Sexual Function in Gynecologic Cancer Survivors

Alison Amsterdam; Michael Krychman

Disclosures

Expert Rev of Obstet Gynecol. 2008;3(3):331-337. 

In This Article

Disease-specific Concerns and Research

One study evaluated women who had a history of cervical cancer. It was shown that these patients had decreased lubrication and genital swelling during sexual activity. In addition, they perceived a reduction of vaginal length and elasticity, which contributed to decreased sexual satisfaction.[14] In a survey of cervical cancer survivors treated with radiation therapy, a statistically significant difference (p = 0.001) in incidence of fatigue, decrease in quality of life, anxiety and depression was observed compared with patients without a history of malignancy, up to 5 years after the completion of treatment.[15] This difference is reproducible and has also been demonstrated in patients with histories of vulvar and vaginal neoplasms.[16,17]

Unlike treatment for cervical cancer, uterine neoplasms can often be treated with operative measures alone, depending on the stage at diagnosis. However, sexual dysfunction can still result from this modality of therapy, although it is sparsely reported. One study comparing women before and after surgical intervention for uterine cancer versus women undergoing hysterectomy for benign etiologies found that urinary and climacteric symptoms were observed 1 year later, in the former two groups. The patients who had procedures for benign causes did not report these concerns after surgery.[18]

Larger studies exist looking at sexual functioning in patients with ovarian cancer, both epithelial and germ cell pathologies. One study surveyed 232 women with epithelial ovarian cancer.[19] Only half of patients had been sexually active within a month of the evaluation and of them 47% reported issues with desire, 80% reported problematic vaginal dryness and 62% said that they had pain or discomfort during penetration. Analyses found demographic, medical and psychosocial factors were significantly associated with sexual functioning or satisfaction, sexual discomfort and sexual frequency or habit. Similar results were found in patients with germ cell neoplasms of the ovary even when fertility-sparing procedures were used.[20] Compared with controls, survivors had significantly less sexual pleasure (p = 0.003) and greater reproductive concerns (p < 0.0001).

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