Sexual Health
CMECNE

Managing Sexual Concerns in Patients with Ovarian Cancer

FavoriteLoading

Learning Objectives and CME/Disclosure Information

CLINICAL ACTIONS:

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

  • Estrogen
    • 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
  • Ospemifene
    • Approved for vaginal symptoms
    • Contraindicated in patients with risk of thromboembolic disease
  • Testosterone
    • 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

SYNOPSIS:

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.

KEY POINTS:

  • 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

Learn More – Primary Sources:

Management of sexuality, intimacy, and menopause symptoms in patients with ovarian cancer

Take a post-test and get CME credits

Now You Can Get ObG Clinical Research Summaries Direct to Your Phone, with ObGFirst

ObGFirst® – Try It Free! »

FavoriteLoading

Related ObG Topics:

North American Menopause Society: Hormone Therapy Statement
Prescribing Ospemifene for Postmenopausal Vaginal Atrophy
Treating Postmenopausal Vaginal Atrophy When Estrogen is Not an Option
Genitourinary Syndrome of Menopause: New Name, Old Problem
Sexual Concerns of Previvors who Undergo Risk-Reducing Salpingo-Oophorectomy
Global Consensus Guidelines on Use of Testosterone in Women
Local Estrogen Treatment Options for Vaginal Atrophy
Get Guideline Alerts Direct to Your Phone

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!