Maintaining sexual health throughout gynecologic cancer survivorship: A comprehensive review and clinical guide

Abstract

Objective: The diagnosis and treatment of gynecologic cancer can cause short- and long-term negative effects on sexual health and quality of life (QoL). The aim of this article is to present a comprehensive overview of the sexual health concerns of gynecologic cancer survivors and discuss evidence-based treatment options for commonly encountered sexual health issues.

Methods: A comprehensive literature search of English language studies on sexual health in gynecologic cancer survivors and the treatment of sexual dysfunction was conducted in MEDLINE databases. Relevant data are presented in this review. Additionally, personal and institutional practices are incorporated where relevant.

Results: Sexual dysfunction is prevalent among gynecologic cancer survivors as a result of surgery, radiation, and chemotherapy-negatively impacting QoL. Many patients expect their healthcare providers to address sexual health concerns, but most have never discussed sex-related issues with their physician. Lubricants, moisturizers, and dilators are effective, simple, non-hormonal interventions that can alleviate the morbidity of vaginal atrophy, stenosis, and pain. Pelvic floor physical therapy can be an additional tool to address dyspareunia. Cognitive behavioral therapy has been shown to be beneficial to patients reporting problems with sexual interest, arousal, and orgasm.

Conclusion: Oncology providers can make a significant impact on the QoL of gynecologic cancer survivors by addressing sexual health concerns. Simple strategies can be implemented into clinical practice to discuss and treat many sexual issues. Referral to specialized sexual health providers may be needed to address more complex problems.

Keywords: Female sexual dysfunction; Gynecologic cancer; Quality of life; Sexual health.

Copyright © 2015 Elsevier Inc. All rights reserved.

Figures

Figure 1

Schema and resources for promoting sexual health in gynecologic cancer survivors based on level of patient complexity.

Figure 2

Options for screening for sexual health problems in gynecologic oncology survivors. *Reprinted with permission from Hatzichristou D, et al. Recommendations for the clinical evaluation of men and women with sexual dysfunction. J Sex Med. 2010;7:337-348. **Proposed by the PROMIS® group and the Scientific Network on Female Sexual Health and Cancer. Reprinted with permission from Flynn K, Development and Validation of a Single-Item Screener for Self-Reporting Sexual Problems in U.S. Adults, JGIM. Online publication 18 April 2015