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Objectives: Sexual dysfunction is a significant survivorship issue in women with gynecologic cancer. We examined the association between chemotherapy and impaired sexual functioning. Methods: A cross sectional study of women with gynecologic cancer was conducted with a 181-item survey of validated instruments. A sub-analysis of women with chemotherapy treatment was performed to examine factors associated with sexual function including age, menopause status, BMI, diagnosis, stage, surgery/radiation use, active disease status, number of regimens, and number of cycles. Sexual dysfunction was measured by change in the Female Sexual Function Index (FSFI) score from pre-treatment with a significant decline in sexual function determined to be a 5.6 point decrease using a Reliable Change Index Statistic (RCIS). Standard statistical tools were employed. Results: A total of 107 (63%) of the women in the larger study had received chemotherapy as part of their treatment and were included in the sub-study. Women undergoing chemotherapy were more likely to experience sexual dysfunction post-treatment (51% vs. 26%; OR 2.9, 95% CI 1.5 -5.7). In bivariate analyses, sexual dysfunction following chemotherapy was associated with age < 50 (80% vs. 42%; OR 5.6, 95% CI 1.9 -16.6), premenopausal (30.8% vs. 12.7%, OR 3.1, 95% CI 1.1 -8.2) cervical cancer (25.5% vs. 10.0%, OR 3.1, 95% CI 1.0 -9.4), and low (I/II) stage (51.1% vs. 24.5%; OR 3.2, 95% CI 1.4 -7.7). Conclusions: Women treated with chemotherapy for gynecologic cancer are at a significant risk of impaired sexual function. Women with cervical cancer, early stage disease, those who are premenopausal, and those younger than age 50 are at the highest risk.

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Despite a 20% discrepancy of preoperative and postoperative histopathology, discrepancy that would alter a perioperative decision for LN dissection occurs in only 0.7% of cases in this retrospective single-institutional experience. Myometrial invasion and tumor size may be more influential than histology in LN selection criteria.

Study Objective: Determine the prevalence of burnout and frustration among participants currently completing a fellowship in minimally invasive gynecologic surgery (FMIGS). Design: Cross-sectional survey.Setting: An anonymous survey was distributed to fellows in November 2018. Participants: Current FMIGS fellows. Interventions: Not applicable. Measurements and Main Results: A total of 57 of 83 (67.7%) FMIGS participants in American Association of Gynecologic Laparoscopists−accredited programs completed a survey regarding fellowship characteristics and experiences. Overall, 40 participants (70.2%) indicated that they were satisfied with their fellowship program experience. There were 33 participants (57.9%) who reported burnout, and 38 participants (66.7%) had experienced anxiety, depression, or extreme fatigue during the last month. Of those who reported burnout, 26 (76.5%) reported that they did not receive support from their fellowship program. Participants who experienced burnout were more likely to be in their second year (p = .003), spent less time per week doing scholarly activities (p = .048), and were less satisfied with their fellowship experience (p <.001). Participants who experienced anxiety, depression, or extreme fatigue had more cofellows in their program (p = .031), worked on average more hours per week (p = .020), and were more often required to practice obstetrics in their fellowship (p = .022). Conclusion: Burnout symptoms are common among physicians across multiple specialties. Our findings suggest that this issue is prevalent among FMIGS participants. In addition, there is a lack of access to emotional and psychologic support programs for fellows experiencing burnout. We hope that this study will prompt attention to this important topic by both individual programs and American Association of Gynecologic Laparoscopists as a society to increase awareness and access to resources and promote wellness for fellows.

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