title: Interventions for sexual dysfunction following treatments for cancer in women.
abstract: BACKGROUND
  The proportion of people living with and surviving cancer is growing. This has led to increased awareness of the importance of quality of life, including sexual function, in those affected by cancer. Sexual dysfunction is a potential long-term complication of many cancer treatments. This includes treatments that have a direct impact on the pelvic area and genitals, and also treatments that have a more generalised (systemic) impact on sexual function.This is an update of the original Cochrane review published in Issue 4, 2007, on interventions for treating sexual dysfunction following treatments for cancer for men and women. Since publication in 2007, there has been an increase in the number of trials for both men and women and this current review critiques only those for women. A review in press will present those for men.
  
  
  OBJECTIVE
  To evaluate the effectiveness of interventions for treating sexual dysfunction in women following treatments for cancer. To assess adverse events associated with interventions.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 9), MEDLINE, EMBASE, PsycINFO, AMED, CINAHL, Dissertation Abstracts and the NHS Research Register. The searches were originally run in January 2007 and we updated these to September 2015.
  
  
  METHODS
  We included randomised controlled trials (RCTs) that assessed the effectiveness of a treatment for sexual dysfunction. The trial participants were women who had developed sexual dysfunction as a consequence of a cancer treatment. We sought evaluations of interventions that were pharmaceutical, mechanical, psychotherapeutic, complementary or that involved physical exercise.
  
  
  METHODS
  Two review authors independently extracted the data and assessed trial quality. We considered meta-analysis for trials with comparable key characteristics.
  
  
  RESULTS
  Since the original version of this review we have identified 11 new studies in women. The one study identified in the earlier version of this review was excluded in this update as it did not meet our narrower inclusion criteria to include only interventions for the treatment, not prevention, of sexual dysfunction.In total 1509 female participants were randomised across 11 trials. All trials explored interventions following treatment either for gynaecological or breast cancer. Eight trials evaluated a psychotherapeutic or psycho-educational intervention. Two trials evaluated a pharmaceutical intervention and one pelvic floor exercises. All involved heterosexual women. Eight studies were at a high risk of bias as they involved a sample of fewer than 50 participants per trial arm. The trials varied not only in intervention content but in outcome measurements, thereby restricting combined analysis. In the trials evaluating a psychotherapeutic intervention the effect on sexual dysfunction was mixed; in three trials benefit was found for some measures of sexual function and in five trials no benefit was found. Evidence from the other three trials, two on different pharmaceutical applications and one on exercise, differed and was limited by small sample sizes. Only the trial of a pH-balanced vaginal gel found significant improvements in sexual function. The trials of pharmaceutical interventions measured harm: neither reported any. Only one psychological intervention trial reported that no harm occurred because of the intervention; the other trials of psychological support did not measure harm.
  
  
  CONCLUSIONS
  Since the last version of this review, the new studies do not provide clear information on the impact of interventions for sexual dysfunction following treatments for cancer in women. The sexual dysfunction interventions in this review are not representative of the range that is available for women, or of the wider range of cancers in which treatments are known to increase the risk of sexual problems. Further evaluations are needed.
authors.affiliation: Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, 6th Floor, Maple House, 149 Tottenham Court Road, London, UK, W1T 7NF.
