Human papillomavirus is among the most prevalent sexually transmitted infections in young adults (1). More than 130 types of this virus have been identified, which are classified as high-risk and low-risk based on their epidemiologic association with cervical cancer. The low-risk types include types 6 and 11 causing genital warts 90% of the time, and the high-risk types include types 16 and 18 causing cervical intraepithelial neoplasia (CIN) and cervical cancer (1). The general prevalence of HPV and its high-risk genotypes (types 16 and 18), which lead to cervical cancer, is high among Iranian women (2). It is estimated that cervical cancer is the fourth cancer and the most common neoplasm in women worldwide. Although cervical cancer can be prevented, it remains a public health issue in developing countries due to poor preventive and control plans (3). Over 570,000 new cervical cancer cases are diagnosed throughout the world every year, most of which are caused by resistant high-risk HPV infection (4). The prevalence of cervical cancer is 6 times higher in developing countries. It has been shown that 35–65% of women are infected due to sexual intercourse with infected men (5).
Quality of life is people’s perception of their situation in terms of their goals, expectations, standards, and concerns (6). Quality of life is a fundamental indicator of health, and it is of great significance since it has different dimensions such as physical health, psychological well-being, social relations, familial life, emotions, physical functions, and professional life (7).
HPV infection affects women’s quality of life in a way that encompasses not only physical but also psychological, environmental, social, sexual, and emotional aspects (6, 8). Anxiety and concerns about the results and cancer (4), a decline in well-being and quality of life in terms of health (9, 10), decreased sexual satisfaction, sexual depression, lower femininity, and disruptions in sexual relationships (11, 12), lower sexual well-being (13), and negative psycho-social impacts (14, 15). are some of the complications. Women who get abnormal pap smear test results experience an undesirable psychological burden (16), leading to a decline in their psychological health and social functions (17).
Positive pap smear results create a fear of being judged, weakness, humiliation, and the sexual partner’s anger (6). Moreover, there are other concerns such as malignancy, partner’s betrayal, being accused of betrayal, transmission to the partner, the pain of colonoscopy, and infertility (18).
Chronic psychological stress can affect the durability of HPV clinical symptoms and contribute to the progress of HPV-related cervical cancer. Furthermore, a large number of studies have reported that there is a relationship between psychological stress and the prevalence and progress of this virus in relation to cervical dysplasia and cancer (19, 20). People with a positive high-risk HPV test have been shown to have significantly higher cortisol levels compared with those with a negative test, and chronic stress and daily cortisol are associated with HPV infection. Therefore, they can contribute to the progress of the lesions toward cervical cancer (19, 20). Stress can increase the severity and duration of infectious diseases and reactivate latent viruses (21).
Self-blame strategies are significantly more prominent in HPV patients, and they use more inconsistent coping mechanisms compared with patients with less stressful events. In fact, helping these people to find effective strategies can lead to a more desirable clinical outcome (21). Interventions based on stress management significantly decrease cervical neoplasia (22). Also, women infected with HPV need more psycho-social support (23). Due to the undesirable effects of HPV, considering psychiatric and psychological treatments can be useful in managing patients (24–26). Women’s negative responses to HPV tests must be identified, and more support should be provided to them (27). Many HPV-positive patients need more information about the transmission methods, causes, and consequences of the virus. They also have concerns and incorrect perceptions such as believing that positive results equal cancer (28). Counseling strategies to establish a connection between healthcare providers and women enable them to gain more awareness about HPV and cervical cancer (29–31). It can also lead to the improvement of health and quality of life in them (32).
HPV patients struggle with numerous challenges and needs in physical, psychological, emotional, and sexual aspects of quality of life in relation to this virus, and various studies have recommended counseling interventions to improve these people’s quality of life. Also, there is a need for standardized and normalized instruments in Iran to evaluate the effect of educational and therapeutic interventions on these patients’ quality of life. Therefore, this study was conducted in gynecologic cancer clinics in Kerman in 2023 to investigate the psychometric properties of the Persian version of the “quality of life of women infected with HPV questionnaire”.