A comprehensive review of sexual health concerns after cancer treatment and the biopsychosocial treatment options available to female patients
Carly S. Sears Bachelor of Arts (Honours) Psychology
Department of Psychology, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorJohn W. Robinson PhD, RPsych
Clinical Psychologist and Associate Professor
Department of Psychology, University of Calgary, Calgary, AB, Canada
Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Psychosocial and Rehabilitation Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
Search for more papers by this authorCorresponding Author
Lauren M. Walker PhD, RPsych
Clinical Psychologist and Research Assistant Professor
Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Psychosocial and Rehabilitation Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
Correspondence
Lauren M. Walker, Psychosocial and Rehabilitation Oncology, Tom Baker Cancer Centre, Calgary AB, Canada.
Email: [email protected]
Search for more papers by this authorCarly S. Sears Bachelor of Arts (Honours) Psychology
Department of Psychology, University of Calgary, Calgary, AB, Canada
Search for more papers by this authorJohn W. Robinson PhD, RPsych
Clinical Psychologist and Associate Professor
Department of Psychology, University of Calgary, Calgary, AB, Canada
Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Psychosocial and Rehabilitation Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
Search for more papers by this authorCorresponding Author
Lauren M. Walker PhD, RPsych
Clinical Psychologist and Research Assistant Professor
Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Psychosocial and Rehabilitation Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
Correspondence
Lauren M. Walker, Psychosocial and Rehabilitation Oncology, Tom Baker Cancer Centre, Calgary AB, Canada.
Email: [email protected]
Search for more papers by this authorAbstract
The repercussions of cancer diagnosis and treatment profoundly impact the sexual wellbeing of women prior to, during, and following cancer treatment. Sexual health concerns are often under-addressed within clinical and research settings, and information tends to be limited to women with breast or gynecological cancers. In this narrative literature review, the authors critically evaluate research published between 1990 and 2016, pertaining to sexual health concerns of women diagnosed with cancer, of any type or stage, and to the psychosocial and biomedical interventions that currently exist for the treatment of sexual health-related side-effects (e.g. vaginal dryness, dyspareunia and vulvo-vaginal atrophy). The findings of 109 published articles are discussed and summarised according to four central themes: how cancer affects female sexual wellbeing; physical impacts of cancer diagnosis and treatment; emotional impacts of cancer diagnosis and treatment; and interventions for sexual dysfunction. Suggestions to enhance research and clinical practice in relation to the sexual health concerns of women following cancer treatments are also presented. Concerns pertaining to women's sexual health are diverse, multiple, and pervade all types and stages of cancer. Several evidence-based psychosocial and biomedical interventions exist to help women manage physical and psychosocial ramifications of cancer diagnosis and treatment.
REFERENCES
- Abbott-Anderson, K., & Kwekkeboom, K. L. (2012). A systematic review of sexual concerns reported by gynecological cancer survivors. Gynecologic Oncology, 124(3), 477–489.
- Advani, P., Brewster, A. M., Baum, G. P., & Schover, L. R. (2017). A pilot randomized trial to prevent sexual dysfunction in postmenopausal breast cancer survivors starting adjuvant aromatase inhibitor therapy. Journal of Cancer Survivorship. Advance online publication. https://doi.org/10.1007/s11764-017-0606-3
- Aerts, L., Enzlin, P., Vergote, I., Verhaeghe, J., Poppe, W., & Amant, F. (2012). Sexual, psychological, and relational functioning in women after surgical treatment for vulvar malignancy: A literature review. The Journal of Sexual Medicine, 9(2), 361–371.
- Aerts, L., Enzlin, P., Verhaeghe, J., Poppe, W., Vergote, I., & Amant, F. (2015). Sexual functioning in women after surgical treatment for endometrial cancer: A prospective controlled study. The Journal of Sexual Medicine, 12(1), 198–209.
- Aizer, A. A., Chen, M. H., McCarthy, E. P., Mendu, M. L., Koo, S., Wilhite, T. J., … Nguyen, P. L. (2013). Marital status and survival in patients with cancer. Journal of Clinical Oncology, 31(31), 3869–3876.
- American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice, & Farrell, R. (2016). ACOG committee opinion no. 659: The use of vaginal estrogen in women with a history of estrogen-dependent breast cancer. Obstetrics and Gynecology, 127(3), e93–e96.
- Andersen, B. L. (1999). Surviving cancer: The importance of sexual self-concept. Medical and Pediatric Oncology, 33(1), 15–23.
10.1002/(SICI)1096-911X(199907)33:1<15::AID-MPO4>3.0.CO;2-L CAS PubMed Web of Science® Google Scholar
- Athanasiou, S., Pitsouni, E., Antonopoulou, S., Zacharakis, D., Salvatore, S., Falagas, M. E., & Grigoriadis, T. (2016). The effect of microablative fractional CO2 laser on vaginal flora of postmenopausal women. Climacteric: The Journal of the International Menopause Society, 19( 5), 512–518. doi: 10.1080/13697137.2016.1212006
- Bae, H., & Park, H. (2016). Sexual function, depression, and quality of life in patients with cervical cancer. Supportive Care in Cancer, 24(3), 1277–1283.
