Managing Sexual Concerns in Patients with Ovarian Cancer
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Describe the potential negative impact of ovarian cancer treatment on patients’ sexual functioning 2. List the possible treatments for managing sexual dysfunction in women following ovarian cancer treatment
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from April 10 2018 through 07/15/2022, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Designated for 0.1 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.
Following treatment for ovarian cancer, approximately 50% of women will experience morbidity related to sexual health, such as vaginal dryness, dyspareunia, decreased arousal or orgasm, hot flashes, low libido, depression, anxiety and changes in self-image. These symptoms can be grouped together under the acronym SIMS – Sexuality, Intimacy, and Menopausal Symptoms.
Treatments to Consider
First-line therapy for vaginal symptoms
Topical estrogen can be used safely in women with gynecological malignancies including ER positive cancer
Literature shows that low-dose systemic HRT may be used when local therapy fails with no increase in disease recurrence or mortality and may have survival benefits
Transdermal, rather than oral, delivery is preferred because ovarian cancer survivors are at higher risk for thromboembolic events
Approved for vaginal symptoms
Contraindicated in patients with risk of thromboembolic disease
Shown to increase libido and improve sexual function and satisfaction and can be prescribed
Not FDA approved in the US
Other non-hormonal therapies
Black Cohosh extract to improve hot flashes, atrophy and anxiety and depression
Maca root or ashwagandha root and vaginal moisturizers to improve libido
Vaginal moisturizers and lubricants for vaginal atrophy and dryness
SSRIs and SNRIs may be an option, although while helping with vasomotor symptoms, they may contribute to low libido
Pelvic floor physical therapy to improve vaginal pain
Cognitive behavioral therapy (CBT), psychoeducation, and mindfulness training may help with many changes in body image and feelings of well-being which may also impact on sexuality
There are many reasons that treatment for ovarian surgery may negatively impact a women’s sexual health. These include a decrease in androgens with oophorectomy, which will also decrease estrogen levels. Chemotherapeutic agents may also impact hormone levels. Platinum-based therapies target dividing cells such as granulosa/theca cells which will reduce estrogen and androstenedione secretion. In addition, there are obvious psychosocial issues to consider, including potential changes to a woman’s relationship with her partner, who may also have legitimate concerns and questions.
There are a variety of treatment modalities available for patients that can greatly improve their quality of life
The most effective treatment plan will likely be multimodal
Issues regarding sexual health can be addressed early in the process, in addition to surgical and medical management plans
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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