Maintaining sexual health throughout gynecologic cancer survivorship: A comprehensive review and clinical guide

Abstract

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.

Physical Therapy in Patients with Cancer

“…A few previous reports showed that physical therapy has a positive efect on gynecologic cancer patients [37]. Physical therapists should perform pelvic loor physical therapy as a tool to aid in addressing pelvic loor symptoms [37].…”

“…Physical therapists should perform pelvic loor physical therapy as a tool to aid in addressing pelvic loor symptoms [37]. In general, physical therapy for gynecologic cancer patients includes locomotion ability exercises such as standing and walking, lymphatic drainage massage, vantage, manual stretching, myofascial therapy, relaxation massage, stretching, strengthening, resisted exercise, PNF, aerobic exercise, TENS, patient education, and behavioral training.…”

Approach to sexual dysfunction in women with cancer

“…Identification of patients suffering from sexual health issues should include information about sexual function before cancer, current sexual activity, and how cancer treatment has affected sexual life and the intimate relationship with their partner 3. Discussions between patients and their providers is often the most important intervention.…”

“…Female sexual dysfunction is classified into three categories, although there is often considerable overlap: female sexual interest/arousal disorder, female orgasmic disorder, and genito-pelvic pain/penetration disorder. In order to meet criteria for the diagnosis of female sexual dysfunction, symptoms must be present for at least 6 months and cause clinically significant distress 3. Definitions are presented in Table 1.…”

“…Typically, gynecologic cancer survivors experience sexual morbidity as a result of their treatment 3. A practical approach to selecting proper treatment of sexual dysfunction in female cancer patients includes three steps focused on knowledge, diagnosis, and dialog.…”