Baseline characteristics and concerns of female cancer patients/survivors seeking treatment at a Female Sexual Medicine Program

Abstract

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.

American Cancer Society Colorectal Cancer Survivorship Care Guidelines

“…Women with vaginal dryness may benefit from the use of vaginal moisturizers and water or silicone‐based lubricants during intercourse, as recommended by the International Menopause Society for postmenopausal women without a cancer history . If available, referral for counseling and/or sexual health programs may be beneficial …”

“…Multiple studies have shown a strong correlation between sexual dysfunction and psychosocial distress . Thus, primary care clinicians should address sexual function when managing CRC survivors.…”

Psychosexual health in gynecological cancer

“…Vaginal dryness can be a major problem to those women who wish to have sex [27], and appropriate vaginal moisturizers and lubricants can help. The issue of vaginal estrogen is still debated, but should be discussed with the patient, weighing up the risk − benefit ratio for each individual.…”

Validation of Clinical Tools for Vaginal and Vulvar Symptom Assessment in Cancer Patients and Survivors

“…3 Vulvovaginal health is impacted by reduced estrogen and results in symptoms of dryness, decreased lubrication and elasticity, irritation, and discomfort of the vaginal and vulvar tissues. 1,2 Unfortunately, there are a lack of clinical tools that effectively address vulvovaginal health concerns beyond the realm of sexual activity.…”