Sexual Function in Gynecologic Cancer Survivors

Alison Amsterdam; Michael Krychman

Disclosures

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

In This Article

Sexual Rehabilitation Medicine

Survivorship programs have been developed to help the survivor improve her quality of life after treatment. Sexual rehabilitation medicine is a subspecialty emerging in this setting, because sexual connectedness and enhanced intimacy are often paramount concerns for the cancer patient. Sexual assessment and counseling are not routinely provided in the oncology setting. Healthcare providers often lack experience in initiating conversations regarding sexual functioning and patients may experience embarrassment with this sensitive subject.[10] One study showed that almost 80% of women had a strong desire to discuss sexual matters but neglected to make inquiries about sexuality and intimacy for fear of rejection.[7]

A comprehensive sexual assessment includes a complete medical and psychosexual history with a physical examination, including pelvic exam. This may be obtained by a single provider or several as part of a multidisciplinary approach. As part of the history, special attention should be made to patients' concurrent medications. Certain drug classes, such as antidepressants[24] and, possibly, antihypertensives[25,26] can affect the female sexual response cycle by causing delayed arousal or inhibited desire or orgasm. Healthcare providers should consult sexual pharmacology sources to help identify potentially offending agents and find alternatives.

Female cancer patients often have comorbidities that directly influence the sexual response cycle. In the acute crisis of cancer care, chronic illnesses often receive lower priority, leading to decreased sexual functioning. Identifying and treating comorbid conditions can be helpful in restoring sexual functioning. For example, checking fasting glucose, thyroid-stimulating hormone and/or fasting lipid profiles may lead to the diagnosis and/or better treatment of diabetes, hypothyroidism and hyperlipidemia, which can directly affect sexual functioning. Referral to other healthcare specialists may be appropriate for these underlying medical conditions. Some of the common medical consultants include oncologists, social services providers, nutritionists, exercise therapists, psychiatrists, pharmacologists and radiation specialists. A list of clinicians and ancillary staff who are sensitive to sexual issues should be readily available.

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