Patient interest in the Lowdown on Down There: attendance at a vulvovaginal and sexual health workshop post-cancer treatment

A randomized comparison of online mindfulness-based group sex therapy vs supportive group sex education to address sexual dysfunction in breast cancer survivors

BACKGROUND

Sexual difficulties and vaginal pain are common following treatment for breast cancer.

AIM

The goal of this study was to evaluate an online mindfulness-based group sex therapy vs an online supportive sex education group therapy to address these sexual difficulties.

METHODS

Breast cancer survivors (n = 118) were randomized to 1 of the 2 arms; 116 provided informed consent and completed the time 1 assessment. Treatment included 8 weekly 2-hour online group sessions. Those randomized to the mindfulness group completed daily mindfulness exercises, and those in the comparison arm read and completed exercises pertaining to sex education.

OUTCOMES

Assessments were repeated at posttreatment and 6 months after the completion of the group.

RESULTS

There was a main effect of treatment on primary endpoints of sexual desire, sexual distress, and vaginal pain, with all outcomes showing significant improvements, with no differential impact by treatment arm. Secondary endpoints of interoceptive awareness, mindfulness, and rumination about sex also significantly improved with both treatments, with no group-by-time interaction.

CONCLUSION

Both mindfulness-based sex therapy and supportive sex education delivered in group format online are effective for improving many facets of sexual function, vaginal pain, rumination, mindfulness, and interoceptive awareness in breast cancer survivors.

STRENGTHS AND LIMITATIONS

We used a randomized methodology. Future studies should seek to diversify participants.

CLINICAL IMPLICATIONS

These findings highlight the need to offer similar treatments to more breast cancer survivors immediately after and in the years following cancer treatment as a means of improving survivorship quality of life.

Feasibility and Acceptability of a Group-Based Mindfulness Intervention for Sexual Interest/Arousal Disorder Following Breast Cancer Treatment

This study aimed to assess feasibility and preliminary efficacy of an 8-week Mindfulness-Based Cognitive Therapy (MBCT) group program to treat Sexual Interest/Arousal Disorder (SIAD) in women following breast cancer (BrCa) treatment. Thirty women participated, of whom 67% (n = 20) attended at least 6 of 8 group sessions. Feedback indicated the program was relevant and valuable; minor modifications were suggested to further address survivorship concerns. Results of pre-post questionnaires demonstrated significant improvements in sexual distress and sexual interest/desire, with large effect sizes. Results support the feasibility and preliminary efficacy of an 8-week MBCT program among women following breast cancer treatment.

Implementation of individually tailored treatment plans in a group-based intervention for women with mixed vulvo-vaginal and sexual health concerns following cancer treatment: A feasibility study

PURPOSE

This study evaluated a professionally-led, group-based vulvo-vaginal and sexual health (VSH) workshop for women diagnosed with cancer. The study goals were to: (1) implement and assess a novel group intervention for diverse VSH concerns; (2) explore post-workshop changes in symptom bother, motivation to use VSH treatments, and frequency of VSH treatment use; (3) examine post-workshop changes in sexual well-being.

METHODS

A group-based educational workshop to address a variety of VSH concerns was developed and implemented. During the workshop, participants created an individualized treatment plan by selecting from various VSH treatment options presented. Treatment plan follow-ups were administered online at one-, two-, and three-months post-workshop. At baseline and three-month follow-up, participants completed online questionnaires to assess self-reported vulvo-vaginal symptoms, sexual function, sexual distress, and use of VSH strategies.

RESULTS

195 participants (age 20-81) attended workshops over a 2.5-year period. Individualized treatment plans were effectively completed by most participants (92%). Preliminary results show decreases in bother severity associated with VSH concerns post-workshop, stabilizing after 2 months. At three-month follow-up, participants reported increased use of VSH treatment strategies. Sexual satisfaction, sexual distress, and emotional impact of vulvovaginal symptoms also improved.

CONCLUSIONS

Workshop attendance was associated with increased uptake of VSH treatment strategies and improvements in several parameters of sexual well-being. Findings indicate that individualized treatment plans can be implemented effectively in a group setting and that a one-time, group-based educational workshop can meaningfully impact VSH-related behavior change, reduce vulvo-vaginal symptom bother and promote sexual well-being in patients with diverse VSH concerns.

Management Strategies for Sexuality Complaints after Gynecologic Cancer: A Systematic Review

OBJECTIVE

 To explore the main sexuality complaints of gynecologic cancer survivors after treatment and to identify the care strategies provided.

DATA SOURCE

 Searches were conducted in six electronic databases: Scopus, Web of Science, LILACS, MEDLINE, PsychINFO, and EMBASE.

STUDY SELECTION

 Articles published between 2010 and 2020 were selected and the following descriptors were used in the English language: female genital neoplasms and gynaecological cancer. The methodological quality of the studies used the Mixed Methods Appraisal Tool (MMAT).

DATA COLLECTION

 The primary data extracted were: names of the authors, year of publication, country of origin, objective and type of study, data collection instrument, sample size and age range, types of cancer, and symptoms affected with the strategies adopted.

DATA SUMMARY

 A total of 34 out of 2,536 screened articles were included. The main strategies found for patient care were patient-clinician communication, practices for sexuality care, individualized care plan, multiprofessional team support, and development of rehabilitation programs. For sexuality care, the most common practices are pelvic physiotherapy sessions and the use of vaginal gels and moisturizers.

CONCLUSION

 The main complaints identified in the scientific literature were low libido and lack of interest in sexual activity, vaginal dryness, pain during sexual intercourse, and stenosis. Different care strategies may be adopted, such as follow-up with a multidisciplinary health team and sexual health rehabilitation programs, which could minimize these symptoms and ensure the quality of life of patients.

