A significant number of gynecologic and breast cancer survivors report chronic issues with pain during sexual activity. The fear-avoidance (FA) model of chronic pain provides a potential framework for addressing chronic sexual pain. The purpose of this study is to investigate the relationships among components of the FA model (acute pain, anxiety, avoidance, and distress) among gynecologic and breast cancer survivors to help identify those who may be at risk for chronic sexual pain. Gynecologic and breast cancer patients (n = 97) completed baseline questionnaires as part of a psychosexual intervention. Linear regression model was used to test components of the FA model. Overall, 17-34% of female cancer survivors experienced pain related to sexual activity in the month prior to enrolling in a psychosexual intervention trial. Further, 51% of participants reported clinically significant levels of sexual distress. Results of a multiple linear regression show that sexual distress was significantly associated with acute sexual pain (Standardized β = 0.34, p <.01), anxiety (Standardized β = 0.28, p <.05), and avoidance of sexual activity (Standardized β = 0.28, p <.01) when controlling for sexual activity. Survivors of breast and gynecologic cancer entering a sexuality treatment study reported pain with sexual activity. Further, sexual distress was significantly associated with acute sexual pain, anxiety, and avoidance of sexual activity, pointing to contributions each of these FA model components have on sexual distress in this population. These findings point to the need for interventions to explicitly address anxiety and avoidance of chronic sexual pain among female cancer survivors.
Trial registration: ClinicalTrials.gov NCT01764802.
Keywords: Breast cancer; Gynecological cancer; Pain; Sexual health.
© 2025. The Author(s).