Introduction Surgical management of gynecologic cancer can cause short- and long-term effects on sexuality, reproductive function, and overall quality of life (QOL) (e.g., sexual dysfunction, infertility, lymphedema). However, innovative approaches developed over the past several decades have improved oncologic outcomes and reduced treatment sequelae. Aim To provide an overview of the standards of care and major advancements in gynecologic cancer surgery, with a focus on their direct physical impact, as well as emotional, sexual, and QOL issues. This overview will aid researchers and clinicians in the conceptualization of future clinical care strategies and interventions to improve sexual/vaginal/reproductive health and QOL in gynecologic cancer patients. Main Outcome Measures Comprehensive overview of the literature on gynecologic oncology surgery. Methods Conceptual framework for this overview follows the current standards of care and recent surgical approaches to treat gynecologic cancer, with a brief overview describing primary management objectives and the physical, sexual, and emotional impact on patients. Extensive literature support is provided. Results The type and radicality of surgical treatment for gynecologic cancer can influence sexual function and play a significant role in QOL. Psychological, sexual, and QOL outcomes improve as surgical procedures continue to evolve. Procedures for fertility preservation, laparoscopy, sentinel lymph node mapping, and robotic and risk-reducing surgery have advanced the field while reducing treatment sequelae. Nevertheless, interventions that address sexual and vaginal health issues are limited. Conclusions It is imperative to consider QOL and sexuality during the treatment decision-making process. New advances in detection and treatment exist; however, psycho-educational interventions and greater patient–physician communication to address sexual and vaginal health concerns are warranted. Large, prospective clinical trials including patient-reported outcomes are needed in gynecologic oncology populations to identify subgroups at risk. Future study designs need clearly defined samples to gain insight about sexual morbidity and foster the development of targeted interventions.

Purpose To characterize patients seeking treatment at a Female Sexual Medicine and Women’s Health Program and examine their sexual/vaginal health issues. Methods Data from clinical assessment forms were extracted from 509 women referred to the Female Sexual Medicine and Women’s Health Program during/after cancer treatment. The form consists of a Vaginal Assessment Scale [VAS], vaginal health items, patient-reported outcomes (PROs) (Sexual Activity Questionnaire [SAQ], Sexual Self-Schema Scale [SSS], Female Sexual Function Index [FSFI]), and exploratory items. Results Of 509 patients, 493 (97%) completed PROs; 253 (50%) received a pelvic examination. The majority had a history of breast (n=260, 51%), gynecologic (n=184, 36%), or colorectal/anal (n=35, 7%) cancer. Mean age was 51.2 years; 313 (62%) were married/partnered. Approximately two-thirds had elevated vaginal pH scores (5–6.5 [35%] or 6.5+ [33%]) and minimal (62%) or no (5%) vaginal moisture. Eighty-seven patients (44%) experienced pain during their exam (23% mild, 11% moderate, 1.5% severe, and 8.5% not indicated). Fifty-three percent engaged in sexual activity with a partner; only 43% felt confident about future sexual activity. Ninety-three percent were somewhat-to-very concerned/worried about sexual function/vaginal health. Approximately half had moderate/severe dryness (n=133, 51%) and dyspareunia (n=120, 46%). Mean SSS score was 60.7, indicating a slightly positive sexual self-view. However, 93.5% (n=429) had an FSFI score <26.55, suggesting sexual dysfunction. Conclusions At initial consult, women reported vaginal dryness, pain, and sexual dysfunction. For many women, pelvic exams showed elevated vaginal pH, lack of moisture, and discomfort with the exam itself. Future analyses will examine changes over time.

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