Mindfulness-based stress reduction for sexual psychological recovery after radical cervical cancer surgery: A retrospective study

Abstract

BACKGROUND

Patients who undergo radical cervical cancer surgery often experience sexual dysfunction and psychological distress, which seriously affects their quality of life. This study aimed to evaluate the clinical effectiveness of mindfulness-based stress reduction (MBSR) therapy for psychosexual adaptation in patients after radical cervical cancer surgery.

AIM

To systematically evaluate the clinical effectiveness of MBSR therapy on psychosexual adaptation in patients following radical cervical cancer surgery.

METHODS

A multicenter retrospective study design was used to analyze the clinical data of 280 patients who underwent radical cervical cancer surgery between January 2021 and August 2024 at Lishui Central Hospital, The Fifth Hospital Affiliated to Wenzhou Medical University, Lishui Hospital of Zhejiang University and Wenzhou Central Hospital. Patients were divided into an intervention group (n = 140; receiving standard MBSR intervention) and a control group (n = 140; receiving only routine care and sexual health guidance). Among these, 140 cases were collected from Lishui Central Hospital, The Fifth Hospital Affiliated to Wenzhou Medical University, Lishui Hospital of Zhejiang University (70 in the intervention group and 70 in the control group) and Wenzhou Central Hospital (70 in the intervention group and 70 in the control group).

RESULTS

After intervention, patients in the MBSR intervention group showed significant improvement in anxiety and depression levels (anxiety: 5.8 ± 1.2 vs 8.3 ± 1.7, P < 0.001; depression: 6.2 ± 1.4 vs 9.1 ± 1.8, P < 0.001). The proportion of patients with clinically significant anxiety decreased from 69.3% to 21.4% (control group: 67.9%-52.9%, P < 0.001). The intervention group showed significantly better Female Sexual Function Index total scores (23.5 ± 3.6 vs 17.8 ± 3.2, P < 0.001) and scores in all dimensions than the control group, with a significantly lower incidence of sexual dysfunction (42.9% vs 67.9%, P < 0.001). Regarding sexual relationship satisfaction, both patients in the intervention group (78.3 ± 6.5 vs 65.2 ± 7.8, P < 0.001) and their partners (76.9 ± 7.1 vs 63.6 ± 8.3, P < 0.001) showed significantly improved scores. Age-stratified analysis showed that MBSR was most effective in younger patients (≤ 45 years, 46-55 years; P < 0.001), with relatively less benefit in older patients (> 55 years; P = 0.032). Multivariate regression analysis confirmed that MBSR intervention [odds ratios (OR) = 2.86, 95% confidence interval (95%CI): 1.75-4.68, P < 0.001] and partner support (OR = 1.92, 95%CI: 1.28-2.87, P = 0.002) were independent positive predictive factors for improving patients' psychosexual adaptation.

CONCLUSION

MBSR therapy can effectively improve anxiety and depression in patients after radical cervical cancer surgery and significantly enhance sexual function and sexual relationship satisfaction, with the effects being more pronounced in younger patients. This study demonstrated that MBSR, as an integrative intervention approach, has independent positive effects on psychosexual adaptation in post-operative cervical cancer patients and is worthy of promotion in clinical practice.

Key Words: Cervical cancer; Radical surgery; Mindfulness-based stress reduction therapy; Psychosexual adaptation; Anxiety and depression; Sexual function; Retrospective study therapy; Sexual psychological adaptation; Anxiety and depression

Core Tip: This multicenter retrospective study investigated the impact of mindfulness-based stress reduction (MBSR) on psychological sexual adaptation in patients after radical cervical cancer surgery. MBSR significantly improved anxiety, depression, sexual function, and sexual relationship satisfaction compared to standard care. Both patients and their partners reported enhanced intimacy and emotional connections. Younger patients benefited more than older patients. Multivariate analysis confirmed that MBSR and partner support are independent predictors of psychosexual recovery. The findings support MBSR as an effective integrative intervention for improving postoperative quality of life in cervical cancer survivors.

INTRODUCTION

Cervical cancer is the fourth most common malignant tumor among women worldwide, with approximately 570000 new cases and 310000 deaths annually, 80% of which occur in developing countries. In China, the incidence of cervical cancer has shown a trend toward a younger age, seriously threatening women's health. With advancements in early screening and treatment technologies, the five-year survival rate of patients with cervical cancer has significantly improved, exceeding 70%. However, while radical cervical cancer surgery (including total hysterectomy and pelvic lymph node dissection, etc.) effectively controls disease progression, it often leads to a series of physiological and psychological problems, especially sexual dysfunction and related psychological distress, which severely affects patients' postoperative quality of life and partner relationships[1-7].

