Our research shows that most women diagnosed with either breast or gynecologic cancer have concerns about how treatment may affect their sexual and vaginal health. Moreover, they want their healthcare providers to initiate the discussion.
At Memorial Sloan Kettering Cancer Center (MSK), we have developed research-based intervention strategies that can significantly improve sexual function and quality of life for women experiencing changes in sexual and vaginal health during and after cancer treatment, such as problems with vaginal dryness, discomfort during intercourse, and decreased libido.
Large Unmet Need
To assess the sexual and vaginal health needs and educational preferences in women, we conducted a needs assessment of 218 participants, half of whom had a history of gynecologic cancer and the other half a history of breast cancer. Overall, 70 percent of women reported that they were somewhat or very concerned about their sexual function and vaginal health, 55 percent had experienced vaginal dryness, 39 percent had experienced vaginal pain, and 51 percent suffered a loss of libido. (1)
Many women had heard about vaginal and vulvar moisturizers and lubricants, as well as pelvic floor exercises, but utilization of these strategies varied. Seventy-five percent of women had used lubricants, but only 28 percent had used moisturizers or performed pelvic floor exercises. A clear majority, 70 percent, preferred healthcare providers to initiate a discussion about sexual health, and most wanted written material followed by expert discussion. (1)
Vaginal Dryness and Vulvovaginal Atrophy
With natural menopause, vulvovaginal atrophy is a chronic and progressive condition that can significantly reduce intimacy, enjoyment of intercourse, and spontaneity. These sexual health challenges tend to be more acute for women who experience iatrogenic menopause from cancer treatment and may contribute to noncompliance with risk-reduction treatment. For example, women with breast cancer taking aromatase inhibitors to reduce the risk of cancer recurrence can experience vulvovaginal tissue quality changes that can make intercourse painful and gynecological exams uncomfortable, which in turn can lead to noncompliance with treatment. Women treated with pelvic radiation or who develop vaginal graft-versus-host disease after allogeneic stem cell transplantation can also suffer more severe vaginal pain. (2) Reduced moisture can lead to abandoning vaginal dilator therapy intended to restore sexual function in women who have undergone radiation treatment for gynecologic cancer.
Measuring the Effectiveness of Interventions
To efficiently assess vaginal and vulvar health and the effectiveness of treatment interventions, we have developed and validated two new clinical tools: the vaginal assessment scale (VAS) and the vulvar assessment scale (VuAS). These tools can easily be incorporated into any busy oncology practice, helping clinicians quickly identify patients’ sexual health issues and provide simple solutions proven to improve vulvovaginal tissue quality. (3)
Intervention strategies make a significant difference in alleviating vulvovaginal atrophy and improving sexual health, intimacy, and confidence. In another recent study, we used the VAS and VuAS to evaluate adherence to interventions and improvements in vulvovaginal health among 175 cancer survivors who attended our Female Sexual Medicine & Women’s Health Program. (4)
Of these women, seen over an average of 3.43 visits, we found that 89 percent had complied with the recommendation to use moisturizers two to five times per week. Overall, vaginal PH scores declined, both VAS and VuAS scores improved, and sexual function scores increased significantly. Women reported enhanced sexual function and increased intimacy and confidence. (4)
At MSK, patient care extends beyond cancer treatment. Our multidisciplinary team of clinical psychologists, certified sexual therapists, and breast and gynecologic cancer specialists are committed to helping women address sexual health challenges during cancer treatment and after it is completed.
We conduct clinical trials to look for new ways to improve patient care. For example, we are currently recruiting participants for a study that is examining whether the use of a nonhormonal vaginal moisturizer containing hyaluronic acid vaginal gel (HyaloGYN) improves vulvovaginal health in hormone receptor-positive postmenopausal cancer survivors who are experiencing vaginal or vulvar symptoms due to estrogen deprivation following cancer treatment. We are also conducting a study evaluating the impact of breast cancer therapy on sexual and reproductive health. Within the next month or two, a new study will open to evaluate the use of flibanserin (Addyi®) for the treatment of decreased libido in women with breast cancer who are on tamoxifen (Nolvadex®, Soltamox®). In addition, we have several new studies in the pipeline for 2018 that will evaluate the use of novel therapies for the treatment of vulvovaginal dryness and dyspareunia in women with breast cancer.