authors.forename: Bridget
authors.initials: B
authors.lastname: Candy
authors.forename: Louise
authors.initials: L
authors.lastname: Jones
authors.forename: Victoria
authors.initials: V
authors.lastname: Vickerstaff
authors.forename: Adrian
authors.initials: A
authors.lastname: Tookman
authors.forename: Michael
authors.initials: M
authors.lastname: King
mesh_terms: D000282:Administration, Intravaginal; D000328:Adult; D001943:Breast Neoplasms / Q000628:therapy*; D005260:Female; D005833:Genital Neoplasms, Female / Q000628:therapy*; D006801:Humans; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D011613:Psychotherapy; D016032:Randomized Controlled Trials as Topic; D012735:Sexual Dysfunction, Physiological / Q000209:etiology / Q000628:therapy*; D020018:Sexual Dysfunctions, Psychological / Q000628:therapy; D013739:Testosterone / Q000627:therapeutic use; D002583:Uterine Cervical Neoplasms / Q000628:therapy; D014622:Vaginal Creams, Foams, and Jellies / Q000008:administration & dosage
chemical_list: D010726:Phosphodiesterase Inhibitors; D014622:Vaginal Creams, Foams, and Jellies; D013739:Testosterone
references.citation: J Sex Marital Ther. 2006 Oct-Dec;32(5):389-99
references.pmid: 16959662
references.citation: Trials. 2013 Feb 11;14:39
references.pmid: 23399476
references.citation: J Clin Oncol. 2006 Apr 1;24(10):1620-6
references.pmid: 16575013
references.citation: J Multidiscip Healthc. 2014 Jul 16;7:301-11
references.pmid: 25075194
references.citation: J Clin Oncol. 1998 Feb;16(2):501-14
references.pmid: 9469334
references.citation: Curr Psychiatry Rep. 2000 Jun;2(3):215-22
references.pmid: 11122959
references.citation: Am J Obstet Gynecol. 1984 Mar 1;148(5):552-7
references.pmid: 6367474
references.citation: Obstet Gynecol. 2003 Jun;101(6):1213-20
references.pmid: 12798527
references.citation: J Endocrinol. 2003 Jan;176(1):163-8
references.pmid: 12525260
references.citation: Obstet Gynecol. 1995 Apr;85(4):529-37
references.pmid: 7898828
references.citation: Obstet Gynecol. 2002 Feb;99(2):281-9
references.pmid: 11814510
references.citation: Psychooncology. 2009 Dec;18(12):1261-72
references.pmid: 19235193
references.citation: J Womens Health (Larchmt). 2008 Jul-Aug;17(6):955-63
references.pmid: 18681816
references.citation: Cancer. 2011 Jun 15;117(12):2643-51
references.pmid: 21656742
references.citation: Semin Oncol Nurs. 2002 Aug;18(3):223-30
references.pmid: 12184045
references.citation: Int J Radiat Oncol Biol Phys. 2006 Jun 1;65(2):404-11
references.pmid: 16542794
references.citation: Arch Sex Behav. 2013 Aug;42(6):915-33
references.pmid: 23559141
references.citation: Gynecol Oncol. 2012 Jun;125(3):705-11
references.pmid: 22472463
references.citation: N Engl J Med. 1999 Jun 3;340(22):1733-9
references.pmid: 10352166
references.citation: Maturitas. 1980 Jan;2(1):19-28
references.pmid: 7402084
references.citation: J Sex Marital Ther. 2002;28 Suppl 1:165-73
references.pmid: 11898698
references.citation: J Natl Cancer Inst. 2007 May 2;99(9):672-9
references.pmid: 17470735
references.citation: Clin Oncol (R Coll Radiol). 1999;11(1):46-8
references.pmid: 10194586
references.citation: Radiother Oncol. 2007 Sep;84(3):217-25
references.pmid: 17692977
references.citation: BMC Cancer. 2015 Apr 28;15:321
references.pmid: 25927495
references.citation: Laryngoscope. 2008 Dec;118(12):2218-24
references.pmid: 19029864
references.citation: J Palliat Care. 2002 Winter;18(4):300-6
references.pmid: 12611322
references.citation: Dis Colon Rectum. 2011 Jan;54(1):113-25
references.pmid: 21160322
references.citation: Ann Surg. 2005 Aug;242(2):212-23
references.pmid: 16041212
references.citation: BMJ. 2008 Sep 29;337:a1655