- Bakker, R. M., ter Kuile, M. M., Vermeer, W. M., Nout, R. A., Mens, J. W., Van Doorn, L. C., … Creutzberg, C. L. (2014). Sexual rehabilitation after pelvic radiotherapy and vaginal dilator use: Consensus using the Delphi method. International Journal of Gynecological Cancer, 24(8), 1499–1506.
- Basson, R., & Schultz, W. W. (2007). Sexual sequelae of general medical disorders. The Lancet (London, England), 369(9559), 409–424.
- Baumgart, J., Nilsson, K., Evers, A. S., Kallak, T. K., & Poromaa, I. S. (2013). Sexual dysfunction in women on adjuvant endocrine therapy after breast cancer. Menopause (New York, NY), 20(2), 162–168.
- Bennett, N., Incrocci, L., Baldwin, D., Hackett, G., El-Zawahry, A., Graziottin, A., … Krychman, M.(2016). Cancer, benign gynecology, and sexual function-issues and answers. The Journal of Sexual Medicine, 13(4), 519–537.
- Bergmark, K., Avall-Lundqvist, E., Dickman, P. W., Henningsohn, L., & Steineck, G. (1999). Vaginal changes and sexuality in women with a history of cervical cancer. The New England Journal of Medicine, 340(18), 1383–1389.
- Bergmark, K., Avall-Lundqvist, E., Dickman, P. W., Henningsohn, L., & Steineck, G. (2002). Patient-rating of distressful symptoms after treatment for early cervical cancer. Acta Obstetricia Et Gynecologica Scandinavica, 81(5), 443–450.
- Biglia, N., Peano, E., Sgandurra, P., Moggio, G., Panuccio, E., Migliardi, M., … Sismondi, P. (2010). Low-dose vaginal estrogens or vaginal moisturizer in breast cancer survivors with urogenital atrophy: A preliminary study. Gynecological Endocrinology, 26(6), 404–412.
- Bober, S. L., Recklitis, C. J., Bakan, J., Garber, J. E., & Patenaude, A. F. (2015). Addressing sexual dysfunction after risk-reducing salpingo-oophorectomy: Effects of a brief, psychosexual intervention. Journal of Sexual Medicine, 12, 189–197.
- Bober, S. L., Reese, J. B., Barbera, L., Bradford, A., Carpenter, K. M., Goldfarb, S., & Carter, J. (2016). How to ask and what to do: A guide for clinical inquiry and intervention regarding female sexual health after cancer. Current Opinion in Supportive & Palliative Care, 10(1), 44–54.
- Booth, B. B., Rasmussen, A., & Jensen, J. B. (2015). Evaluating sexual function in women after radical cystectomy as treatment for bladder cancer. Scandinavian Journal of Urology. https://doi.org/10.3109/21681805.2015.1055589
- Boquiren, V. M., Esplen, M. J., Wong, J., Toner, B., Warner, E., & Malik, N. (2016). Sexual functioning in breast cancer survivors experiencing body image disturbance. Psycho-Oncology, 25(1), 66–76.
- Bouchard, C., Labrie, F., Derogatis, L., Girard, G., Ayotte, N., Gallagher, J., … VVA Prasterone Group. (2016). Effect of intravaginal dehydroepiandrosterone (DHEA) on the female sexual function in postmenopausal women: ERC-230 open-label study. Hormone Molecular Biology and Clinical Investigation, 25(3), 181–190.
- Breast International Group (BIG) 1-98 Collaborative Group, Thurlimann, B., Keshaviah, A., Coates, A. S., Mouridsen, H., Mauriac, L., … Goldhirsch, A. (2005). A comparison of letrozole and tamoxifen in postmenopausal women with early breast cancer. The New England Journal of Medicine, 353(26), 2747–2757.
- Briere, T. M., Crane, C. H., Beddar, S., Bhosale, P., Mok, H., Delclos, M. E., … Das, P. (2012). Reproducibility and genital sparing with a vaginal dilator used for female anal cancer patients. Radiotherapy and Oncology, 104(2), 161–166.
- Brotto, L. A., Erskine, Y., Carey, M., Ehlen, T., Finlayson, S., Heywood, M., … Miller, D. (2012). A brief mindfulness-based cognitive behavioral intervention improves sexual functioning versus wait-list control in women treated for gynecologic cancer. Gynecologic Oncology, 125(2), 320–325.
- Brotto, L. A., Heiman, J. R., Goff, B., Greer, B., Lentz, G. M., Swisher, E., … Van Blaricom, A. (2008). A psychoeducational intervention for sexual dysfunction in women with gynecologic cancer. Archives of Sexual Behavior, 37(2), 317–329.
- Brotto, L. A., Mehak, L., & Kit, C. (2009). Yoga and sexual functioning: A review. Journal of Sex & Marital Therapy, 35(5), 378–390.
- Brotto, L. A., Smith, K. B., Breckon, E., & Plante, M. (2013). Pilot study of radical hysterectomy versus radical trachelectomy on sexual distress. Journal of Sex & Marital Therapy, 39(6), 510–525.