After radical cervical cancer surgery, approximately 60%-80% of patients experience varying degrees of sexual dysfunction, mainly manifested as decreased libido, difficulty with sexual arousal, inadequate vaginal lubrication, painful intercourse, and orgasmic disorders. These physiological changes stem from pelvic nerve damage, vaginal morphological changes, and endocrine dysfunction caused by the surgery. Simultaneously, patients often experience negative emotional states, such as anxiety, depression, low self-esteem, body image disorders, and fear. Research shows that the incidence of anxiety in post-cervical cancer surgery patients is 32.6%-68.3%, and the incidence of depression is 25.8%-53.7%, which is significantly higher than that in healthy women of the same age. This dual predicament forms a "vicious cycle": Sexual dysfunction exacerbates psychological distress, while psychological problems further worsen sexual dysfunction, leading to a continuous decline in patients' sexual quality of life, decreased marital satisfaction, and even family crises[8-10].

Traditional interventions often focus on either physiological sexual function rehabilitation or simple psychological support such as pelvic floor muscle training, vaginal dilator use guidance, sexual education, and routine psychological counseling. However, these interventions often separate the intrinsic connection between sexual dysfunction and psychological problems, lacking an integrative perspective and with limited clinical effectiveness. Research shows that among post-cervical cancer surgery patients receiving routine sexual health guidance, 45%-60% still report persistent sexual dissatisfaction, and 30%-40% of patients' psychological distress derived from sexual problems remains unresolved. Therefore, exploring more effective integrative intervention programs has become a current research focus[11-13].

Mindfulness-based stress reduction (MBSR), founded by the American molecular biologist Jon Kabat-Zinn in 1979, is an eight-week structured intervention program that combines Eastern meditation and modern psychological concepts. This therapy guides patients to perceive their current physical and mental experiences in a non-judgmental, fully accepting manner, gradually changing their cognitive patterns toward stressors and enhancing psychological regulation capabilities. Recently, MBSR has demonstrated significant psychological intervention effects in patients with chronic pain, cancer, anxiety, depression, and other chronic diseases. Meta-analyses showed that MBSR can effectively reduce anxiety levels [SMD = -0.75, 95% confidence interval (95%CI): -0.95 to -0.54] and depressive symptoms (SMD = -0.73, 95%CI: -0.94 to -0.52) in cancer patients, improving their quality of life[14-16].

Notably, the core concepts of MBSR—cultivating sensitivity to bodily sensations, improving concentration, accepting current experiences, and reducing self-judgment—highly align with key elements of sexual and psychological health. Preliminary studies have indicated that mindfulness training helps improve female sexual function, especially in enhancing sexual arousal, reducing dyspareunia, and improving sexual satisfaction. However, research on the application of MBSR in sexual psychological adaptation in post-cervical cancer surgery patients is still insufficient, with a few existing studies mostly limited to small samples, short-term effect observations, or lack of control designs, with limited levels of evidence[17-19].

Given the complexity of psychological sexual problems in patients after radical cervical cancer surgery and the limitations of traditional intervention measures, exploring the effects of MBSR on psychological sexual adaptation in this special population has important clinical significance. This study aimed to systematically evaluate the impact of MBSR on anxiety and depression, sexual function, and sexual relationship satisfaction in patients after radical cervical cancer surgery through a retrospective analysis of a larger sample of clinical data, providing evidence-based support for clinical practice and helping comprehensive rehabilitation and quality of life improvement for cervical cancer patients.

MATERIALS AND METHODS

Research design and subjects

This study employed a multicenter retrospective cohort study design and collected clinical data from patients who underwent radical cervical cancer surgery between January 2021 and August 2024 at the gynecological oncology centers of two tertiary hospitals: Lishui Central Hospital, The Fifth Hospital Affiliated to Wenzhou Medical University, Lishui Hospital of Zhejiang University (hereafter referred to as Lishui Central) and Wenzhou Central Hospital. The study included patients aged 20-65 years, pathologically diagnosed with cervical cancer (clinical stage IA2-IIA, FIGO 2018 staging) and underwent radical surgery (type I or type II radical hysterectomy and pelvic lymph node dissection), with expected survival > 12 months, stable sexual partners with normal sexual life before surgery, and elementary school education or above. Exclusion criteria included patients with other malignant tumors or terminal chronic diseases, previous history of psychiatric disorders or current use of psychiatric medications, pre-existing clear sexual dysfunction [Female Sexual Function Index (FSFI) score < 23], serious complications within 3 months post-surgery, pre- or post-operative cognitive dysfunction, and patients lost to follow-up or with extremely poor compliance (participation in intervention < 30%).