Investigating the impact of the COVID-19 pandemic on breast cancer clinicians’ communication about sexual health

Purpose

We assessed breast cancer clinicians’ perspectives on how the COVID-19 pandemic and increased use of telehealth affected their clinical communication about sexual heath.

Methods

Breast cancer clinicians participating in a sexual health communication intervention study (N = 29; 76% female; 66% oncologists; 34% advanced practice clinicians) completed an online survey. Data analysis consisted of descriptive statistics and thematic analysis.

Results

All clinicians were using telehealth, with most (66%) using it for up to half of their clinic appointments. Although only 14% of clinicians reported having shorter clinic visits, 28% reported having less time to discuss sexual health; 69% reported no change; and 3% said they had more time. Forty-one percent reported sexual health was less of a priority; 55% reported no change; and 3% said it was more of a priority. Thirty-five percent reported telehealth was less conducive to discussing sexual health; 59% reported no change; and 7% reported more conducive. Qualitative analysis revealed key issues underlying the perceived impact of the pandemic on discussions of sexual health including heightened clinician discomfort discussing such issues via telehealth, the less personal nature and privacy issues in telehealth visits, increased concerns about risk of COVID-19 infection and other health concerns (e.g., missing recurrence, mental health) taking priority, and clinician-perceived patient factors (e.g., discomfort, decreased priority) in discussing sexual concerns.

Conclusion

Pandemic-related changes in breast cancer clinicians’ practice could be exacerbating challenges to discussing sexual health. Methods for integrating sexual health into cancer care are needed, regardless of the mode of delivery.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00520-022-07003-8.

Perspectives of health care providers referring patients to a newly implemented sexual health program in a Canadian cancer center

PURPOSE

Screening and discussion about sexual health concerns within cancer care are frequently impeded by lack of access to sexual health resources and lack of fluency with sexual health topics. To address this, a multi-disciplinary sexual health program was developed and piloted in a Canadian tertiary cancer center. The aim of this study was to assess referring health care providers' perspectives on the newly implemented oncology sexual health program.

METHODS

A brief online survey was administered system-wide to cancer care providers to query their perceptions of the pilot multidisciplinary sexual health program, the Oncology and Sexuality, Intimacy and Survivorship (OASIS) program.

RESULTS

According to survey results, the OASIS program was perceived by health care providers as valuable, helpful for patients, and important for addressing gaps in clinical care. Additional comments indicated an ongoing need for increased access to information about the program and referral procedures.

CONCLUSION

Survey results highlight the need for consistent program dissemination efforts to equip health care providers with accessible patient education materials and easily implemented referral procedures. Importantly, providers indicated that they were more likely to raise the topic of sexuality with patients because they had somewhere to refer patients who had sexual concerns. Overall, findings inform efforts to implement sexual health programming within cancer care institutions.

Development, implementation, and evaluation of a multidisciplinary oncology sexual health clinic in a Canadian cancer care setting

PURPOSE

Untreated cancer-related sexual health concerns cause significant distress for cancer survivors. To appropriately address the complex sexual health needs of cancer patients, we piloted a specialized, multidisciplinary oncology sexual health clinic within a tertiary cancer center. A quality assurance evaluation was conducted.

METHODS

During once monthly half-day clinics, a multidisciplinary team of psychologists, advanced practice nurses, and radiation and gynecological oncologists offered specialist integrated care to oncology patients. Patients completed assessment questionnaires prior to each clinic appointment and a follow-up telephone interview approximately 4 months after their initial appointment.

RESULTS

Over the 2-year pilot, 224 patients were referred to the cancer center's broader sexual health program; 100 patients were triaged to the clinic. A total of 79 new and 58 follow-up appointments were offered. Average wait time for an initial visit was 97 days. Patients' most frequent concerns included vulvovaginal atrophy, dyspareunia, reduced sexual desire, and erectile dysfunction. Self-reported sexual distress was well above the clinical cutoff at baseline (N = 77, M = 29.78, SD = 12.74). A significant reduction in sexual distress was observed at follow-up (N = 67, M = 21.90, SD = 11.34, t(66) = 7.41, p < 0.001).

CONCLUSIONS

Referral rates indicate a high demand for specialized sexual health services within cancer care. Ongoing specialist care is needed to appropriately address the multifaceted sexual concerns of cancer survivors and to adequately manage high distress and symptom comorbidity.

IMPLICATIONS FOR CANCER SURVIVORS

Results inform a more comprehensive characterization of the presenting concerns of cancer survivors seeking multidisciplinary sexual health care.

Barriers to sexual recovery in women with urologic cancers

Sexual health concerns are prevalent and distressing in oncology patients and survivors. While urologic cancers are more prevalent in men, women often have more advanced disease at initial diagnosis, require more advanced surgical resection, and experience higher postoperative complication rates, as well as morbidity and mortality. Women with urologic cancers undergo treatment that is highly likely to impact their sexual function and well-being, however, attention to sexual recovery in this patient population has been limited. Barriers to sexual recovery in women with urologic cancers are biopsychosocial in nature and include complications related to treatment procedures, cancer-related distress, sexual anxiety and avoidance, partner and relational dynamics, and sexual communication skills. Healthcare providers do not adequately address sexual difficulties for these patients and their partners. Sexual minority women and transgender patients with urologic cancer have unique psychosocial and sexual health needs though, due to a lack of research, these remain poorly understood. More research is needed to pinpoint the sexual health needs of this specific oncology population and to explore how various treatment options, such as pelvic organ-sparing cystectomy, can impact sexual health outcomes. Evidence-based and multidisciplinary oncologic and survivorship care, which includes licensed mental health providers, certified sex therapists, and other sexual health experts, is essential for assisting women in their sexual recovery following urologic cancer.