Sexual Health Screening for Gynecologic and Breast Cancer Survivors: A Review and Critical Analysis of Validated Screening Tools

Abstract

Introduction Studies have shown that the sexual health concerns of gynecologic and breast cancer survivors are not adequately being addressed by clinicians. Aim To provide a comprehensive narrative review of validated sexual health screening tools and aid clinicians in choosing a screening tool that will allow them to best address their patients' sexual health concerns Methods A review of PubMed and Google Scholar databases was conducted, using search terms “sexual health”, “screening”, “tools”, “cancer”, and “survivors” to identify sexual health screening tools meeting the following inclusion criteria: 1) published in a peer-reviewed journal, 2) were written in English, 3) included breast and/or gynecological cancer patient population, 4) included self-reported measure of sexual health and function, and 5) underwent psychometric validation. Main Outcome Measure Criteria used to evaluate identified screening tools included ability to assess desire, arousal, satisfaction, orgasm, dyspareunia, solo sexual expression, relationship with partner, body image, distress over changes in sexual function, and support systems. Pre and post- treatment comparisons, differentiation between lack of sexual desire and inability, heterosexual bias, diversity in patient population, and ease of scoring were also evaluated. Results Based upon the inclusion criteria, the following 10 sexual health screening tools were identified and reviewed: Female Sexual Function Index, European Organization for Research and Treatment of Cancer Quality of Life Questionnaires for both Cervical and Endometrial Cancer, Sexual Adjustment and Body Image Scale, Sexual Adjustment and Body Image Scale- Gynecologic Cancer, Sexual Function and Vaginal Changes Questionnaire, Gynaecologic Leiden Questionnaire, Information on Sexual Health: Your Needs after Cancer, Sexual Satisfaction Questionnaire, and Sexual Activity Questionnaire. Most tools assessed satisfaction (n=10), desire (n=9), and dyspareunia (n=8). Fewer addressed objective arousal (n=7), body image/femininity (n=7), partner relationship (n=7), orgasm (n=5), pre/post treatment considerations (n=5), distress (n=4), and solo-sexual expression (n=2). Heterosexual bias (n=3) and failure to differentiate between lack of desire and inability (n=2) were encountered. Conclusion Understanding the strengths and limitations of sexual health screening tools can help clinicians more effectively address cancer survivors' sexual health concerns, which is essential in providing comprehensive care and improving quality of life. Screening tools have room for improvement, such as eliminating heterosexual bias and including cancer and treatment-specific questions. Clinicians can use this guide to select the most appropriate screening tool for their patients and begin bridging the gap in sexual healthcare.

Sexual Health in Women Affected by Gynecologic or Breast Cancer

“…A number of tools exist to assess for sexual dysfunction (Table 1), many of which have been validated among populations of patients with cancer, including 58 : the Brief Sexual Symptom Checklist for Women as a primary screening tool, the ASEX (Arizona Sexual Experience Scale), and the FSFI. 59 Additional options include the single-item screener from the National Institutes of Health’s PROMIS (Patient-Reported Outcomes Measurement Information System) group and the Scientific Network on Female Sexual Health and Cancer, the Sexual Function Questionnaire, 60 and the Sexual Function and Satisfaction measure developed by the PROMIS Network.…”

Pembrolizumab (Keytruda)

“…21 Based on consensus-based standards, the EORTC QLQ-CX24 has been reported to have poor internal consistency and structural validity, but excellent content and cross-cultural validity in a review report. 42 In another systematic review, good evidence for reliability, construct validity and content validity, and some limited evidence for criterion validity had been reported for the EORTC QLQ-CX24. 43 Another systematic review paper discussed about the uncertainty of the validity of the EORTC QLQ-CX24 questionnaire for cervical cancer patients, focusing on the fact that 5 out of 9 psychometric properties were either doubtful or not reported in current literature.…”

“…43 Another systematic review paper discussed about the uncertainty of the validity of the EORTC QLQ-CX24 questionnaire for cervical cancer patients, focusing on the fact that 5 out of 9 psychometric properties were either doubtful or not reported in current literature. 44 The responsiveness was either not reported 42,43 or had a doubtful design or method to get a score. 44…”

Factors affecting women's sexual life after oncological treatment of breast cancer

“…Due to the detrimental consequences on quality of life, the impact on selfesteem and interpersonal relationships, and the association with recurrent emotional disorders, the World Health Organization (WHO) recognizes sexual dysfunction as a public health problem [14]. Oncological patients must overcome many challenges that will allow them to return to total sexual health: reduced self-attractiveness, decreased libido, sexual dysfunction, a sense of imperfection, and fear of rejection [15]. As already mentioned, there are various treatment options for breast cancer, and choosing a specific therapy will have several consequences.…”