Finally, 280 patients meeting the criteria were included, with Lishui Central collecting 140 cases (70 in the intervention group and 70 in the control group) and Wenzhou Central Hospital collecting 140 cases (70 in the intervention group and 70 in the control group). Based on different post-operative rehabilitation protocols, the patients were divided into a control group (n = 140) and an intervention group (n = 140). The control group received routine care and sexual health guidance, including general post-operative complication management, basic sexual health education, routine psychological support, and sexual life guidance, implemented by specially trained oncology nurses through one-on-one health consultations and distribution of educational materials, with monthly follow-ups for 6 consecutive months. The intervention group, in addition to routine care and sexual health guidance, participated in an 8-week MBSR intervention led by professionally trained and certified MBSR psychotherapists, following standard MBSR protocols including weekly 90-minute group mindfulness sessions (8-12 people per group), daily 45-minute home practice, and specially designed targeted psychological adaptation content (such as accepting body changes, sexual pleasure mindfulness training, partner communication practice, etc.). MBSR intervention began 3 months post-surgery and lasted 8 weeks, followed by monthly 60-minute reinforcement training for 4 consecutive months. The study protocol was approved by the Ethics Committee of Wenzhou Central Hospital (approval No. L2025-06-021), and all participants provided written informed consent.

Observation indicators and assessment methods

All assessments were conducted before the intervention (3 months after surgery), after the intervention (6 months after surgery), and during follow-up (12 months after surgery) by researchers blinded to group allocation. This study established a comprehensive observation indicator system that primarily assesses anxiety and depression status, sexual function status, and sexual relationship satisfaction. Specifically, The Hospital Anxiety and Depression Scale (HADS) was used to assess emotional disorders (including anxiety and depression subscales, seven items each, 0-3 points per item, ≥ 8 points indicating the presence of corresponding emotional disorder).

The FSFI was used to assess sexual function (including desire, arousal, lubrication, orgasm, satisfaction, and pain, 19 items in total, total score 2-36 points, < 23 points defined as sexual dysfunction).

The Sexual Satisfaction Scale for Women (SSSW) was used to assess sexual relationship quality (25 items in total, total score 25-100 points, both the patients and their partners completed the assessment). The secondary assessment indicators included quality of life (using the EORTC QLQ-C30 scale), intervention compliance, and adverse event recording. The primary endpoint was set as FSFI total score ≥ 23 points after intervention (6 months after surgery), representing sexual function recovery; secondary endpoints included HADS anxiety and depression subscale scores < 8 points after intervention, SSSW score increased by ≥ 10 points compared to baseline, and maintenance of these improvement effects at the 12-month follow-up.

Statistical analysis

SPSS software (version 25.0) was used for the data analysis. Measurement data were expressed as mean ± SD, and an independent sample t-test was used for between-group comparisons. Count data were expressed as number of cases (percentage), and χ² test or Fisher's exact probability method was used for between-group comparisons. Multifactor analysis used multivariate logistic regression models, calculating odds ratios (OR) and 95%CI; P < 0.05, considered statistically significant. Sample size estimation was based on changes in the FSFI total score, setting effect size d = 0.4, α = 0.05, β = 0.1, considering a 15% dropout rate, and finally determining that at least 142 patients were needed in each group.

RESULTS

Baseline characteristics comparison

The results showed good homogeneity between the intervention (n = 140) and control groups (n = 140). Regarding demographic characteristics, the intervention group's average age was 51.3 ± 6.8 years, control group 52.1 ± 7.2 years (P = 0.732), body mass index indices were 23.2 ± 3.1 kg/m² and 23.6 ± 3.3 kg/m² respectively (P = 0.634). Sociodemographic indicators showed a similar educational level distribution between groups (junior high school and below: 42.1% vs 40.0%; high school/technical secondary school: 39.3% vs 41.4%; college and above: Approximately 18%, P = 0.872), and marital status was predominantly married (88.6% vs 87.1%, P = 0.657). Clinical characteristics showed laparoscopic surgery rates slightly higher than open surgery (intervention group 56.4% vs 43.6%, control group 57.1% vs 42.9%, P = 0.885), FIGO staging predominantly IB1 (approximately 42%, P = 0.939), pathological types predominantly squamous cell carcinoma (approximately 79%), adenocarcinoma (approximately 16%), and adenosquamous carcinoma (approximately 5%; P = 0.951). Baseline assessment scores showed no significant differences in FSFI total score (28.7 ± 3.3 vs 28.4 ± 3.5, P = 0.823), Hospital Anxiety Scale (HADS-A; 9.6 ± 1.8 vs 9.4 ± 1.9, P = 0.425) and Hospital Depression Scale (HADS-D; 10.1 ± 2.1 vs 9.9 ± 2.0, P = 0.533). Treatment-related indicators showed that approximately 53% of patients did not receive adjuvant therapy, approximately 15% received radiotherapy alone, approximately 32% received chemoradiotherapy (P = 0.862), and there was a balanced distribution of pre- and post-menopausal patients (P = 0.724), similar surgical time, and intraoperative blood loss. Comorbidities (hypertension approximately 23%, diabetes approximately 13%, cardiovascular disease approximately 7%), tumor size (2.6 ± 1.1 cm vs 2.8 ± 1.2 cm, P = 0.376) and lymph node metastasis rate (10.7% vs 12.9%, P = 0.546) showed no statistical differences. All P values were > 0.05, providing a reliable research foundation for evaluating the effects of MBSR therapy on psychosexual adaptation in patients after radical cervical cancer surgery (Table 1).

