Repair of the Threatened Feminine Identity

Experience of Women With Cervical Cancer Undergoing Fertility Preservation Surgery

Hiroko Komatsu, PhD, RN; Kaori Yagasaki, MSN, RN; Rie Shoda, RN; Younghui Chung, RN; Takashi Iwata, PhD, MD; Juri Sugiyama, MD; Takuma Fujii, PhD, MD

Disclosures

Cancer Nurs. 2014;37(1):75-82. 

In This Article

Abstract and Introduction

Abstract

Background: Fertility preservation is important for women of reproductive age with cervical cancer. The underlying reasons behind suboptimal reproductive results after successful fertility-preserving surgery have not yet been fully revealed.

Objective: The objective of this study was to explore the experience of fertility preservation with radical trachelectomy from the perspective of women with cervical cancer.

Methods: We conducted interviews with women with cervical cancer who underwent radical trachelectomy using a Grounded Theory methodology with a theoretical framework of symbolic interactionism.

Results: Our findings articulate a process in which feminine identity is first threatened by a diagnosis of cancer, then repaired by fertility preservation with radical trachelectomy, and finally reconstructed after the surgery, through interactions with self, others, and external events in women with cervical cancer. Feeling incomplete as a woman because of the loss of the uterus was a critical factor in the women's feeling that their feminine identity was threatened. Thus, fertility preservation was significant for these women. The meaning of fertility preservation varied among the women, and their life perspectives were therefore distinct after the surgery.

Conclusions: Women with cervical cancer who undergo radical trachelectomy experience an identity transformation process, and child bearing is not the only expected outcome of fertility preservation.

Implications for Practice: Nurses should coordinate care through the cancer trajectory. Understanding the identity transformation process helps nurses to assess patients' needs and provide appropriate individual care.

Introduction

Given the recent global rise in cervical cancer at younger ages, fertility concerns are warranted.[1–4] Women of reproductive age with cervical cancer are at 2 different ends of the spectra: a confrontation with a life-threatening disease and the creation of a new life. Being sensitive to patients' true feelings and thoughts helps nurses provide the best and most appropriate care.[5]

Radical trachelectomy has been available for 2 decades as a fertility preservation surgery for early-stage cervical cancer patients who wish to preserve their fertility.[6] Radical trachelectomy is similar to a radical hysterectomy that the cervix is removed after ruling out metastasis with lymphadenectomy, but it leaves the uterus so that later pregnancy could occur.[4] However, despite successful fertility-preserving surgery, both pregnancy and birth rates are unexpectedly low (20 pregnancies and 13 live births in 269 radical trachelectomies between 2000 and 2008), according to a survey by the Japan Society of Obstetrics and Gynecology.[3] The corresponding results at our institution seem better (16 pregnancies and 14 live births in 126 trachelectomies),[7] as do the international data (300 pregnancies and 196 live births in more than 900 trachelectomies worldwide);[8] however, these results are still suboptimal.

Despite a high pregnancy rate among those who tried to become pregnant, 64.1% of patients who underwent trachelectomy reported they had no current wish for pregnancy,[9] and very few women tried to conceive in the 12 to 24 months after the surgery.[10] The underlying reasons for these suboptimal reproductive results have not yet been fully medically explained. Although women have reproductive freedom and choices,[11] the meanings of fertility preservation and childbearing before and after the surgery have rarely been studied from the perspective of women.

The aim of this study was to explore the experience of fertility preservation with radical trachelectomy from the perspective of women with cervical cancer. The following research questions framed this research:

  1. What is the meaning of fertility preservation for women with cervical cancer?

  2. Why do reproductive outcomes remain suboptimal despite successful fertility preservation surgery?

  3. How do the women in question perceive childbearing after fertility-preserving surgery?

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