2024 SOGC, 2024 NCCN, 2022 ESO-ESMO, and 2018 ASCO: a comparison of female cancer survivorship guidelines for the management of sexual health concerns.
This paper systematically compares four major oncology and gynecology clinical practice guidelines — ASCO (2018), ESO-ESMO (2022), NCCN (2024), and SOGC (2024) — regarding the management of sexual health concerns in female cancer survivors. The authors grouped recommendations across five domains of sexual dysfunction: vaginal dryness, low sex drive, pain, orgasmic dysfunction, and psychological concerns. All four guidelines consistently recommend non-hormonal therapies (lubricants and moisturizers) as first-line treatment for vaginal dryness, with low-dose local estrogen as a second-line option. All guidelines endorse multidisciplinary care including psychosocial counseling, relationship counseling, specialist referral, and cognitive behavioral therapy. Three guidelines (ASCO, NCCN, SOGC) support vaginal dilators and pelvic floor physical therapy for pain. ASCO uniquely recommends any form of stimulation to improve sexual response, while NCCN and SOGC endorse sexual aids for arousal. Pharmacological agents for low libido — including androgens, bupropion, flibanserin, bremelanotide, and buspirone — are mentioned in all guidelines except ESO-ESMO, though the authors note the underlying evidence base is limited. A key limitation is that this is a narrative comparison of guidelines rather than a primary study. The authors conclude that while consensus exists in several areas, further research on pharmacological and counseling interventions is needed.
Why this grade: This is a narrative comparative review of clinical practice guidelines, not a primary study with original data; it synthesizes expert recommendations rather than generating new human or experimental evidence.
Purpose Female cancer survivors often experience sexual dysfunction, which is a significant and increasingly recognized aspect of survivorship. This review compares guidelines from the American Society of Clinical Oncology (ASCO), the European School of Oncology-European Society of Medical Oncology (ESO-ESMO), the National Comprehensive Cancer Network (NCCN), and the Society of Obstetricians and Gynaecologists of Canada (SOGC) for managing sexual health symptoms. Methods The most recent guidelines from ASCO, ESO-ESMO, NCCN, and SOGC were examined and compared. The recommendations were grouped by type of sexual dysfunction: vaginal dryness, low sex drive, pain, orgasmic dysfunction, and psychological concerns. Results All guidelines strongly recommend non-hormonal therapies (i.e., lubricants or moisturizers) as first-line treatments for managing vaginal dryness. If unsuccessful, there is consensus for low-dose estrogen creams, tablets, capsules, or rings as second-line treatments. Multidisciplinary care is also recommended by all, including psychosocial and relationship counselling, specialist referrals, and cognitive behavioral therapy to address psychological concerns. ASCO, NCCN, and SOGC recommend vaginal dilators, and pelvic physical therapy for relieving pain. ASCO recommends any kind of stimulation (including masturbation) to improve sexual response, while NCCN and SOGC recommend the use of sexual aids (e.g., vibrators) to enhance arousal. Although all guidelines, except ESO-ESMO, include recommendations for androgens, bupropion, flibanserin, bremelanotide, and buspirone for low sex drive, there is limited data. Conclusion There is consensus among guidelines on certain sexual health recommendations, with some variation. Additional research is needed on pharmacological interventions and types of counselling to strengthen their evidence.
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