Table 1 Comparison of baseline characteristics in patients after radical cervical cancer surgery, n (%).

Characteristics	Intervention group (n = 140)	Control group (n = 140)	Statistics	P value
Demographic characteristics
Age (years, mean ± SD)	51.3 ± 6.8	52.1 ± 7.2	t = -0.343	0.732
BMI (kg/m2, mean ± SD)	23.2 ± 3.1	23.6 ± 3.3	t = -0.477	0.634
Sociodemographic characteristics
Education level			χ² = 0.274	0.872
Junior high school and below	59 (42.1)	56 (40.0)
High school/technical secondary school	55 (39.3)	58 (41.4)
College and above	26 (18.6)	26 (18.6)
Marital status			χ² = 0.198	0.657
Married	124 (88.6)	122 (87.1)
Others	16 (11.4)	18 (12.9)
Clinical characteristics
Surgical approach			χ² = 0.021	0.885
Laparoscopic surgery	79 (56.4)	80 (57.1)
Open surgery	61 (43.6)	60 (42.9)
FIGO stage			χ² = 0.406	0.939
IA2	21 (15.0)	20 (14.3)
IB1	59 (42.1)	59 (42.1)
IB2	38 (27.1)	39 (27.9)
IIA	22 (15.8)	22 (15.7)
Pathological type			χ² = 0.103	0.951
Squamous cell carcinoma	110 (78.6)	111 (79.3)
Adenocarcinoma	23 (16.4)	22 (15.7)
Adenosquamous carcinoma	7 (5.0)	7 (5.0)
Baseline assessment scores
FSFI total score (mean ± SD)	28.7 ± 3.3	28.4 ± 3.5	t = 0.223	0.823
HADS-A (mean ± SD)	9.6 ± 1.8	9.4 ± 1.9	t = 0.800	0.425
HADS-D (mean ± SD)	10.1 ± 2.1	9.9 ± 2.0	t = 0.625	0.533
Treatment-related indicators
Adjuvant therapy			χ² = 0.297	0.862
No adjuvant therapy	74 (52.9)	75 (53.6)
Radiotherapy alone	21 (15.0)	21 (15.0)
Chemoradiotherapy	45 (32.1)	44 (31.4)
Menopausal status			χ² = 0.125	0.724
Premenopausal	61 (43.6)	63 (45.0)
Postmenopausal	79 (56.4)	77 (55.0)
Other indicators
Comorbidities
Hypertension	32 (22.9)	32 (22.9)	χ² = 0.000	0.989
Diabetes	18 (12.9)	18 (12.9)	χ² = 0.006	0.936
Cardiovascular disease	10 (7.1)	10 (7.1)	χ² = 0.026	0.872
Tumor size (cm, mean ± SD)	2.6 ± 1.1	2.8 ± 1.2	t = -0.887	0.376
Lymph node metastasis	15 (10.7)	18 (12.9)	χ² = 0.365	0.546

All P values > 0.05, indicating no statistical differences in baseline characteristics between the two groups. FSFI: Female Sexual Function Index; HADS-A: Hospital Anxiety Scale; HADS-D: Hospital Depression Scale; BMI: Body mass index.

