Sexual Health

CMECNE

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

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.

The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.

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 12/01/2022 through 12/01/2024, 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 test and evaluation. Upon registering and successfully completing the test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

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.

Read Disclaimer & Fine Print

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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