references.pmid: 18824488
references.citation: J Urol. 2003 Dec;170(6 Pt 1):2333-8
references.pmid: 14634409
references.citation: Ann R Coll Surg Engl. 1990 Jul;72(4):273
references.pmid: 2143365
references.citation: Oncol Nurs Forum. 2005 Mar 05;32(2):273-9
references.pmid: 15759065
references.citation: J Clin Oncol. 2015 Oct 20;33(30):3394-400
references.pmid: 26215946
references.citation: J Sex Med. 2008 Feb;5(2):357-64
references.pmid: 18042215
references.citation: J Sex Marital Ther. 1979 Fall;5(3):244-81
references.pmid: 513144
references.citation: Radiology. 1971 May;99(2):417-21
references.pmid: 5553582
references.citation: Psychiatry (Edgmont). 2008 Jun;5(6):50-5
references.pmid: 19727285
references.citation: Oncol Nurs Forum. 2002 Nov-Dec;29(10):1411-9
references.pmid: 12432412
references.citation: Cancer. 1999 Nov 1;86(9):1768-74
references.pmid: 10547550
references.citation: Eur J Cancer. 2005 Nov;41(17):2673-81
references.pmid: 16239103
references.citation: J Support Oncol. 2011 May-Jun;9(3):105-12
references.pmid: 21702402
references.citation: Crit Care. 2013 Jan 09;17(1):R2
references.pmid: 23302257
references.citation: Anticancer Drugs. 2004 Sep;15(8):753-60
references.pmid: 15494636
references.citation: Ann Oncol. 2001;12 Suppl 3:S37-42
references.pmid: 11804383
references.citation: BMC Complement Altern Med. 2010 Aug 06;10:44
references.pmid: 20691074
references.citation: Obstet Gynecol. 2014 Jun;123(6):1231-1236
references.pmid: 24807329
references.citation: J Natl Compr Canc Netw. 2013 Nov;11(11):1389-97
references.pmid: 24225972
references.citation: J Sex Marital Ther. 1983 Winter;9(4):266-75
references.pmid: 6663643
references.citation: Support Care Cancer. 2013 Jan;21(1):271-80
references.pmid: 22714701
references.citation: MMWR Morb Mortal Wkly Rep. 2011 Mar 11;60(9):269-72
references.pmid: 21389929
references.citation: J Consult Clin Psychol. 2004 Dec;72(6):1122-35
references.pmid: 15612858
references.citation: J Clin Pharm Ther. 2006 Aug;31(4):331-4
references.pmid: 16882101
references.citation: BMC Cancer. 2015 Aug 11;15:580
references.pmid: 26260318
references.citation: Obstet Gynecol. 2011 Apr;117(4):922-927
references.pmid: 21422866
references.citation: J Pain Symptom Manage. 2002 May;23(5):442-7
references.pmid: 12007762
references.citation: Iran Red Crescent Med J. 2014 Jan;16(1):e8763
references.pmid: 24719718
references.citation: Psychol Health. 2015;30(3):284-300
references.pmid: 25271396
references.citation: Psychooncology. 2013 Mar;22(3):555-63
references.pmid: 22290823
references.citation: J Clin Oncol. 2015 Apr 1;33(10):1171-9
references.pmid: 25713429
references.citation: Best Pract Res Clin Obstet Gynaecol. 2007 Apr;21(2):309-20
references.pmid: 17196433
references.citation: Oral Oncol. 2009 Oct;45(10):898-903
references.pmid: 19457705
references.citation: Patient Educ Couns. 2006 Feb;60(2):212-9
references.pmid: 16442463
references.citation: Health Soc Work. 2004 Nov;29(4):330-4
references.pmid: 15575461
references.citation: Int J Impot Res. 1999 Sep;11 Suppl 1:S31-8
references.pmid: 10554927
references.citation: J Sex Marital Ther. 1998 Apr-Jun;24(2):139-43
references.pmid: 9611693
references.citation: Cochrane Database Syst Rev. 2006 Oct 18;(4):CD001500
references.pmid: 17054136
references.citation: Psychosom Med. 1985 Jul-Aug;47(4):339-51
references.pmid: 4023162
references.citation: Climacteric. 2008 Jun;11(3):181-91
references.pmid: 18568783
references.citation: Gynecol Oncol. 2012 May;125(2):320-5
references.pmid: 22293042
references.citation: Homeopathy. 2003 Jul;92(3):131-4
references.pmid: 12884894
references.citation: Cancer. 2011 Nov 1;117(21):4983-92
