Strategies for Treating Sexual Health Concerns After Breast and Gynecologic Cancer.
This review examines sexual dysfunction as a sequela of breast and gynecologic cancer treatment, with a focus on genitourinary syndrome of menopause (GSM). The authors conducted a comprehensive literature search across PubMed, Google Scholar, and Scopus, covering peer-reviewed studies from the past 30 years. Findings were synthesized thematically, grouping studies by cancer type, treatment modality, and impact on sexual function. The review found that common symptoms—including vaginal dryness, dyspareunia, and diminished sexual desire—are frequently underrecognized. Nonhormonal management strategies identified included minimizing irritants, vaginal moisturizers, lubricants, dilators, and pelvic floor therapy. Local hormonal therapies were noted as potentially appropriate for select patients depending on cancer hormone-sensitivity status. For low sexual desire, pharmacological agents such as bremelanotide and flibanserin were reported to have demonstrated efficacy in the literature reviewed. The authors advise against vaginal laser treatments and compounded hormones in these populations due to safety concerns. A multidisciplinary approach involving gynecologic, psychological, and oncologic expertise was emphasized. Limitations include the absence of a formal quality assessment tool and reliance on narrative thematic synthesis rather than meta-analytic methods.
Why this grade: This is a narrative literature review without formal quality appraisal or meta-analysis, synthesizing existing studies rather than generating new primary evidence.
Objective Sexual dysfunction is a common but underrecognized sequelae of breast and gynecologic cancer treatment. Many patients experience symptoms of genitourinary syndrome of menopause, including vaginal dryness, dyspareunia, and diminished sexual desire. Addressing these challenges requires a comprehensive, evidence-based approach to management. Data sources A comprehensive literature search was conducted using PubMed, Google Scholar, and Scopus to identify peer-reviewed studies published within the last 30 years. The search incorporated Medical Subject Headings and keywords related to sexual dysfunction and cancer survivorship, including terms such as "sexual dysfunction," "dyspareunia," "vaginal dryness," "vaginal hormone therapy," "breast cancer survivors," and "low desire." Methods of study selection Studies were included if they examined sexual dysfunction in cancer patients or survivors, were published in English, and addressed either physiological or psychological aspects of sexual health. Articles were excluded if they lacked methodological rigor. An initial screening of titles and abstracts was followed by full-text review to determine relevance and inclusion. Tabulation Findings were synthesized using thematic analysis, with studies grouped by cancer type, treatment modality, and impact on sexual function. Although no formal quality assessment tool was applied, emphasis was placed on high-impact studies and comprehensive reviews published in reputable journals. Integration and results Effective management of genitourinary syndrome of menopause includes nonhormonal options such as minimizing irritants, vaginal moisturizers, lubricants, the use of dilators, and pelvic floor therapies. Local hormonal therapies may offer relief for select patients depending on the hormone sensitivity of their cancer diagnosis. For low sexual desire, psychological and pharmacological agents such as bremelanotide and flibanserin have demonstrated efficacy. Vaginal lasers and compounded hormones pose significant risks to these patient populations and should be avoided. Multidisciplinary approaches, incorporating gynecologic, psychological, and oncologic expertise, are essential for optimizing patient outcomes. Conclusion Sexual dysfunction following breast and gynecologic cancer requires individualized, multimodal management. A combination of nonhormonal and hormonal therapies, behavioral interventions, and emerging pharmacologic treatments offers promising avenues for improving sexual health and overall quality of life in survivors. Future research should focus on the effects of specific cancer therapies on sexual health, investigate the role of biological markers and dysfunction, and refine more personalized approaches to care.
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