Attachment style and body image as mediators between marital adjustment and sexual satisfaction in women with cervical cancer

Purpose The majority of cervical cancer survivors face persisting sexual debilitating problems over time. The impairment in sexual function and satisfaction are not limited to physical dimensions. The goals of this study were to assess if marital adjustment and body image mediated the relationship between attachment style, sexual functioning, and sexual satisfaction. Methods This study used a cross-sectional design. The sample included 113 sexually active women that completed the EORTC QLQ C30 and EORTC QLQ CX24, the Index of Sexual Satisfaction, the Experiences in Close Relationships Scale, and the Revised Dyadic Adjustment Scale. Results Using structural equation modeling to describe the relationship between variables, an excellent fitted model was found: X-(5)(2) = 6.309 (p = 0.277); X-2/df = 1262; GFI = 0.982; CFI = 0.986; SRMR = 0.0475; RMSEA = 0.048; P (RMSEA< 0.05) = 0.429. Sexual/vaginal functioning and avoidance had a direct effect on sexual satisfaction. Marital adjustment was a partial mediator in the relation between avoidance and sexual satisfaction. Avoidance and anxious attachment had an indirect effect on sexual satisfaction mediated by marital adjustment. Body image was a partial mediator in the relationship between marital adjustment and sexual satisfaction. Conclusions The results showed that vaginal/sexual functioning, attachment style, marital adjustment, and body image were important predictors of sexual satisfaction. Psychoeducational programs to help patients deal with the impairment of sexual/vaginal functioning, as well as emotional support programs for couples to strengthen their marital relationship, need to be implemented, i.e., the couple's intimacy and women's body image, that have a clear impact on sexual satisfaction.