Sexual Concerns of Previvors who Undergo Risk-Reducing Salpingo-Oophorectomy
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. Discuss ‘SIMS’ and the related symptoms this acronym describes 2. Counsel previvors as to their potential options in the treatment of SIMS
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.
Previvor is a relatively recent term describing an individual who is at risk for cancer due to a genetic predisposition (e.g., women who are carriers for deleterious mutations in BRCA1 or BRCA2). A previvor may opt to undergo risk-reducing bilateral salpingo-oophorectomy. With the sudden drop in estrogen, women need to be informed of the potential impact on sexual function and a plan for dealing with Sexuality, Intimacy, and Menopausal Symptoms (SIMS) should be undertaken. Research indicates that one month following risk-reducing bilateral salpingo-oophorectomy, a majority of women will experience decreased sexual desire and activity due to symptoms associated with rapid estrogen depletion.
Consider the following treatment options
First-line therapy for vaginal symptoms including dryness and ease of penetration
Available in cream, table or ring form
Systemic hormone therapy
Studies have shown no increase in breast cancer risk in women who have had risk reducing salpingo-oopherectomy
Patients should receive counseling on systemic therapy with evidence review to enable shared decision making
Unopposed estrogen in a woman with a uterus is always contraindicated as it increases the risk for endometrial hyperplasia
Shown to increase libido and improve sexual function and satisfaction
Not FDA approved in the US
SSRIs and SNRIs
May be considered
Vasomotor symptoms may improve but can also result in further low libido
Daily dose of 100 mg at bedtime has been shown to provide up to 50% meaningful response
Over the counter and herbal supplements that may be helpful include
Black cohosh for hot flashes, atrophy and anxiety and depression
Maca root or ashwagandha root for low libido
Vaginal moisturizers and lubricants
Pelvic floor physical therapy
May be considered to help with vaginal pain
Behavioral therapy, psychoeducation, and mindfulness training
May help with many changes in body image and feelings of well-being which may also impact on sexuality
Previvors should be fully informed regarding the potential effects of the surgery including hormonal changes. Levels of androgens and estrogens decline and women may experience decrease in sexual desire, arousal and orgasm, vaginal atrophy, dyspareunia, and hot flashes as a result. Psychological and psychosocial effects may include reduced self-confidence, poor body image and feelings of guilt and anxiety. Unlike ovarian cancer survivors, many previvors will be younger, and risks surrounding early menopause is a concern.
While systemic hormonal replacement in cancer patients remains controversial, the abrupt loss of estrogen in premenopausal women has effects extending beyond cancer risk, including implications for bone and cardiovascular health
There are a variety of treatment modalities available for these patient that can greatly improve their quality of life
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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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