- Brotto, L. A., Yule, M., & Breckon, E. (2010). Psychological interventions for the sexual sequelae of cancer: A review of the literature. Journal of Cancer Survivorship: Research and Practice, 4(4), 346–360.
- Burger, H. G., Hale, G. E., Robertson, D. M., & Dennerstein, L. (2007). A review of hormonal changes during the menopausal transition: Focus on findings from the Melbourne women's midlife health project. Human Reproduction Update, 13(6), 559–565.
- Bychkovsky, B. L., Dizon, D. S., & Sikov, W. M. (2016). Systemic therapies for nonmetastatic breast cancer: The role of neoadjuvant and adjuvant chemotherapy and the use of endocrine therapy. Clinical Obstetrics and Gynecology, 59(4), 756–771.
- Carpenter, K. M., Andersen, B. L., Fowler, J. M., & Maxwell, G. L. (2009). Sexual self schema as a moderator of sexual and psychological outcomes for gynecologic cancer survivors. Archives of Sexual Behavior, 38(5), 828–841.
- Carter, J., Stabile, C., Seidel, B., Baser, R. E., Gunn, A. R., Chi, S., … Goldfrank, D. J. (2015). Baseline characteristics and concerns of female cancer patients/survivors seeking treatment at a female sexual medicine program. Supportive Care in Cancer, 23(8), 2255–2265.
- Cella, D., Fallowfield, L., Barker, P., Cuzick, J., Locker, G., & Howell, A., & ATAC Trialistsa9 Group. (2006). Quality of life of postmenopausal women in the ATAC (“arimidex”, tamoxifen, alone or in combination) trial after completion of 5 years’ adjuvant treatment for early breast cancer. Breast Cancer Research and Treatment, 100(3), 273–284.
- Chen, J., Geng, L., Song, X., Li, H., Giordan, N., & Liao, Q. (2013). Evaluation of the efficacy and safety of hyaluronic acid vaginal gel to ease vaginal dryness: A multicenter, randomized, controlled, open-label, parallel-group, clinical trial. The Journal of Sexual Medicine, 10(6), 1575–1584.
- Cherpak, G. L., & Santos, F. C. (2016). Assessment of physicians’ addressing sexuality in elderly patients with chronic pain. Einstein (Sao Paulo), 14(2), 178–184.
- Classen, C. C., Chivers, M. L., Urowitz, S., Barbera, L., Wiljer, D., O'Rinn, S., & Ferguson, S. E. (2013). Psychosexual distress in women with gynecologic cancer: A feasibility study of an online support group. Psycho-Oncology, 22(4), 930–935.
- Clayton, A. H. (2010). The pathophysiology of hypoactive sexual desire disorder in women. International Journal of Gynaecology and Obstetrics, 110(1), 7–11.
- Cleary, V., & Hegarty, J. (2011). Understanding sexuality in women with gynaecological cancer. European Journal of Oncology Nursing, 15(1), 38–45.
- Colleoni, M., & Munzone, E. (2015). Picking the optimal endocrine adjuvant treatment for pre-menopausal women. Breast (Edinburgh, Scotland), 24(Suppl. 2), S11–S14.
- Cull, A., Cowie, V. J., Farquharson, D. I., Livingstone, J. R., Smart, G. E., & Elton, R. A. (1993). Early stage cervical cancer: Psychosocial and sexual outcomes of treatment. British Journal of Cancer, 68(6), 1216–1220.
- Cullen, K., Fergus, K., DasGupta, T., Kong, I., Fitch, M., Doyle, C., & Adams, L. (2013). Toward clinical care guidelines for supporting rehabilitative vaginal dilator use with women recovering from cervical cancer. Supportive Care in Cancer, 21(7), 1911–1917.
- Denlinger, C. S., Carlson, R. W., Are, M., Baker, K. S., Davis, E., Edge, S. B., … National Comprehensive Cancer Network. (2014). Survivorship: Sexual dysfunction (female), version 1.2013. Journal of the National Comprehensive Cancer Network, 12(2), 184–192.
- Derogatis, L., Clayton, A., Lewis-D'Agostino, D., Wunderlich, G., & Fu, Y. (2008). Validation of the female sexual distress scale-revised for assessing distress in women with hypoactive sexual desire disorder. The Journal of Sexual Medicine, 5(2), 357–364.
- Derogatis, L. R., Rosen, R., Leiblum, S., Burnett, A., & Heiman, J. (2002). The female sexual distress scale (FSDS): Initial validation of a standardized scale for assessment of sexually related personal distress in women. Journal of Sex & Marital Therapy, 28(4), 317–330.
- Derzko, C., Elliott, S., & Lam, W. (2007). Management of sexual dysfunction in postmenopausal breast cancer patients taking adjuvant aromatase inhibitor therapy. Current Oncology (Toronto, ON), 14(Suppl. 1), S20–S40.
- DeSimone, M., Spriggs, E., Gass, J. S., Carson, S. A., Krychman, M. L., & Dizon, D. S. (2014). Sexual dysfunction in female cancer survivors. American Journal of Clinical Oncology, 37(1), 101–106.