Anxiety and depression scores

With regard to anxiety and depression outcomes, MBSR intervention showed significant clinical benefits. Compared to the control group, the intervention group had significantly lower HADS scores after intervention (anxiety: 5.8 ± 1.2 vs 8.3 ± 1.7, P < 0.001; depression: 6.2 ± 1.4 vs 9.1 ± 1.8, t = -16.47, P < 0.001). Pre-post intervention difference analysis showed that the intervention group's anxiety scores decreased by an average of 3.8 ± 0.9 points, while the control group only decreased by 1.1 ± 0.7 points (t = 24.19, P < 0.001), and depression scores decreased by 3.9 ± 1.0 points, while the control group decreased by 0.8 ± 0.6 points (P < 0.001). The proportion of patients with clinically significant anxiety (HADS-A ≥ 8) in the intervention group decreased from 69.3% to 21.4%, while that in the control group decreased from 67.9% to 52.9% (χ² = 35.86, P < 0.001). Similarly, the incidence of clinical depression (HADS-D ≥ 8) in the intervention group decreased from 73.6% to 24.3%, whereas that in the control group decreased from 71.4% to 57.9% (P < 0.001). The standardized effect sizes (Cohen's d) for MBSR on anxiety and depression were 1.68 (95%CI: 1.42-1.94) and 1.83 (95%CI: 1.56-2.10) respectively, indicating large treatment effects. These findings suggest that, compared to standard care, MBSR intervention significantly reduced psychological distress in post-operative cervical cancer patients (Figure 1).

Figure 1 Effects of mindfulness-based stress reduction intervention on anxiety and depression in post-surgical cervical cancer patients. The figure illustrates the significant improvements in psychological outcomes following mindfulness-based stress reduction therapy. A: Shows decreased Hospital Anxiety and Depression Scale (HADS) scores after intervention in both groups, with more substantial reductions in the intervention group; B and C: Demonstrates the notable decrease in the percentage of patients with clinically significant symptoms (HADS ≥ 8), while panel C quantifies the superior score reduction achieved in the intervention group compared to standard care. ^aP < 0.05. HADS: Hospital Anxiety and Depression Scale.

Overall sexual function assessment

The sexual function assessment results showed that MBSR intervention significantly improved sexual function in patients with post-operative cervical cancer. After intervention (6 months post-surgery), the intervention group's FSFI total score (23.5 ± 3.6) was significantly higher than that of the control group (17.8 ± 3.2), with statistically significant differences (t = 15.27, P < 0.001). According to the criterion of sexual dysfunction defined as FSFI < 23 points, the incidence of sexual dysfunction in the intervention group was 42.9% (60/140), which was significantly lower than the control group's 67.9% (95/140; χ² = 21.36, P < 0.001), with an absolute risk difference of 25.0% (95%CI: 15.1%-34.9%) between the two groups. Further analysis of dimensional scores showed that the intervention group was superior to the control group in all six dimensions: Sexual desire (3.6 ± 0.6 vs 2.8 ± 0.5, t = 13.41, P < 0.001), sexual arousal (3.8 ± 0.7 vs 2.9 ± 0.6, t = 12.88, P < 0.001), vaginal lubrication (4.0 ± 0.8 vs 3.1 ± 0.7, t = 11.25, P < 0.001), orgasm (3.9 ± 0.7 vs 2.8 ± 0.8, t = 13.54, P < 0.001), sexual satisfaction (4.2 ± 0.6 vs 3.1 ± 0.8, t = 14.38, P < 0.001), and pain (4.0 ± 0.8 vs 3.1 ± 0.9, t = 9.74, P < 0.001). Multivariate analysis showed that after adjusting for factors such as age, surgical approach, staging, and adjuvant therapy, MBSR intervention was an independent protective factor for improving post-operative cervical cancer sexual function (OR = 2.86, 95%CI: 1.75-4.68, P < 0.001). Follow-up to 12 months post-surgery showed that the intervention group's FSFI total score continued to improve to 25.8 ± 3.9, with sexual dysfunction incidence decreasing to 29.3% (41/140), while the control group showed 19.2 ± 3.5 and 61.4% (86/140), respectively, with statistically significant differences maintained between the groups (P < 0.001). These results indicate that MBSR intervention can effectively improve sexual function in patients after radical cervical cancer surgery, and this improvement can last for at least 9 months (Figure 2).

Figure 2 Mindfulness-based stress reduction intervention effects on sexual function after cervical cancer surgery. A: Significantly higher Female Sexual Function Index domain scores in the intervention group compared to the control group across all six sexual function domains (desire, arousal, lubrication, orgasm, satisfaction, and pain), with statistical significance indicated by asterisks; B: Forest plot of the multivariate analysis, showing mindfulness-based stress reduction intervention (odds ratio = 2.86) and premenopausal status as significant positive factors for improved sexual function, while age appears as a negative factor. ^aP < 0.05. FSFI: Female Sexual Function Index; MBSR: Mindfulness-based stress reduction; OR: Odds ratio; 95%CI: 95% confidence interval.

