title: Vaginal and sexual health treatment strategies within a female sexual medicine program for cancer patients and survivors.
abstract: We sought to evaluate patient adherence and response to simple vaginal and sexual health treatment strategies in female cancer patients receiving treatment at a female sexual medicine and health program and identify improvements of physical symptoms, per patient and clinical evaluation.
  
  
  
  Evaluability criteria included gynecologic exam at initial visit, at least one follow-up with gynecologic exam within 8 months of initial visit, and all consecutive follow-ups <6 months apart. Demographics, medical information, and clinical assessments from 175 evaluable patients with at least one follow-up from 09/12 to 10/14 were analyzed. The majority of patients were being treated for or had a history of breast (n = 90, 53 %), gynecologic (n = 54, 32 %), or colorectal/anal (n = 15, 9 %) cancers. An assessment form included a clinician evaluation, Vaginal Assessment Scale (VAS), Vulvar Assessment Scale (VuAS), and patient-reported outcomes. Compliance with treatment recommendations were summarized, and changes over time were compared for clinical outcomes.
  
  
  
  Mean number of visits was 3.43. Mean age was 55.4 years; 92 % (n = 155/169) were in menopause. Treatment strategies included rationale and instruction for use of vaginal moisturizers, lubricants, pelvic floor exercises, and dilator therapy, in addition to psychosexual education regarding sexual changes (response, anatomy, and function) associated with cancer treatment and support. At last assessment, 89 % had complied with the clinical recommendation (moisturize 2-5+ times/week). Vaginal pH scores >6.5 declined over time (p = 0.03). VAS scores improved by last assessment (p < 0.001), as did VuAS scores (p = 0.001). Sexual function scores significantly improved (p < 0.001), confidence about future sexual activity increased (p = 0.004), and sexual/vaginal health concerns decreased (p = 0.00003).
  
  
  
  Significant changes were observed in women using treatment strategies, with improvement in vulvovaginal symptoms, a decrease in elevated vaginal pH and pain with exams, enhanced sexual function, and increased intimacy confidence.
  
  
  
  These findings have high clinical relevance for symptom management with improvement of sexual function using simple strategies and clinical tools in the oncology setting.
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA. carterj@mskcc.org.|Psychiatry Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA. carterj@mskcc.org.|Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA. carterj@mskcc.org.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Carter
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
authors.forename: Cara
authors.initials: C
authors.lastname: Stabile
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Seidel
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Raymond E
authors.initials: RE
authors.lastname: Baser
authors.affiliation: Breast Cancer Medicine Service, Department of Medicine-Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.|Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Shari
authors.initials: S
authors.lastname: Goldfarb
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.|Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Goldfrank
mesh_terms: D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D011788:Quality of Life; D060728:Reproductive Health / Q000193:education*; D012725:Sexual Behavior / Q000523:psychology*; D011795:Surveys and Questionnaires; D017741:Survivors; D014621:Vagina / Q000473:pathology*
keywords: Cancer; Female sexual health; Quality of life; Survivorship; Vaginal health