- Dhand, A., & Dhaliwal, G. (2010). Examining patient conceptions: A case of metastatic breast cancer in an African American male to female transgender patient. Journal of General Internal Medicine, 25(2), 158–161.
- K. S. Dobson(Ed.). (2010). Handbook of cognitive behavioral therapies ( 3rd edn). New York: The Guilford Press.
- Donovan, K. A., Taliaferro, L. A., Alvarez, E. M., Jacobsen, P. B., Roetzheim, R. G., & Wenham, R. M. (2007). Sexual health in women treated for cervical cancer: Characteristics and correlates. Gynecologic Oncology, 104(2), 428–434.
- DuHamel, K., Schuler, T., Nelson, C., Philip, E., Temple, L., Schover, L., … Carter, J. (2016). The sexual health of female rectal and anal cancer survivors: Results of a pilot randomized psycho-educational intervention trial. Journal of Cancer Survivorship: Research and Practice, 10(3), 553–563.
- Duijts, S. F., van Beurden, M., Oldenburg, H. S., Hunter, M. S., Kieffer, J. M., Stuiver, M. M., … Aaronson, N. K. (2012). Efficacy of cognitive behavioral therapy and physical exercise in alleviating treatment-induced menopausal symptoms in patients with breast cancer: Results of a randomized, controlled, multicenter trial. Journal of Clinical Oncology, 30(33), 4124–4133.
- Dyer, G., Gilroy, N., Bradford, J., Brice, L., Kabir, M., Greenwood, M., … Kerridge, I. (2016). A survey of fertility and sexual health following allogeneic haematopoietic stem cell transplantation in New South Wales, Australia. British Journal of Haematology, 172(4), 592–601.
- Eden, J. (2016). Endocrine dilemma: Managing menopausal symptoms after breast cancer. European Journal of Endocrinology/European Federation of Endocrine Societies, 174(3), R71–R77.
- Ekin, M., Yasar, L., Savan, K., Temur, M., Uhri, M., Gencer, I., & Kivanc, E. (2011). The comparison of hyaluronic acid vaginal tablets with estradiol vaginal tablets in the treatment of atrophic vaginitis: A randomized controlled trial. Archives of Gynecology and Obstetrics, 283(3), 539–543.
- Ekwall, E., Ternestedt, B. M., & Sorbe, B. (2003). Important aspects of health care for women with gynecologic cancer. Oncology Nursing Forum, 30(2), 313–319.
- Falk, S. J., & Bober, S. (2016). Vaginal health during breast cancer treatment. Current Oncology Reports, https://doi.org/10.1007/s11912-016-0517-x
- Falk, S. J., & Dizon, D. S. (2013). Sexual dysfunction in women with cancer. Fertility and Sterility, 100(4), 916–921.
- Farthmann, J., Hanjalic-Beck, A., Veit, J., Rautenberg, B., Stickeler, E., Erbes, T., … Hasenburg, A. (2016). The impact of chemotherapy for breast cancer on sexual function and health-related quality of life. Supportive Care in Cancer, 24(6), 2603–2609.
- Fernandes, T., Costa-Paiva, L. H., & Pinto-Neto, A. M. (2014). Efficacy of vaginally applied estrogen, testosterone, or polyacrylic acid on sexual function in postmenopausal women: A randomized controlled trial. The Journal of Sexual Medicine, 11(5), 1262–1270.
- Ferreira, C. H., Dwyer, P. L., Davidson, M., de Souza, A., Ugarte, J. A., & Frawley, H. C. (2015). Does pelvic floor muscle training improve female sexual function? A systematic review International Urogynecology Journal, 26(12), 1735–1750.
- Fitch, M. I., Beaudoin, G., & Johnson, B. (2013a). Challenges having conversations about sexuality in ambulatory settings: Part II–health care provider perspectives. Canadian Oncology Nursing Journal (Revue Canadienne De Nursing Oncologique), 23(3), 182–196.
- Fitch, M. I., Beaudoin, G., & Johnson, B. (2013b). Challenges having conversations about sexuality in ambulatory settings: Part I–patient perspectives. Canadian Oncology Nursing Journal (Revue Canadienne De Nursing Oncologique), 23(1), 4–18.
- Flynn, K. E., Reese, J. B., Jeffery, D. D., Abernethy, A. P., Lin, L., Shelby, R. A., … Weinfurt, K. P. (2012). Patient experiences with communication about sex during and after treatment for cancer. Psycho-Oncology, 21(6), 594–601.
- Frechette, D., Paquet, L., Verma, S., Clemons, M., Wheatley-Price, P., Gertler, S. Z., … Dent, S. (2013). The impact of endocrine therapy on sexual dysfunction in postmenopausal women with early stage breast cancer: Encouraging results from a prospective study. Breast Cancer Research and Treatment, 141(1), 111–117.
