# Attachment Styles and Sexual Function Among Survivors of Autologous Hematopoietic Stem Cell Transplantation: A Multicenter Study

## TL;DR

This study explores how attachment styles relate to sexual function in cancer survivors who underwent stem cell transplants, finding gender-specific patterns.

## Contribution

The study introduces gender-specific insights into how attachment styles influence sexual function in AHSCT survivors.

## Key findings

- Men showed high erectile function, while women reported moderate sexual dysfunction.
- Women scored higher in discomfort with closeness and showed specific correlations between attachment styles and sexual function domains.
- Findings suggest the need for attachment-informed interventions to improve relationship satisfaction and quality of life.

## Abstract

Background and Objectives: Autologous hematopoietic stem cell transplantation (AHSCT) offers life-saving treatment for hematologic malignancies but can result in persistent sexual dysfunction and relationship challenges. Attachment theory provides a valuable framework for understanding how enduring relational patterns influence sexual well-being. This study aimed to assess sexual function and attachment styles in AHSCT survivors and examine correlations between attachment and sexual health outcomes. Materials and Methods: A multicenter, cross-sectional study was conducted from December 2019 to March 2022 in five public hospitals in Athens, Greece. Participants were 127 adult survivors who had undergone AHSCT between 6 months and 5 years before enrollment. Sexual function was evaluated with the International Index of Erectile Function (IIEF) for men and the Female Sexual Function Index (FSFI) for women. Attachment style was measured using the Experience in Close Relationships Scale–Short Form (ECRSHORT-FORMSCALE). Results: Men demonstrated high erectile function (IIEF total: 54.10 ± 20.1), whereas women reported moderate sexual dysfunction (FSFI total: 22.51 ± 8.95). Both genders showed average attachment levels, with anxiety scoring lowest and discomfort with closeness highest. Between-group comparisons revealed no significant difference in anxiety (p = 0.95), a near-significant difference in avoidance (p = 0.056), and a significant difference in discomfort with closeness (p < 0.0001), with women scoring higher. In men, no significant correlations emerged between attachment and sexual function. In women, higher attachment anxiety correlated negatively with all FSFI domains except pain, avoidance correlated positively with lubrication, and discomfort with closeness correlated negatively with desire and pain. Conclusions: Findings reveal gender-specific patterns in attachment and their influence on sexual function of AHSCT survivors, highlighting the need for attachment-informed interventions to support intimacy, relationship satisfaction, and overall quality of life in survivorship care.