references.pmid: 21495025
references.citation: BMJ. 2006 Apr 22;332(7547):942-8
references.pmid: 16597660
references.citation: Urology. 2006 Apr;67(4):742-5
references.pmid: 16566975
references.citation: J Clin Oncol. 1998 Sep;16(9):3148-57
references.pmid: 9738587
references.citation: Int Urogynecol J Pelvic Floor Dysfunct. 2009 Feb;20(2):149-58
references.pmid: 18958382
references.citation: J Sex Med. 2013 Oct;10(10):2549-58
references.pmid: 23635341
references.citation: J Korean Acad Nurs. 2013 Oct;43(5):681-9
references.pmid: 24351999
references.citation: Mater Med Pol. 1995 Oct-Dec;27(4):153-6
references.pmid: 9000840
references.citation: Psychother Res. 2009 Jul;19(4-5):418-28
references.pmid: 19034715
references.citation: Eur J Oncol Nurs. 2014 Aug;18(4):385-92
references.pmid: 24793004
references.citation: Int J Radiat Oncol Biol Phys. 2005 Mar 15;61(4):1078-86
references.pmid: 15752887
references.citation: Endocrinol Jpn. 1967 Mar;14(1):27-33
references.pmid: 4863025
references.citation: Nurs Res. 2006 May-Jun;55(3):161-71
references.pmid: 16708040
references.citation: Eur J Cancer Care (Engl). 2015 Jul;24(4):493-502
references.pmid: 25651297
references.citation: Br J Obstet Gynaecol. 1999 Mar;106 Suppl 19:1-21
references.pmid: 10890791
references.citation: Cardiovasc Hematol Agents Med Chem. 2009 Oct;7(4):260-9
references.pmid: 19538161
references.citation: Psychopharmacol Bull. 1997;33(4):731-45
references.pmid: 9493486
references.citation: Br J Clin Psychol. 1985 Feb;24 ( Pt 1):63-4
references.pmid: 3971070
references.citation: Br J Cancer. 2014 Feb 4;110(3):593-601
references.pmid: 24280999
references.citation: Psychooncology. 2014 Sep;23(9):1005-13
references.pmid: 24615831
references.citation: J Sex Marital Ther. 2000 Apr-Jun;26(2):191-208
references.pmid: 10782451
references.citation: Menopause. 2014 Jun;21(6):612-23
references.pmid: 24281237
references.citation: J Clin Oncol. 2004 Feb 1;22(3):507-16
references.pmid: 14752074
references.citation: Palliat Med. 2003 Mar;17(2):202-5
references.pmid: 12701852
references.citation: Eur J Cancer Care (Engl). 2009 Jan;18(1):69-77
references.pmid: 19473224
references.citation: Psychooncology. 2009 Mar;18(3):276-83
references.pmid: 18702064
references.citation: Eur J Cancer. 2011 Jun;47(9):1363-72
references.pmid: 21458989
references.citation: J Sex Med. 2012 Dec;9(12):3089-107
references.pmid: 23088533
references.citation: Support Care Cancer. 1995 Nov;3(6):428-31
references.pmid: 8564350
references.citation: Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005540
references.pmid: 17943864
references.citation: Climacteric. 2002 Dec;5(4):357-65
references.pmid: 12626215
references.citation: Endocrinol Metab Clin North Am. 2003 Jun;32(2):325-36
references.pmid: 12800534
references.citation: Int J Gynecol Cancer. 2006 Jan-Feb;16(1):354-63
references.pmid: 16445658
references.citation: Psychooncology. 2014 Jul;23(7):832-4
references.pmid: 24497302
references.citation: Psychooncology. 2013 Apr;22(4):930-5
references.pmid: 22374732
references.citation: Int J Gynecol Cancer. 1999 Sep;9(5):387-395
references.pmid: 11240799
references.citation: Cancer Control. 2010 Jan;17(1):44-51
references.pmid: 20010518
references.citation: Breast Cancer Res Treat. 2009 Nov;118(1):99-111
references.pmid: 19390963
references.citation: Int J Radiat Oncol Biol Phys. 1999 Jun 1;44(3):497-506
references.pmid: 10348277
references.citation: J Natl Cancer Inst. 2000 Jul 5;92(13):1054-64
references.pmid: 10880548
references.citation: Int J Impot Res. 2010 Nov-Dec;22(6):355-62
references.pmid: 20962793
references.citation: Urology. 2004 Jun;63(6):1153-7
references.pmid: 15183970