- Ganz, P. A., Cecchini, R. S., Julian, T. B., Margolese, R. G., Costantino, J. P., Vallow, L. A., … Wolmark, N. (2016). Patient-reported outcomes with anastrozole versus tamoxifen for postmenopausal patients with ductal carcinoma in situ treated with lumpectomy plus radiotherapy (NSABP B-35): A randomised, double-blind, phase 3 clinical trial. Lancet (London, England), 387(10021), 857–865.
- Gilbert, E., Ussher, J. M., & Perz, J. (2011). Sexuality after gynaecological cancer: A review of the material, intrapsychic, and discursive aspects of treatment on women's sexual-wellbeing. Maturitas, 70(1), 42–57.
- Giraldi, A., Rellini, A., Pfaus, J. G., Bitzer, J., Laan, E., Jannini, E. A., & Fugl-Meyer, A. R. (2011). Questionnaires for assessment of female sexual dysfunction: A review and proposal for a standardized screener. The Journal of Sexual Medicine, 8(10), 2681–2706.
- Goel, S., Sharma, R., Hamilton, A., & Beith, J. (2009). LHRH agonists for adjuvant therapy of early breast cancer in premenopausal women. The Cochrane Database of Systematic Reviews, 4, CD004562.
- Green, M. S., Naumann, R. W., Elliot, M., Hall, J. B., Higgins, R. V., & Grigsby, J. H. (2000). Sexual dysfunction following vulvectomy. Gynecologic Oncology, 77(1), 73–77.
- Grimm, D., Hasenburg, A., Eulenburg, C., Steinsiek, L., Mayer, S., Eltrop, S., … Woelber, L. (2015). Sexual activity and function in patients with gynecological malignancies after completed treatment. International Journal of Gynecological Cancer, 25(6), 1134–1141.
- Haboubi, N. H., & Lincoln, N. (2003). Views of health professionals on discussing sexual issues with patients. Disability and Rehabilitation, 25(6), 291–296.
- Hendren, S. K., O’Connor, B. I. R., Liu, M., Asano, T., Cohen, Z, Swallow, C. J., … McLeod, R. S. (2005). Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Annals of Surgery, 242(2), 212–223.
- Hickey, M., Marino, J. L., Braat, S., & Wong, S. (2016). A randomized, double-blind, crossover trial comparing a silicone- versus water-based lubricant for sexual discomfort after breast cancer. Breast Cancer Research and Treatment, 158(1), 79–90.
- Hill, E. K., Sandbo, S., Abramsohn, E., Makelarski, J., Wroblewski, K., Wenrich, E. R., … Lindau, S. T. (2011). Assessing gynecologic and breast cancer survivors’ sexual health care needs. Cancer, 117(12), 2643–2651.
- Hordern, A. J., & Street, A. F. (2007a). Communicating about patient sexuality and intimacy after cancer: Mismatched expectations and unmet needs. The Medical Journal of Australia, 186(5), 224–227.
- Hordern, A. J., & Street, A. F. (2007b). Let's talk about sex: Risky business for cancer and palliative care clinicians. Contemporary Nurse, 27(1), 49–60.
- Huffman, L. B., Hartenbach, E. M., Carter, J., Rash, J. K., & Kushner, D. M. (2016). Maintaining sexual health throughout gynecologic cancer survivorship: A comprehensive review and clinical guide. Gynecologic Oncology, 140(2), 359–368.
- Hummel, S. B., van Lankveld, J. J., Oldenburg, H. S., Hahn, D. E., Broomans, E., & Aaronson, N. K. (2015). Internet-based cognitive behavioral therapy for sexual dysfunctions in women treated for breast cancer: Design of a multicenter, randomized controlled trial. BMC Cancer, 15(321), 1–12.
- Hummel, S. B., van Lankveld, J. J., Oldenburg, H. S., Hahn, D. E., Kieffer, J. M., Gerritsma, M. A., … Aaronson, N. K. (2017). Efficacy of internet-based cognitive behavioral therapy in improving sexual functioning of breast cancer survivors: Results of a randomized controlled trial. Journal of Clinical Oncology, 35(12), 1328–1340.
- Iavazzo, C., Johnson, K., Savage, H., Gallagher, S., Datta, M., & Winter-Roach, B. A. (2015). Sexuality issues in gynaecological oncology patients: Post treatment symptoms and therapeutic options. Archives of Gynecology and Obstetrics, 291(3), 653–656.
- Ibeanu, O., Modesitt, S. C., Ducie, J., von Gruenigen, V., Agueh, M., & Fader, A. N. (2011). Hormone replacement therapy in gynecologic cancer survivors: Why not? Gynecologic Oncology, 122(2), 447–454.
- Jensen, P. T., & Froeding, L. P. (2015). Pelvic radiotherapy and sexual function in women. Translational Andrology and Urology, 4(2), 186–205.
- Jensen, P. T., Groenvold, M., Klee, M. C., Thranov, I., Petersen, M. A., & Machin, D. (2004). Early-stage cervical carcinoma, radical hysterectomy, and sexual function. A longitudinal study. Cancer, 100(1), 97–106.
- Johnson, N., Miles, T. P., & Cornes, P. (2010). Dilating the vagina to prevent damage from radiotherapy: Systematic review of the literature. BJOG: An International Journal of Obstetrics and Gynaecology, 117(5), 522–531.