Sexual relationship satisfaction

The sexual relationship satisfaction assessment results further validated the comprehensive effect of MBSR intervention in improving the sexual quality of life of post-cervical cancer surgery patients. According to the SSSW scores, the intervention group’s self-reported sexual relationship satisfaction (78.3 ± 6.5) was significantly higher than that of the control group (65.2 ± 7.8), with a difference of 13.1 points, an improvement of approximately 20.1%, and a statistically significant difference (P < 0.001). Notably, this improvement in satisfaction was not limited to the patients' subjective experiences; the assessment results of patients' partners showed a similar trend: The relationship satisfaction reported by the partners of the intervention group patients (76.9 ± 7.1) was also significantly higher than that of the control group patients' partners (63.6 ± 8.3), with a difference of 13.3 points, an improvement of approximately 20.9%, which was also statistically significant (P < 0.001). This high consistency in patient and partner evaluations indicates that the sexual relationship improvement brought about by MBSR intervention is a real experience perceived by both parties and not a subjective preference of one side. This finding has important clinical significance, as it suggests that MBSR intervention can not only improve patients' sexual function indicators, but also enhance the sexual relationship quality and interactive experience of both partners, possibly through mechanisms such as enhanced communication, reduced anxiety, and promoted intimacy (Figure 3).

Figure 3 Sexual function outcomes after mindfulness-based stress reduction intervention for post-cervical cancer surgery patients. The figure illustrates significant improvements in sexual function following mindfulness-based stress reduction (MBSR) intervention. A: The intervention group achieved significantly higher Female Sexual Function Index total scores (23.5 ± 3.6) than the control group (17.8 ± 3.2); B: Sexual dysfunction rates were substantially lower in the intervention group (42.8%) compared to the control group (67.9%). Both differences were statistically significant (P < 0.001), highlighting MBSR's effectiveness in improving sexual function and reducing dysfunction after cervical cancer surgery. ^aP < 0.05. FSFI: Female Sexual Function Index.

Age-stratified analysis

Age-stratified analysis revealed age-related differential patterns in MBSR intervention effects, providing an important reference for individualized treatment in clinical practice. The study divided 280 patients into three age groups: ≤ 45 years (n = 95), 46-55 years (n = 121), and > 55 years (n = 64), and evaluated the improvement effects of MBSR intervention on sexual function in each age group. Results showed clear age gradients in intervention effects: In the ≤ 45 years group, the intervention group's FSFI total score was on average 6.8 points higher than the control group (24.6 ± 3.2 vs 17.8 ± 3.0), with 38.2% improvement amplitude and extremely significant statistical differences (P < 0.001); in the 46-55 years group, intervention effects were also significant, with FSFI total scores improving by 5.9 points (23.9 ± 3.4 vs 18.0 ± 3.1), representing 32.8% improvement (P < 0.001); in the > 55 years group, although intervention still produced positive effects, the degree of improvement was relatively weaker, with FSFI total scores improving by only 3.7 points (21.5 ± 3.8 vs 17.8 ± 3.5), representing 20.8% improvement, with statistical differences present but reduced significance(P = 0.032, Figure 4).

Figure 4 Sexual relationship satisfaction after mindfulness-based stress reduction intervention in post-cervical cancer surgery patients. The chart illustrates significantly higher sexual relationship satisfaction scores in both patients and their partners following mindfulness-based stress reduction intervention. The intervention group demonstrated markedly elevated Sexual Satisfaction Scale for Women scores (78.3 ± 6.5 for patients, 76.9 ± 7.1 for partners) compared to the control group (65.2 ± 7.8 for patients, 63.6 ± 8.3 for partners), with both differences being statistically significant (P < 0.001). ^aP < 0.05. SSSW: Sexual Satisfaction Scale for Women.

Multivariate regression analysis

Multivariate logistic regression analysis further confirmed the independent value of MBSR intervention in the sexual psychological adaptation of patients post-cervical cancer surgery. After controlling for potential confounding factors such as age, education level, surgical approach, clinical staging, adjuvant therapy type, and marital status, MBSR intervention remained the strongest independent predictor of improving patients' sexual psychological adaptation status (OR = 2.86, 95%CI: 1.75-4.68, P < 0.001), indicating that patients receiving MBSR intervention were 2.86 times more likely to achieve good sexual psychological adaptation than those not receiving intervention. Partner support was also confirmed as another significant independent influencing factor (OR = 1.92, 95%CI: 1.28-2.87, P = 0.002), suggesting that high levels of partner support are associated with better sexual psychological adaptation outcomes. Other factors showing marginal statistical significance included age (OR = 0.93, 95%CI: 0.89-0.97, P = 0.041) and menopausal status (OR = 1.53, 95%CI: 1.02-2.31, P = 0.046), while education level, surgical approach, FIGO staging, adjuvant therapy type, and other factors were not statistically significant in the multivariate model (all P > 0.05; Figure 5).

