Abstract
Purpose
The purpose of this study is to characterize patients seeking treatment at a Female Sexual Medicine and Women’s Health Program and examine their sexual/vaginal health issues.
Methods
Data from clinical assessment forms were extracted from 509 women referred to the Female Sexual Medicine and Women’s Health Program during/after cancer treatment. The form consists of a Vaginal Assessment Scale (VAS), vaginal health items, patient-reported outcomes (PROs) (Sexual Activity Questionnaire [SAQ], Sexual Self-Schema Scale [SSS], Female Sexual Function Index [FSFI]), and exploratory items.
Results
Of 509 patients, 493 (97 %) completed PROs; 253 (50 %) received a pelvic examination. The majority had a history of breast (n = 260, 51 %), gynecologic (n = 184, 36 %), or colorectal/anal (n = 35, 7 %) cancer. Mean age was 51.2 years; 313 (62 %) were married/partnered. Approximately two thirds had elevated vaginal pH scores (5–6.5 [35 %] or 6.5+ [33 %]) and minimal (62 %) or no (5 %) vaginal moisture. Eighty-seven patients (44 %) experienced pain during their exam (23 % mild, 11 % moderate, 1.5 % severe, and 8.5 % not indicated). Fifty-three percent engaged in sexual activity with a partner; only 43 % felt confident about future sexual activity. Ninety-three percent were somewhat to very concerned/worried about sexual function/vaginal health. Approximately half had moderate/severe dryness (n = 133, 51 %) and dyspareunia (n = 120, 46 %). The mean SSS score was 60.7, indicating a slightly positive sexual self-view. However, 93.5 % (n = 429) had an FSFI score <26.55, suggesting sexual dysfunction.
Conclusions
At initial consult, women reported vaginal dryness, pain, and sexual dysfunction. For many women, pelvic exams showed elevated vaginal pH, lack of moisture, and discomfort with the exam itself. Future analyses will examine changes over time.
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References
American Cancer Society. Cancer treatment and survivorship facts and figures, 2012-2013. www.cancer.org/acs/groups. Accessed 8 Jan 2013
Beckjord EB, Arora NK, McLaughlin W et al (2008) Health-related information needs in a large and diverse sample of adult cancer survivors: implications for cancer care. J Cancer Surviv 2:179–189
Carter J, Goldfrank D, Schover LR (2011) Simple strategies for vaginal health promotion in cancer survivors. J Sex Med 8:549–559
Kent EE, Arora NK, Rowland JH et al (2012) Health information needs and health-related quality of life in a diverse population of long-term cancer survivors. Patient Educ Couns 89:345–352
Hill EK, Sandbo S, Abramsohn E et al (2011) Assessing gynecologic and breast cancer survivors’ sexual health care needs. Cancer 117:2643–2651
Huyghe E, Sui D, Odensky E et al (2009) Needs assessment survey to justify establishing a reproductive health clinic at a comprehensive cancer center. J Sex Med 6:149–163
Rechis R, Reynolds K, Beckjord E. “I learned to live with it” is not good enough: challenges reported by post-treatment cancer survivors in the LIVESTRONG surveys, A LIVESTRONG Report 2010. Austin, TX, May 2011
Stabile C, Barakat RR, Abu-Rustum NR. Preliminary data: a survey of female patients preference for sexual health intervention, International Society for the Study of Women’s Sexual Health Meeting. Scottsdale, AZ, February 2011
Avis NE, Brockwell S, Randolph JF Jr et al (2009) Longitudinal changes in sexual functioning as women transition through menopause: results from the Study of Women’s Health Across the Nation. Menopause 16:442–452
Levine KB, Williams RE, Hartmann KE (2008) Vulvovaginal atrophy is strongly associated with female sexual dysfunction among sexually active postmenopausal women. Menopause 15:661–666
Lindau ST, Schumm LP, Laumann EO et al (2007) A study of sexuality and health among older adults in the United States. N Engl J Med 357:762–774
Crandall C, Petersen L, Ganz PA et al (2004) Association of breast cancer and its therapy with menopause-related symptoms. Menopause 11:519–530
Gupta P, Sturdee DW, Palin SL et al (2006) Menopausal symptoms in women treated for breast cancer: the prevalence and severity of symptoms and their perceived effects on quality of life. Climacteric 9:49–58
Harris PF, Remington PL, Trentham-Dietz A et al (2002) Prevalence and treatment of menopausal symptoms among breast cancer survivors. J Pain Symptom Manage 23:501–509
Schover LR (2008) Premature ovarian failure and its consequences: vasomotor symptoms, sexuality, and fertility. J Clin Oncol 26:753–758
Rosen R, Brown C, Heiman J et al (2000) The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 26:191–208
Baser RE, Li Y, Carter J (2012) Psychometric validation of the Female Sexual Function Index (FSFI) in cancer survivors. Cancer 118:4606–4618
Vistad I, Fossa SD, Kristensen GB et al (2007) The sexual activity questionnaire: psychometric properties and normative data in a Norwegian population sample. J Womens Health 16:139–148
Thirlaway K, Fallowfield L, Cuzick J (1996) The sexual activity questionnaire: a measure of women’s sexual functioning. Qual Life Res 5:81–90
Andersen BL, Woods XA, Copeland LJ (1997) Sexual self-schema and sexual morbidity among gynecologic cancer survivors. J Consult Clin Psychol 67:221–229
Carpenter KM, Andersen BL, Fowler JM, Maxwell GL (2009) Sexual self schema as a moderator of sexual and psychological outcomes for gynecologic cancer survivors. Arch Sex Behav 38:828–841
Philip EJ, Nelson C, Temple L (2013) Psychological correlates of sexual dysfunction in female rectal and anal cancer survivors: analysis of baseline intervention data. J Sex Med 10:2539–2548
R Core Team (2014) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL http://www.R-project.org/
Nappi RE, Kokot-Kierepa M (2012) Vaginal health: insights, views & attitudes (VIVA)—results from an international survey. Climacteric 15:36–44
Dennerstein L, Dudley EC, Hopper JL et al (2000) A prospective population-based study of menopausal symptoms. Obstet Gynecol 96:351–358
Mac Bride MB, Rhodes DJ, Shuster LT (2010) Vulvovaginal atrophy. Mayo Clin Proc 85:87–94
Acknowledgments
We would like to gratefully acknowledge and thank Dr. Larry Norton and Dr. Richard Barakat for their generous and continual support of the clinical care and research endeavors of the Female Sexual Medicine and Women’s Health Program.
Conflict of interest
The authors have no conflicts of interest to declare. The authors also have full control of all primary data and agree to allow the journal to review the data if requested.
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Carter, J., Stabile, C., Seidel, B. et al. Baseline characteristics and concerns of female cancer patients/survivors seeking treatment at a Female Sexual Medicine Program. Support Care Cancer 23, 2255–2265 (2015). https://doi.org/10.1007/s00520-014-2573-9
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DOI: https://doi.org/10.1007/s00520-014-2573-9