- Juraskova, I., Jarvis, S., Mok, K., Peate, M., Meiser, B., Cheah, B. C., … Friedlander, M. (2013). The acceptability, feasibility, and efficacy (phase I/II study) of the OVERcome (olive oil, vaginal exercise, and MoisturizeR) intervention to improve dyspareunia and alleviate sexual problems in women with breast cancer. The Journal of Sexual Medicine, 10(10), 2549–2558.
- Katz, A. (2005). The sounds of silence: Sexuality information for cancer patients. Journal of Clinical Oncology, 23(1), 238–241.
- Katz, A. (2009). Interventions for sexuality after pelvic radiation therapy and gynecological cancer. Cancer Journal (Sudbury, MA), 15(1), 45–47.
- Kingsberg, S. A., Wysocki, S., Magnus, L., & Krychman, M. L. (2013). Vulvar and vaginal atrophy in postmenopausal women: Findings from the REVIVE (REal women's VIews of treatment options for menopausal vaginal ChangEs) survey. The Journal of Sexual Medicine, 10(7), 1790–1799.
- Knoepp, L. R., Shippey, S. H., Chen, C. C., Cundiff, G. W., Derogatis, L. R., & Handa, V. L. (2010). Sexual complaints, pelvic floor symptoms, and sexual distress in women over forty. The Journal of Sexual Medicine, 7(11), 3675–3682.
- Labrie, F., Archer, D. F., Koltun, W., Vachon, A., Young, D., Frenette, L., … VVA Prasterone Research Group. (2016). Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause. Menopause (New York, NY), 23(3), 243–256.
- Laumann, E. O., & Waite, L. J. (2008). Sexual dysfunction among older adults: Prevalence and risk factors from a nationally representative U.S. probability sample of men and women 57–85 years of age. The Journal of Sexual Medicine, 5(10), 2300–2311.
- Law, E., Kelvin, J. F., Thom, B., Riedel, E., Tom, A., Carter, J., … Goodman, K. A. (2015). Prospective study of vaginal dilator use adherence and efficacy following radiotherapy. Radiotherapy and Oncology, 116(1), 149–155.
- Lee, R. (2000). Health care problems of lesbian, gay, bisexual, and transgender patients. The Western Journal of Medicine, 172(6), 403–408.
- Lee, Y. K., Chung, H. H., Kim, J. W., Park, N. H., Song, Y. S., & Kang, S. B. (2011). Vaginal pH-balanced gel for the control of atrophic vaginitis among breast cancer survivors: A randomized controlled trial. Obstetrics and Gynecology, 117(4), 922–927.
- Levin, A. O., Carpenter, K. M., Fowler, J. M., Brothers, B. M., Andersen, B. L., & Maxwell, G. L. (2010). Sexual morbidity associated with poorer psychological adjustment among gynecological cancer survivors. International Journal of Gynecological Cancer, 20(3), 461–470.
- Li, Z., Mewawalla, P., Stratton, P., Yong, A. S., Shaw, B. E., Hashmi, S., … Rovo, A. (2015). Sexual health in hematopoietic stem cell transplant recipients. Cancer, 121(23), 4124–4131.
- Loprinzi, C. L., Abu-Ghazaleh, S., Sloan, J. A., vanHaelst-Pisani, C., Hammer, A. M., Rowland, K. M. Jr, … Ellison, N. (1997). Phase III randomized double-blind study to evaluate the efficacy of a polycarbophil-based vaginal moisturizer in women with breast cancer. Journal of Clinical Oncology, 15(3), 969–973.
- Makadon, H. J. (2011). Ending LGBT invisibility in health care: The first step in ensuring equitable care. Cleveland Clinic Journal of Medicine, 78(4), 220–224.
- McClelland, S. I., Holland, K. J., & Griggs, J. J. (2015). Vaginal dryness and beyond: The sexual health needs of women diagnosed with metastatic breast cancer. Journal of Sex Research, 52(6), 604–616.
- McGrath, P. D. (2012). The impact on sexuality after diagnosis and treatment for a hematologic malignancy: Findings from Australia. Oncology Nursing Forum, 39(6), 595–600.
- Miles, T., & Johnson, N. (2014). Vaginal dilator therapy for women receiving pelvic radiotherapy. The Cochrane Database of Systematic Reviews, (9), CD007291. DOI: 10.1002/14651858.CD007291.pub3
- Moreno, K. F., Khabbaz, E., Gaitonde, K., Meinzen-Derr, J., Wilson, K. M., & Patil, Y. J. (2012). Sexuality after treatment of head and neck cancer: Findings based on modification of sexual adjustment questionnaire. The Laryngoscope, 122(7), 1526–1531.
- Parker, P. A., Baile, W. F., de Moor, C., & Cohen, L. (2003). Psychosocial and demographic predictors of quality of life in a large sample of cancer patients. Psycho-Oncology, 12(2), 183–193.
- Peate, M., Meiser, B., Hickey, M., & Friedlander, M. (2009). The fertility-related concerns, needs and preferences of younger women with breast cancer: A systematic review. Breast Cancer Research and Treatment, 116(2), 215–223.