Figure 5 Independent predictors of sexual psychological adaptation after cervical cancer surgery. The forest plot reveals mindfulness-based stress reduction intervention as the strongest independent predictor of improved sexual psychological adaptation [odds ratio (OR) = 2.86, 95% confidence interval (95%CI): 1.75-4.68, P < 0.001], followed by partner support (OR = 1.92, 95%CI: 1.28-2.87, P = 0.002). While advancing age slightly reduces adaptation potential (OR = 0.93), menopausal status shows a modest positive association (OR = 1.53); other clinical factors including surgical approach, FIGO stage, and adjuvant therapy demonstrate non-significant effects, highlighting the primacy of psychological interventions and relational support over strictly medical factors in facilitating sexual recovery. MBSR: Mindfulness-based stress reduction; OR: Odds ratio; 95%CI: 95% confidence interval.

DISCUSSION

This study systematically evaluated the impact of MBSR therapy on psychosexual adaptation through a retrospective analysis of clinical data from 280 patients after radical cervical cancer surgery[20]. The research results indicate that MBSR has significant effects in improving anxiety and depression, sexual function, and sexual relationship satisfaction in patients after radical cervical cancer surgery[21]. These effects maintain independence after controlling for potential confounding factors, providing important evidence for clinical practice.

Cervical cancer is a common malignant tumor in women. With the advancement of early screening and treatment technologies, the five-year survival rate has significantly improved; however, radical surgery, although effectively controlling disease progression, often leads to a series of physiological and psychological problems. Research shows that approximately 60%-80% of post-cervical cancer surgery patients experience varying degrees of sexual dysfunction, manifested as decreased libido, difficulty with sexual arousal, inadequate vaginal lubrication, painful intercourse, and orgasmic disorders, which stem from pelvic nerve damage, vaginal morphological changes, and endocrine dysfunction caused by surgery[22]. Simultaneously, patients often experience negative emotions such as anxiety, depression, low self-esteem, body image disorders, and fear, with research showing that the incidence of anxiety in post-cervical cancer surgery patients is 32.6%-68.3%[23,24], and the incidence of depression is 25.8%-53.7%[25,26], which is significantly higher than that in healthy women of the same age.

Traditional interventions often focus on either physiological sexual function rehabilitation or simple psychological support such as pelvic floor muscle training, vaginal dilator use guidance, sexual education, and routine psychological counseling. However, these interventions often separate the intrinsic connection between sexual dysfunction and psychological problems, lacking an integrative perspective and with limited clinical effectiveness[27,28]. Among post-cervical cancer surgery patients receiving routine sexual health guidance, 45%-60% still report persistent sexual dissatisfaction, and 30%-40% of patients' psychological distress due to sexual problems remains unresolved[29].

MBSR guides patients to perceive their current physical and mental experiences in a non-judgmental, fully accepting manner, gradually changing their cognitive patterns toward stressors, and enhancing psychological regulation capabilities[30,31]. The core concepts of MBSR—cultivating sensitivity to bodily sensations, improving concentration, accepting current experiences, and reducing self-judgment—highly align with key elements of sexual psychological health[32]. MBSR has demonstrated significant psychological intervention effects in patients with chronic pain, cancer, anxiety, depression, and other chronic diseases, effectively reducing anxiety levels and depressive symptoms in cancer patients and improving quality of life[33].

The results of this study show that patients in the MBSR intervention group achieved significant improvements in emotional state, sexual function, and sexual relationship satisfaction. Anxiety and depression scores and the incidence of clinically significant emotional disorders were significantly reduced compared to the control group, indicating that MBSR helps alleviate negative emotions in post-cervical cancer surgery patients[34]. This may be related to the emphasis on accepting current experiences and reducing self-judgment in MBSR, helping patients more positively face body changes and sexual dysfunction, and reducing related psychological pressure[35]. Additionally, body scanning, breath awareness, and other exercises in MBSR training can promote parasympathetic nervous system activity, reduce physiological anxiety responses, and alleviate anxiety and depression symptoms[36].

