Objective: To review the sexual health concerns of women with gynecologic cancer and provide guidance for primary care physicians.
Methods: Review of the literature.
Results: Issues of sexuality and intimacy are known to significantly impact the quality of life of patients following diagnosis and treatment of gynecologic cancers. At the time of diagnosis, women should be informed of the potential physiologic, hormonal, and psychosocial effects of gynecologic cancer on sexuality. Many providers fail to address these issues given time constraints and patients’ trepidation in alerting their providers to their concerns. While systemic hormone therapy directly addresses these symptoms, its use remains controversial due to potential cancer recurrence risks. Thus, treatment centers around therapeutic alternatives. For vasomotor symptoms, selective serotonin reuptake inhibitors have shown effectiveness and are typically well tolerated, and antiepileptics such as gabapentin have shown promise. There is promising but limited data employing pelvic floor physical therapy as a tool to aid in addressing pelvic floor symptoms. Psychological care and the involvement of the partner are also part of managing the sexual health concerns of these patients.
Conclusion: Sexual morbidity is a distressing and undertreated problem among gynecologic cancer survivors. Successful treatment requires the provider’s appreciation of the problem and willingness to address it.
Issues of sexuality and intimacy are known to significantly impact the lives of patients following diagnosis and treatment of gynecologic cancers. [1,2] Treatment of gynecologic malignancy is highly dependent on pathology and stage, with some patients receiving small excisional procedures while others subject to extensive surgeries, chemotherapy, and radiation treatment, and it is difficult to predict how each individual’s sexual health will be impacted. However, the evidence suggests that at least half of women treated for gynecologic cancer will experience sexual dysfunction [3]. Although the impact of gynecologic cancer and treatment can be profound, providers often do not address their patients’ sexual concerns [4,5], yet most patients have indicated that they would like these issues to be addressed [6].
Female Sexual Dysfunction
Sexual dysfunction is multifactorial and involves physical, social, and psychological dimensions. It is common in the general population, with rates ranging from 25-63% [7]. The DSM-IV [8] defines female sexual dysfunction as a disturbance in or pain during the sexual response, which can be further classified as hypoactive sexual disorder, orgasmic disorder, sexual pain disorder, or sexual arousal disorder [9]. It should be noted that women who have been treated for gynecologic cancers may have a premorbid history of sexual dysfunction. Assessment of a woman’s sexual function prior to her cancer diagnosis can help establish which sexuality changes are due to the cancer treatment and may allow the provider to tailor interventions accordingly.
Sexual Dysfunction and Quality of Life
As treatments for gynecologic cancers improve, toxicity of treatment decreases, and survival increases, quality of life for survivors has become as become an increasingly important health issue. Several studies have examined patient-reported quality of life in short- and long-term cancer survivors and report overall significant alteration in quality of life over many aspects of health and psychological well-being [10]. It is well established that health-related quality of life and sexual functioning are closely associated [11].
