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

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

This Team in the News

Meet Some of the Teams at the Bass Connections Showcase

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