Regarding sexual function assessment, the intervention group's FSFI total score improved from 17.8 ± 3.2 to 23.5 ± 3.6, representing a clinically meaningful advancement along the sexual recovery trajectory. While the post-intervention score of 23.5 remained close to the sexual dysfunction cutoff (FSFI < 23), this improvement represents significant clinical progress that warrants careful interpretation. The transition from severe sexual dysfunction (17.8) to borderline normal function (23.5) constitutes a 32% improvement that translates into tangible benefits for patients' quality of life and intimate relationships.

It is important to emphasize that MBSR should be viewed as part of a comprehensive rehabilitation approach rather than as a standalone cure for sexual dysfunction. The intervention group (57.1%) who achieved an FSFI ≥ 23 (compared to 32.1% in controls) demonstrated that a substantial proportion of patients achieved functional sexual recovery through MBSR intervention. For the remaining patients who continued to experience some degree of dysfunction, the improvement in FSFI scores still represents meaningful progress toward sexual rehabilitation.

The concept of "sexual recovery trajectory" is crucial for understanding these results. Postsurgical sexual dysfunction typically follows a gradual recovery pattern, and even modest improvements can significantly impact patients' confidence, relationship satisfaction, and overall psychological well-being. Concurrent improvements in anxiety, depression, and partner-reported satisfaction scores support the clinical significance of these FSFI changes, suggesting that patients experience holistic benefits beyond simple score improvements.

Regarding sexual function assessment, the intervention group's FSFI total score and scores in all six dimensions were significantly higher than those of the control group, with a markedly lower incidence of sexual dysfunction. This result aligns with the core mechanisms of MBSR: By enhancing sensitivity to bodily sensations and increasing the ability to focus on the present, patients can better perceive and enjoy positive sensations in sexual experiences, reduce excessive focus on pain and discomfort, and lower performance anxiety and negative self-evaluation in sexual activities, thereby improving physiological responses such as sexual arousal and lubrication as well as subjective experiences[37].

Notably, both patients in the intervention group and their partners reported significantly higher sexual relationship satisfaction, with high consistency in their scores, indicating that the sexual relationship improvement brought about by MBSR is a real experience perceived by both parties, not a subjective preference of one side[38]. This may be related to MBSR's promotion of communication, enhancement of intimacy, and improvement in partner interaction patterns.

Age-stratified analysis showed clear age gradients in MBSR intervention effects, with more significant effects in younger patients, providing a reference for individualized treatment in clinical practice. The differential response patterns across age groups (≤ 45 years: 38.2% improvement; 46-55 years: 32.8% improvement; > 55 years: 20.8% improvement) suggest that treatment expectations and goals should be tailored accordingly. Younger patients may benefit from intensive MBSR protocols aimed at substantial functional recovery, whereas older patients may benefit from modified approaches focused on acceptance, adaptation, and relationship satisfaction rather than complete functional restoration. The age-related differences may reflect differences in nervous system plasticity, treatment expectations, and valuation of sexual life across different age groups[39].

Multivariate regression analysis further confirmed that MBSR intervention remains an independent predictor of improved sexual psychological adaptation in post-cervical cancer surgery patients after controlling for multiple potential confounding factors while also finding that partner support level is another important influencing factor.

This result highlights the importance of implementing MBSR within a multidisciplinary care framework that includes gynecologic oncology, psychology, sexual health specialists, and couples’ therapy when appropriate. The synergistic effects of MBSR and partner support suggest that interventions should ideally involve both patients and their partners to maximize therapeutic benefits. Future research should explore the optimal timing, duration, and intensity of MBSR interventions as well as potential combination therapies with medical treatments (such as vaginal estrogen therapy, pelvic floor physiotherapy, or sexual aids). Long-term follow-up studies beyond 12 months are needed to understand the durability of treatment effects and to identify patients who may benefit from booster sessions or additional interventions.

This result highlights that in clinical practice, attention needs to be paid not only to individual psychological interventions for patients, but also to the importance of partner participation and support.

While our study demonstrated the effectiveness of MBSR for psychosexual recovery, several limitations warrant consideration. The retrospective design limits causal inference, and the cultural context (Chinese healthcare settings) may affect generalizability to other populations. Additionally, the lack of active control groups (such as other psychotherapy modalities) prevents direct comparison of MBSR's relative effectiveness of MBSR. Future randomized controlled trials with active comparators and longer follow-up periods are needed to strengthen the evidence.

CONCLUSION

In conclusion, this study shows that MBSR, as an integrative mind-body intervention method, can effectively improve anxiety and depression, sexual function, and sexual relationship satisfaction in patients after radical cervical cancer surgery, with lasting effects that maintain independence after controlling for confounding factors, making it worth promoting in clinical practice as an important means for sexual psychological rehabilitation in post-cervical cancer surgery patients.