sciences–Psychology and Neuroscience–Ph.D. Student
  • Rebecca Shelby, School of Medicine-Psychiatry and Behavioral Sciences

/undergraduate Team Members

  • Shernice Martin, Neuroscience (BS)

/yfaculty/staff Team Members

  • Diandra Ayala-Peacock, School of Medicine-Radiation Oncology
  • Brittany Davidson, School of Medicine-Obstetrics and Gynecology
  • Carol Figuers, School of Medicine-Family Medicine and Community Health: Doctor of Physical Therapy
  • Ashley Hill, School of Medicine-Psychiatry and Behavioral Sciences
  • Lisa Massa, Physical Therapy
  • Niharika Mettu, School of Medicine-Medicine: Medical Oncology

/zcommunity Team Members

  • Sisters Network Triangle NC