The Physical Consequences of Gynecologic Cancer Surgery and Their Impact on Sexual, Emotional, and Quality of Life Issues

Abstract

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.

Self-Reported Sexual Function Measures Administered to Female Cancer Patients: A Systematic Review, 2008–2014

“…Standardization also helps measure the magnitude of expected versus observed sexual functioning. Clinically, using any sexual functioning measure may help patients and/or providers initiate questions about sexual function and improve their communication about sexual functioning (Carter, Stabile, Gunn, & Sonoda, 2013; Dizon, Suzin, & McIlvenna, 2014). Elsewhere, with men treated for prostate cancer, help seeking behaviors for sexual dysfunction appears to be directly related to cancer stage and severity of dysfunction (Schover, Fouladi, Warneke, et al, 2004).…”

Sexual Activity and Function in Patients With Gynecological Malignancies After Completed Treatment

“…1,9Y12 Most women diagnosed with GC are elderly and postmenopausal; however, previous studies have also shown that elderly patients continue sexual relationships after diagnosis of cancer if possible. 13,14 Sexuality should therefore be addressed as a central topic during consultation of all patients. 15 Ekwall et al observed that openness and communication about sexual issues is often lacking.…”

Determination of Sexual Problems of Turkish Patients Receiving Gynecologic Cancer Treatment: a Cross-sectional Study

“…Womens' perceived causes of diseases may increase their risk for anxiety. Communication between the patient and clinician about sexual issues offers the health care professional the ability to understand a patient's concerns and offer appropriate treatments (Audette and Waterman, 2010;Carter et al, 2013).…”