title: Sexuality issues in gynaecological oncology patients: post treatment symptoms and therapeutic options.
abstract: OBJECTIVE
  According to recent studies up to 80% of patients would like to receive more information about how cancer treatments can affect their sexual functioning. Moreover, 75 % of them would not feel comfortable being the first to bring up the subject. Our Gynaecological Advice Clinic was established in 2006 at the Christie Hospital and offers support to cancer patients who face sexuality issues. A previous evaluation established that the service sees approximately, 200 patients per year. The aims of this study are to evaluate the service by collecting data relating to levels of attendance, type and amount of clinical activity and to explore further patients' experiences and management.
  
  
  METHODS
  This is a retrospective study which was carried out in 2012-2013. Different models are used to evaluate our patients including history taking integrated therapy model, consultations to understand the normal anatomy and physiology with the use of diagrams and photographs, psycho-education and the international classification "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition" (DSMV). The treatment options advised include medications such as hormone replacement treatment, testosterone, antidepressant, local oestrogen, tibolone, aqueous cream, lubrication to introitus, diprobase, dermal cream and advice for massage to areas of discomfort. Moreover, the use of vaginal dilators, the role of pelvic floor exercises, vulval care and self examination are explained. The team works closely with the psycho-oncology department. The most frequently discussed topics that were covered during the consultation are analysed.
  
  
  RESULTS
  41 outpatient clinics were held between 2012 and 2013. 194 patients attended those clinics during the study period. Single and not group therapy was offered to all the participants. 216 patients were offered appointments while 194 patients actually attended (90%). Patients' age ranged from 24 to 91 years with a mean age of 59 years. 45% had endometrial and 32% cervical cancer, 18% vulval cancer, 4 % ovarian cancer. 74% attended on their own while 18% with their partners and 8% with another family member or friend. 98% of the patients had confidence/trust in the healthcare professional. 95% felt involved with treatment decisions. 82% reported completely understanding information about side-effects. 16% were unaware of who to contact once they had completed treatment. 8% were attending for on-going help with psycho-sexual concerns following completion of treatment.
  
  
  CONCLUSIONS
  The clinic was positively evaluated by patients, they had a high level of trust in the nurses running the service and they found it beneficial. Consultations were generally lasting 20-30 min and most patients reported this was an appropriate length. It once again highlights that although the service was set-up to address psycho-sexual concerns, in reality it dealt with a variety of other patient concerns. Due to the success of the clinic, the service has expanded and we are now supporting patients from other tumour groups such as colorectal, urology and plastic surgery.
authors.affiliation: Gynaecological Oncology Department, The Christie Hospital, Manchester, UK, christosiavazzo@hotmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Iavazzo
authors.forename: K
authors.initials: K
authors.lastname: Johnson
authors.forename: H
authors.initials: H
authors.lastname: Savage
authors.forename: S
authors.initials: S
authors.lastname: Gallagher
authors.forename: M
authors.initials: M
authors.lastname: Datta
authors.forename: B A
authors.initials: BA
authors.lastname: Winter-Roach
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005833:Genital Neoplasms, Female / Q000628:therapy*; D006282:Health Personnel; D006296:Health Services / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D009723:Nurse-Patient Relations; D009726:Nurses; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012725:Sexual Behavior; D019529:Sexuality / Q000502:physiology / Q000523:psychology*; D011795:Surveys and Questionnaires