Sexual Health
CMECNE

Managing Sexual Concerns in Patients with Ovarian Cancer

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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

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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

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