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


Cancer Nurs. 2014;37(1):75-82. 

In This Article


This study provides a new look at the meaning of fertility preservation in women with cervical cancer through the identity transformation process. A process was articulated in which the feminine identity of women with cervical cancer was threatened by the diagnosis of cancer, repaired by fertility preservation with radical trachelectomy, and reconstructed after the surgery, through interactions with self, others, and external events.

Fertility is a major concern of young female cancer patients as well as those who have their children before the diagnosis of cancer but want more children.[17] The cancer patient's complex needs are often discussed in the literature;[18–20] however, the meaning of fertility preservation, especially after fertility preservation surgery, has not yet been explored. Our findings challenge the perceived notion that all women who undergo fertility preservation surgery want children as soon as their condition allows.

Childbearing is a core component of a woman's identity,[21–23] and therefore the possibility of losing fertility poses an identity crisis. Femininity is a fundamental part of the female consciousness and behaviors. In the present study, the women felt that they would be "less" or "incomplete" as a woman if the uterus were removed. These feelings are often cited in the literature.[6,10,20,21] Feeling incapable as a woman is critical for the female cancer patient, and being "infertile" or "presumably fertile" is completely different for her: being infertile makes her feel "defective" as a woman,[22] but being "presumably fertile" maintains a female function, and thus her feminine identity is protected. This perception is reflected in the high satisfaction of the participants with respect to their radical trachelectomy, even though their reproductive outcomes have not yet been achieved in many cases.

Olsbansky[24] describes the unpleasant feelings of infertile women that cause them to try to "shed," "push," or "diminish" their identity as infertile to a peripheral position. Involuntary sterility means a loss of the woman's reproductive control and issues then arise with respect to the resultant adjustment of identity and redefinition of femininity.[22] Similar feelings of "incompleteness" and shifting priorities are indicated in studies on masculine identity in patients with prostate cancer.[25,26] Incontinence and erectile dysfunction as sequelae weaken the men's beliefs about masculinity, but they reprioritize their values.[25,26]

It is important that healthcare providers understand the meaning of fertility preservation for individual women. It is common for the gynecologist to encourage the patient to attempt to conceive after radical trachelectomy,[9] but some of the participants in the present study confessed that they felt pressure to do so. These results indicate that there are still gaps in understanding between the patient and the healthcare provider. Healthcare providers are easily guided by their preconception that fertility preservation surgery equals childbearing, and they therefore try to achieve it, often with fertility treatment for the patient. However, the present study strongly suggests that healthcare providers need to change their way of thinking and should be flexible dealing with cases that are not necessarily typical. It is particularly important in societies such as Japan, where strong social pressure still exists on women to be good wives and mothers, although women are gaining equality in urban cities. Advanced reproductive technology gives great hope to infertile women who desire to have children; however, it also may exert the social pressure on women to conceive.

The identity transformation process can be explained in the context of the theory of symbolic interactionism. As Blumer[12] explains, self-interaction is a reflexive process; the woman expresses herself, and the meaning of fertility preservation for her determines whether she undergoes radical trachelectomy and her life perspectives after the surgery. The woman also compares her meaning of fertility preservation with the views of "significant others" and "generalized others," because the meaning was created through interactions with self and others. As other studies have noted in a society in which femininity is equal to fertility and motherhood is the most desired virtue in a wife,[20,21] social norms often influence the feminine identity in addition to the views of the woman's family. The identity or self-concept is not static; it is a continuous process that evolves through ongoing interaction.[13,27] Interactions change women's views so that the meaning of fertility preservation can be changed.