Representations of Vaginal Symptoms in Cervical Cancer Survivors

Jennifer M. Tornatta MSN, RN; Janet S. Carpenter PhD, RN; Jeanne Schilder, MD; Higinia R. Cardenes, MD, PhD


Cancer Nurs. 2009;32(5):378-384. 

In This Article

Theoretical Framework

Leventhal's Self-regulation Theory, also called the Common Sense Model of Illness Representation, guided this study.[30] This model is based upon a person's understandings, or representations, of a health threat and how representations affect a person's coping or regulate their behavior. The representation is the person's understanding of her/his health threat based upon previous experiences that she/he uses to cope. The understanding of the health threat involves 6 constructs: identity, the label associated with the symptoms of the threat; emotions/distress, the emotional response to the threat; timeline, the threat's length of onset (ie, acute, chronic, or cyclical); consequences, perceived possible outcomes of the threat; cause, the person's beliefs about the origin of the health threat; and control/cure, the belief that something can help control/relieve the threat.[30–32] According to the model, health threat representations influence coping strategies, choices, compliance, and goals.

Leventhal's theory has been adapted for symptoms so that patients' symptom representations are studied, rather than their health threat representations. For example, Donovan and Ward[29] developed a Symptom Representation Questionnaire (SRQ) based upon Leventhal's Self-regulation Theory to measure symptom representations. They found that, on average, gynecologic oncology patients undergoing treatment reported 14 different symptoms with a mean severity of 4.44 on a scale of 1 to 10 (symptom identity).[29] Fatigue was commonly identified among the top 3 most bothersome symptoms. However, 59% of women had not discussed fatigue with their healthcare providers at their last appointment, although it was the most noticed symptom for 50% of patients during the past week.

The study of Donovan and Ward[29] seems to be the only study of symptom representations in gynecological cancer patients. However, vaginal symptoms were not assessed in depth because they were not the focus of the research and all patients were undergoing treatment.[29] No vaginal symptoms and only 1 sexuality item (sexuality concerns) were included. Therefore, this one existing study does not provide information on representations of vaginal symptoms, some of the most commonly experienced symptoms in cervical cancer patients.


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