- Pereira, V. M., Arias-Carrion, O., Machado, S., Nardi, A. E., & Silva, A. C. (2013). Sex therapy for female sexual dysfunction. International Archives of Medicine, 6, 37.
- Perino, A., Calligaro, A., Forlani, F., Tiberio, C., Cucinella, G., Svelato, A., … Calagna, G. (2015). Vulvo-vaginal atrophy: A new treatment modality using thermo-ablative fractional CO2 laser. Maturitas, 80(3), 296–301.
- Pfaus, J. G. (2009). Pathways of sexual desire. The Journal of Sexual Medicine, 6(6), 1506–1533.
- Philip, E. J., Nelson, C., Temple, L., Carter, J., Schover, L., Jennings, S., … DuHamel, K. (2013). Psychological correlates of sexual dysfunction in female rectal and anal cancer survivors: Analysis of baseline intervention data. The Journal of Sexual Medicine, 10(10), 2539–2548.
- Quinn, G. P., Sanchez, J. A., Sutton, S. K., Vadaparampil, S. T., Nguyen, G. T., Green, B. L., … Schabath, M. B. (2015). Cancer and lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations. A Cancer Journal for Clinicians, 65(5), 384–400.
- Ratner, E. S., Foran, K. A., Schwartz, P. E., & Minkin, M. J. (2010). Sexuality and intimacy after gynecological cancer. Maturitas, 66(1), 23–26.
- Reese, J. B., Porter, L. S., Casale, K. E., Bantug, E. T., Bober, S. L., Schwartz, S. C., & Smith, K. C. (2016). Adapting a couple-based intimacy enhancement intervention to breast cancer: A developmental study. Health Psychology, 35(10), 1085–1096.
- Reese, J. B., Sorice, K., Beach, M. C., Porter, L. S., Tulsky, J. A., Daly, M. B., & Lepore, S. J. (2017). Patient-provider communication about sexual concerns in cancer: A systematic review. Journal of Cancer Survivorship, 11(2), 175–188.
- Reis, N., Beji, N. K., & Coskun, A. (2010). Quality of life and sexual functioning in gynecological cancer patients: Results from quantitative and qualitative data. European Journal of Oncology Nursing, 14(2), 137–146.
- Rhoten, B. A. (2016). Head and neck cancer and sexuality: A review of the literature. Cancer Nursing, 39(4), 313–320.
- Robinson, J. W., Lounsberry, J. L., & Walker, L. M. (2017). Communicating about sexuality in cancer care. In D. W. Kissane, B. D. Bultz, P. N. Butow, C. L. Bylund, S. Noble & S. Wilkinson (Eds.), Oxford textbook of communication in oncology and palliative care ( 2nd edn). Oxford University Press. https://doi.org/10.1093/med/9780198736134.001.0001
10.1093/med/9780198736134.003.0043 Google Scholar
- Rosen, R., Brown, C., Heiman, J., Leiblum, S., Meston, C., Shabsigh, R., … D'Agostino, R. Jr (2000). The female sexual function index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. Journal of Sex & Marital Therapy, 26(2), 191–208.
- Rosenbaum, T. Y. (2005). Physiotherapy treatment of sexual pain disorders. Journal of Sex & Marital Therapy, 31(4), 329–340.
- Salvatore, S., Nappi, R. E., Parma, M., Chionna, R., Lagona, F., Zerbinati, N., … Leone Roberti Maggiore, U. (2015). Sexual function after fractional microablative CO(2) laser in women with vulvovaginal atrophy. Climacteric: The Journal of the International Menopause Society, 18(2), 219–225.
- Salvatore, S., Nappi, R. E., Zerbinati, N., Calligaro, A., Ferrero, S., Origoni, M., … Leone Roberti Maggiore, U. (2014). A 12-week treatment with fractional CO2 laser for vulvovaginal atrophy: A pilot study. Climacteric: The Journal of the International Menopause Society, 17(4), 363–369.
- Satcher, D., Hook, E. W. 3rd, & Coleman, E. (2015). Sexual health in America: Improving patient care and public health. JAMA, 314(8), 765–766.
- Schover, L. R. (2014). Premature ovarian failure is a major risk factor for cancer-related sexual dysfunction. Cancer, 120(15), 2230–2232.
- Schover, L. R., van der Kaaij, M., van Dorst, E., Creutzberg, C., Huyghe, E., & Kiserud, C. E. (2014). Sexual dysfunction and infertility as late effects of cancer treatment. European Journal of Cancer Supplements, 12(1), 41–53.
10.1016/j.ejcsup.2014.03.004 Google Scholar
- Schover, L. R., Yuan, Y., Fellman, B. M., Odensky, E., Lewis, P. E., & Martinetti, P. (2013). Efficacy trial of an internet-based intervention for cancer-related female sexual dysfunction. Journal of the National Comprehensive Cancer Network, 11(11), 1389–1397.
