Vaginal and sexual health treatment strategies within a female sexual medicine program for cancer patients and survivors

Abstract

Purpose We sought to evaluate patient adherence and response to simple vaginal and sexual health treatment strategies in female cancer patients receiving treatment at a female sexual medicine and health program, and identify improvements of physical symptoms, per patient and clinical evaluation. Methods Evalubility criteria included gynecologic exam at initial visit; at least one follow-up with gynecologic exam within 8 months of initial visit; and all consecutive follow-ups <6 months apart. Demographics, medical information, and clinical assessments from 175 evaluable patients with at least 1 follow-up from 09/12–10/14 were analyzed. The majority of patients were being treated for or had a history of breast (n=90, 53%), gynecologic (n=54, 32%), or colorectal/anal (n=15, 9%) cancers. An assessment form included a clinician evaluation, Vaginal Assessment Scale (VAS), Vulvar Assessment Scale (VuAS), and patient-reported outcomes. Compliance with treatment recommendations were summarized, and changes over time were compared for clinical outcomes. Results Mean number of visits was 3.43. Mean age was 55.4 years; 92% (n=155/169) were in menopause. Treatment strategies included rationale and instruction for use of vaginal moisturizers, lubricants, pelvic floor exercises and dilator therapy, in addition to psychosexual education regarding sexual changes (response, anatomy and function) associated with cancer treatment and support. At last assessment, 89% had complied with the clinical recommendation (moisturize 2–5+ times/week). Vaginal pH scores >6.5 declined over time (p=0.03). VAS scores improved by last assessment (p<0.001), as did VuAS scores (p=0.001). Sexual function scores significantly improved (p<0.001), confidence about future sexual activity increased (p=0.004), and sexual/vaginal health concerns decreased (p=0.00003). Conclusion Significant changes were observed in women using treatment strategies, with improvement in vulvovaginal symptoms, a decrease in elevated vaginal pH and pain with exams, enhanced sexual function, and intimacy confidence. Implications for Cancer Survivors These findings have high clinical relevance for symptom management with improvement of sexual function using simple strategies and clinical tools in the oncology setting.

Comparação da disfunção do assoalho pélvico com função sexual e qualidade de vida em sobreviventes ao câncer ginecológico

“…Alguns estudos sugerem que a manutenção da atividade sexual regular em mulheres ativas sexualmente é um fator preventivo para o surgimento da estenose vaginal (LANCASTER, 2004;CARTER;GOLDFRANK;SCHOVER, 2011;PESSI et al, 2016;HUFFMAN et al, 2016). Pessi et al (2016) realizaram um estudo descritivo utilizando como intervenção orientações para a prevenção da estenose vaginal pós-braquiterapia em sobreviventes ao câncer de colo uterino, abordando a manutenção das relações sexuais, de duas a três vezes por semana para as pacientes ativas sexualmente, com associação de uma prótese peniana nos casos em que a frequência das relações fosse inferior à indicada.…”

“…As disfunções do assoalho pélvico são tópicos importantes abordados nas complicações pós-tratamento do câncer ginecológico (YE et al, 2014), sendo as queixas mais relatadas pelas mulheres o baixo desejo sexual, secura e alterações anatômicas da região vaginal, anorgasmia e dispareunia (BRADFORD et al, 2015). Ao exame objetivo, a disfunção mais frequente é a estenose vaginal (YOSHIDA et al, 2015), relacionada à diminuição da largura e elasticidade da mucosa vaginal, provocando dor e desconforto durante a atividade sexual (CARTER et al, 2017) e dificultando a realização de exames ginecológicos de rotina, indispensáveis no seguimento clínico dessas mulheres (SILVA et al, 2010;ROS;ESPUNA, 2013).…”

Autologous Platelet-Released Growth Factor and Sexual Dysfunction Amendment: A Pilot Clinical Trial of Successful Improvement Sexual Dysfunction after Pelvic Irradiation

“…Available therapeutic options such as vaginoplasty and hormone replacement therapy are not suitable. The risk of fistula and secondary reconstruction vaginal stenosis following surgery and a relapse of the tumor due to hormonal administration are the common concern of these therapeutic strategies (Kingsberg et al, 2010;Carter et al, 2017). Owing to the many probable etiologic factors involved in FSD and the inconsistency in the response to current treatment modalities, this part needs research to introduce effective therapeutic options (Buster, 2013;Milbury et al, 2013).…”

“…The cited treatment strategies have not been successful, because of the concern around the risk of fistula after surgery and cancer recurrence following estrogen intake (Phillips, 2000;Kingsberg et al, 2010). Therapeutic alternatives for solving these patients are very special because of the median age of adult females who became radiation-induced cancer was so high and the tone of sex life was not a priority for patients (Carter et al, 2017). During the past decade by changing the shape of cancer outbreaks in younger women and progress in developing new radiation methods for cancer treatment, life expectancy has increased and quality of sexual relations has been spotlighted.…”

“…Platelet related products have been a satisfactory outcome in the treatment of chronic skin and soft tissue lesions and plastic surgeries (Serra-Mestre et al, 2014;Mohammadi et al, 2017a). In new strategies for treatment of FSD, following the cited facets should be considered (Farmer et al, 2016;Carter et al, 2017) • Do not contain hormonal combinations • Able to reduce fibrosis and enhances vaginal flexibility…”