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Purpose The adaptation of the Cancer Care Ontario (CCO) guideline Interventions to Address Sexual Problems in People With Cancer provides recommendations to manage sexual function adverse effects that occur as a result of cancer diagnosis and/or treatment. Methods ASCO staff reviewed the guideline for developmental rigor and updated the literature search. An ASCO Expert Panel ( Table A1 ) was assembled to review the guideline content and recommendations. Results The ASCO Expert Panel determined that the recommendations from the 2016 CCO guideline are clear, thorough, and based upon the most relevant scientific evidence. ASCO statements and modifications were added to adapt the CCO guideline for a broader audience. Recommendations It is recommended that there be a discussion with the patient, initiated by a member of the health care team, regarding sexual health and dysfunction resulting from cancer or its treatment. Psychosocial and/or psychosexual counseling should be offered to all patients with cancer, aiming to improve sexual response, body image, intimacy and relationship issues, and overall sexual functioning and satisfaction. Medical and treatable contributing factors should be identified and addressed first. In women with symptoms of vaginal and/or vulvar atrophy, lubricants in addition to vaginal moisturizers may be tried as a first option. Low-dose vaginal estrogen, lidocaine, and dehydroepiandrosterone may also be considered in some cases. In men, medication such as phosphodiesterase type 5 inhibitors may be beneficial, and surgery remains an option for those with symptoms or treatment complications refractory to medical management. Both women and men experiencing vasomotor symptoms should be offered interventions for symptomatic improvement, including behavioral options such as cognitive behavioral therapy, slow breathing and hypnosis, and medications such as venlafaxine and gabapentin.Additional information is available at: www.asco.org/survivorship-guidelines and www.asco.org/guidelineswiki .

BACKGROUND:The Female Sexual Function Index (FSFI) is the most commonly used self-report instrument to measure sexual functioning among women cancer survivors. Despite this, the validity and reliability of the FSFI for use in cancer populations has not been established. METHODS: Data were combined from 3 separate institutional review board-approved studies of the psychosexual adjustment of women cancer survivors conducted at Memorial Sloan-Kettering Cancer Center. Psychometric analysis was applied to the FSFI responses from 181 women comprising 4 cohorts, including survivors of: gynecologic cancer (all types; 2 cohorts), malignancies requiring bone-marrow/stem cell transplantation, and early stage cervical cancer. RESULTS: A factor analysis supported the subscale structure of the FSFI, yielding results nearly identical to those from the original FSFI validation study. Internal consistency reliability was 0.94 for the FSFI total score and ranged from 0.85 to 0.94 for the domain scores. Corrected item-total correlations ranged from 0.44 to 0.79 for the total score and from 0.62 to 0.88 for the domain scores. FSFI scores were correlated negatively with measures of depression, distress, and menopausal symptoms and were correlated positively with quality of life. FSFI scores exhibited a preliminary ability to discriminate between women based on whether or not they received chemotherapy and/or radiation. CONCLUSIONS: The FSFI demonstrated strong psychometric properties in this study, supporting its continued use for monitoring sexual function and cancer-related dysfunction among sexually active women who are cancer survivors.Cancer 2012;118:4606-18. V C 2012 American Cancer Society.KEYWORDS: women, sexual dysfunctions, physiological, sexual dysfunctions, psychological, survivors, quality of life, psychometrics, questionnaires, self-report. INTRODUCTIONFemale sexual dysfunction (FSD) is quite common among women who have survived cancer, 1-5 and the most commonly used measure to assess sexual functioning in this population is the Female Sexual Function Index (FSFI). 6 However, the FSFI originally was developed and validated in healthy women, and the validity and reliability of the FSFI in cancer populations has not been established.FSD resulting from cancer may differ qualitatively and quantitatively from FSD experienced in otherwise healthy women. Cancer treatments, including surgery, chemotherapy, radiotherapy, and hormone therapy, can directly affect sexual organs and hormone levels, 1 resulting in vaginal shortening and stenosis, decreased vaginal lubrication and elasticity, as well as disruption of the sexual response cycle. 2 A survey of long-term vaginal and cervical cancer survivors reported rates of FSD well over twice those of matched healthy controls; in particular, survivors had >14 times the odds of dyspareunia compared with controls. 4 FSD also has been identified as a primary source of psychological distress after cervical cancer treatment 7 and as an independent predictor of depressive symptoms. 8 FSD ca...

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.

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Objective To prospectively assess and describe the emotional, sexual, and QOL concerns of women with early-stage cervical cancer undergoing radical surgery. Methods Seventy-one women who were consented for radical trachelectomy (RT) or radical hysterectomy (RH) were enrolled preoperatively in this 2-year study; 52 women (33 RT; 19 RH) were actively followed. Patients completed self-report surveys composed of 4 empirical measures in addition to exploratory items. Data analyses for the 2 years of prospective data are presented. Results At preoperative assessment, women choosing RH reported greater concern about cancer recurrence (x=7.27 [scale from 0 to 10]) than women choosing RT (x=5.66) (P=0.008). Forty-eight percent undergoing RH compared to 8.6% undergoing RT reported having adequate “time to complete childbearing” (P<0.001). Both groups demonstrated scores suggestive of depression (based on the CES-D scale) and distress (based on the IES scale) preoperatively; over time, however, CES-D and IES scores generally improved. Scores on the Female Sexual Functioning Inventory (FSFI) for the total sample were below the mean cut-off (26.55), suggestive of sexual dysfunction; however, the means increased from 16.79 preoperatively to 23.78 by 12 months and 22.20 at 24 months. Conclusion Measurements of mood, distress, sexual function, and QOL did not differ significantly by surgical type, and instead reflect the challenges faced by young cervical cancer patients treated by RT or RH without adjuvant treatment. Points of vulnerability were identified in which patients may benefit from preoperative consultation or immediate postoperative support. Overall, patients improved during the first year, reaching a plateau between Year-1 and Year-2, which may reflect a new level of functioning in survivorship.

Mortality from ovarian cancer may be dramatically reduced with the implementation of attainable prevention strategies. The new understanding of the cells of origin and the molecular etiology of ovarian cancer warrants a strong recommendation to the public and health care providers. This document discusses potential prevention strategies, which include 1) oral contraceptive use, 2) tubal sterilization, 3) risk-reducing salpingo-oophorectomy in women at high hereditary risk of breast and ovarian cancer, 4) genetic counseling and testing for women with ovarian cancer and other high-risk families, and 5) salpingectomy after childbearing is complete (at the time of elective pelvic surgeries, at the time of hysterectomy, and as an alternative to tubal ligation). The Society of Gynecologic Oncology has determined that recent scientific breakthroughs warrant a new summary of the progress toward the prevention of ovarian cancer. This review is intended to emphasize the importance of the fallopian tubes as a potential source of high-grade serous cancer in women with and without known genetic mutations in addition to the use of oral contraceptive pills to reduce the risk of ovarian cancer. Cancer 2015;121:2108-20.

The emotional and physical impact of impaired or loss of fertility can be complex and long lasting, with women experiencing high levels of distress, menopausal symptoms, and changes in sexual function persisting into survivorship. Future research should focus on the development of strategies to identify, monitor, and address, in a clinical care setting, the issues these cancer survivors face. Alternate family-building strategies should also be explored before treatment and/or upon treatment completion when feasible.