Screening Sexual Health

Although sexual health is important to quality of life and many patients with cancer experience sexual dysfunction, the topic is often not discussed during oncology care visits.3 Barriers to discussing sexual health exist for both the oncology provider and the patient. Oncology providers may assume that the patient is not interested in sexual function due to age, prognosis, or marital/partner status; may not feel comfortable discussing sexual dysfunction due to lack of training; or may simply feel that they do not have the time during the visit to discuss sexual health. Patients often feel uncomfortable or embarrassed raising the topic of sexual dysfunction and may expect that their dysfunction is not treatable. Sexual health, however, is an important aspect of oncology care.

The American Society of Clinical Oncology (ASCO) guideline for sexual problems recommends that oncology providers initiate a discussion about sexual health and dysfunction with all patients with cancer at the time of diagnosis and throughout their care. Partners may be included in the discussion, if the patient desires. The National Comprehensive Cancer Network (NCCN) also recommends that sexual function be screened at regular intervals and provides several screening tools for men and women that oncology providers can use during visits.6 These questionnaires include questions about sexual function, desire, confidence, and satisfaction. Answers to these questions can help oncology providers determine if dysfunction is present and next steps to addressing any potential issues.

Management Options

There are multiple treatment options for sexual dysfunction depending on the problem and its cause. Some oncology providers may feel comfortable providing treatment, whereas others may provide a referral to a gynecologist or a sexual health specialist.2  Some patients may not feel comfortable discussing sexual health with their oncology provider and may prefer a referral to a specialist.6

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Psychosocial or psychosexual counseling may be recommended for women or men and, if desired, their partners, for those who have sexual health issues related to body image, sexual response, intimacy or relationship, and overall concerns about sexual functioning and satisfaction.3

Women

Women with postmenopausal-like symptoms from hormonal therapy may benefit from hormonal therapy, if they do not have a history of hormone-sensitive breast cancer.3

The treatment for vaginal symptoms vary depending on the specific problem. Vaginal or vulvar dryness or atrophy can be treated with frequent use of vaginal moisturizers, lubricants during sexual activity, and local estrogen treatment with creams, rings, or suppositories within the vagina.3,6 Pain with intercourse may be treated with vaginal dilators if narrowing is present, pelvic floor physical therapy, topical anesthetics such as local lidocaine, or the drug ospemifene. Another option is laser therapy of the vaginal wall to help improve the connective tissue.7 A study of patients with vulvovaginal atrophy after breast cancer demonstrated that fractional CO2 laser treatment substantially improved atrophy and pain.

Men

Phosphodiesterase type 5 inhibitors such as sildenafil, tadalafil, or vardenafil or a vacuum erectile device can be used to treat erectile dysfunction and prevent penis length loss.3 Pelvic physical therapy and lifestyle modifications such as physical activity, weight loss, smoking cessation, and reduced alcohol consumption may also be beneficial.6 Testosterone therapy may be used for men without prostate cancer who have low testosterone levels, which can improve erectile dysfunction, ejaculation problems, and problems orgasming. For men who do not respond to other interventions, surgical implantation of a penile prosthesis can be considered for erectile dysfunction.3

References

  1. Flynn KE, Lin L, Watkins Bruner D, et al. Sexual satisfaction and the importance of sexual health to quality of life throughout the life course of US adults. J Sex Med. 2016;13:1642-1650. doi: 10.1016/j.jsxm.2016.08.011
  2. Dizon DS, Suzin D, McIlvenna S. Sexual health as a survivorship issue for female cancer survivors. Oncologist. 2014;19:202-210. doi: 10.1634/theoncologist.2013-0302
  3. Carter J, Lacchetti C, Andersen BL, et al. Interventions to address sexual problems in people with cancer: American Society of Clinical Oncology clinical practice guideline adaptation of Cancer Care Ontario Guideline. J Clin Oncol. 2018;36:492-511. doi: 10.1200/JCO.2017.75.8995
  4. Mathew A. Core principles of sexual health treatments in cancer for men. Curr Opin Support Palliat Care. 2016;10:38-43. doi: 10.1097/SPC.0000000000000183
  5. Cakar B, Karaca B, Uslu R. Sexual dysfunction in cancer patients: a review. J BUON. 2013;18:818-823.
  6. Denlinger CS, Sanft T, Baker KS, et al. Survivorship, Version I.2018. NCCN Clinical Practice Guidelines in Oncology. July 30, 2018.
  7. Preti EP, Landoni F, Colombo N, Dizon DS. How to address sexual problems in female cancer patients. Oncologist (Williston Park). 2017;31:258-262.