- Sekse, R. J., Raaheim, M., Blaaka, G., & Gjengedal, E. (2010). Life beyond cancer: Women's experiences 5 years after treatment for gynaecological cancer. Scandinavian Journal of Caring Sciences, 24(4), 799–807.
- Singh, P., & Oehler, M. K. (2010). Hormone replacement after gynaecological cancer. Maturitas, 65(3), 190–197.
- Sinha, A., & Ewies, A. A. (2013). Non-hormonal topical treatment of vulvovaginal atrophy: An up-to-date overview. Climacteric: The Journal of the International Menopause Society, 16(3), 305–312.
- Son, C. H., Law, E., Oh, J. H., & Apte, A. P.(2015). Dosimetric predictors of radiation-induced vaginal stenosis after pelvic radiation therapy for rectal and anal cancer. International Journal of Radiation Oncology, Biology, Physics, 92 (3), 548–554.
- Sporn, N. J., Smith, K. B., Pirl, W. F., Lennes, I. T., Hyland, K. A., & Park, E. R. (2014). Sexual health communication between cancer survivors and providers: How frequently does it occur and which providers are preferred? Psycho-Oncology, 24(9), 1167–1173.
- Stead, M. L., Brown, J. M., Fallowfield, L., & Selby, P. (2003). Lack of communication between healthcare professionals and women with ovarian cancer about sexual issues. British Journal of Cancer, 88(5), 666–671.
- Stead, M. L., Fallowfield, L., Selby, P., & Brown, J. M. (2007). Psychosexual function and impact of gynaecological cancer. Best Practice & Research Clinical Obstetrics & Gynaecology, 21(2), 309–320.
- Sun, V., Grant, M., Wendel, C. S., McMullen, C. K., Bulkley, J. E., Herrinton, L. J., … Krouse, R. S. (2016). Sexual function and health-related quality of life in long-term rectal cancer survivors. The Journal of Sexual Medicine, 13(7), 1071–1079.
- Sunesen, K. G., Norgaard, M., Lundby, L., Havsteen, H., Buntzen, S., Thorlacius-Ussing, O., & Laurberg, S. (2015). Long-term anorectal, urinary and sexual dysfunction causing distress after radiotherapy for anal cancer: A Danish multicentre cross-sectional questionnaire study. Colorectal Disease, 17(11), O230–O239.
- Surbeck, W., Herbet, G., & Duffau, H. (2015). Sexuality after surgery for diffuse low-grade glioma. Neuro-Oncology, 17(2), 574–579.
- Tan, O., Bradshaw, K., & Carr, B. R. (2012). Management of vulvovaginal atrophy-related sexual dysfunction in postmenopausal women: An up-to-date review. Menopause (New York, NY), 19(1), 109–117.
- Turan, V., & Oktay, K. (2014). Sexual and fertility adverse effects associated with chemotherapy treatment in women. Expert Opin Drug Saf, 13(6), 775–783.
- van der Laak, J. A., de Bie, L. M., de Leeuw, H., de Wilde, P. C., & Hanselaar, A. G. (2002). The effect of replens on vaginal cytology in the treatment of postmenopausal atrophy: Cytomorphology versus computerised cytometry. Journal of Clinical Pathology, 55(6), 446–451.
- van Lankveld, J. (2016). Internet-based interventions for women's sexual dysfunction. Current Sexual Health Reports, 8, 136–143.
- Van Londen, G. J., Perera, S., Vujevich, K., Rastogi, P., Lembersky, B., Brufsky, A., … Greenspan, S. L. (2011). The impact of an aromatase inhibitor on body composition and gonadal hormone levels in women with breast cancer. Breast Cancer Research and Treatment, 125(2), 441–446.
- Vermeer, W. M., Bakker, R. M., Kenter, G. G., Stiggelbout, A. M., & ter Kuile, M. M. (2016). Cervical cancer survivors’ and partners’ experiences with sexual dysfunction and psychosexual support. Supportive Care in Cancer, 24(4), 1679–1687.
- Vermeer, W. M., Bakker, R. M., Stiggelbout, A. M., Creutzberg, C. L., Kenter, G. G., & ter Kuile, M. M. (2015). Psychosexual support for gynecological cancer survivors: Professionals’ current practices and need for assistance. Supportive Cancer Care, 23, 831–839.
- Wittmann, D. (2016). Emotional and sexual health in cancer: Partner and relationship issues. Current Opinion in Supportive and Palliative Care, 10(1), 75–80.
- Yang, E. J., Lim, J. Y., Rah, U. W., & Kim, Y. B. (2012). Effect of a pelvic floor muscle training program on gynecologic cancer survivors with pelvic floor dysfunction: A randomized controlled trial. Gynecologic Oncology, 125(3), 705–711.
- Yi, J. C., & Syrjala, K. L. (2009). Sexuality after hematopoietic stem cell transplantation. Cancer Journal (Sudbury, MA), 15(1), 57–64.
- Zahariou, A. G., Karamouti, M. V., & Papaioannou, P. D. (2008). Pelvic floor muscle training improves sexual function of women with stress urinary incontinence. International Urogynecology Journal and Pelvic Floor Dysfunction, 19(3), 401–406.