If a woman is partnered, evidence indicates couples-based interventions are effective when compared with usual care. No recommendation can be made for or against group therapy with or without exercise for women with body image issues. If a woman is partnered, evidence indicates that couples-based interventions are effective when compared with usual care. Overall Sexual Functioning and Satisfaction: The expert panel recommends psychosocial counseling directed at the individual or couple or delivered in a group be offered to women with cancer who have problems with overall sexual functioning.
Physical exercise or pelvic floor physiotherapy, in addition to psychosocial counseling, may also be of benefit. Current evidence does not support a specific psychosocial counseling intervention to improve sexual functioning and satisfaction. Health-care providers should screen patients with cancer for overall sexual functioning and satisfaction, and a diagnosis should be established when there are physical issues playing a contributing role.
For patients with persistent concerns, such as physical issues, a gynecologic examination would be ideal. Vasomotor Symptoms: For women with vasomotor symptoms, hormone therapy is the most effective intervention.
For women unwilling or unable to use hormonal therapy, alternatives exist— for example, paroxetine, venlafaxine, gabapentin, or clonidine. Having a hormone-sensitive breast cancer is a contraindication to using systemic hormone therapy. Paroxetine and fluoxetine should not be offered to women with breast cancer taking tamoxifen. Adverse events of clonidine include hypotension, light-headedness, headache, dry mouth, dizziness, sedation, and constipation.
Sudden cessation of treatment can lead to significant elevations in blood pressure.
Book Sexual Health And Genital Medicine In Clinical Practice 2001
Lubricants for all sexual activity or touch, in addition to vaginal moisturizers to improve vulvovaginal tissue quality, may be tried first. It should be noted that moisturizers may need to be applied at a higher frequency 3—5 times per week in the vagina, at the vaginal opening, and on the external folds of the vulva for symptom relief in female patients with cancer and survivors.
For those who do not respond or whose symptoms are more severe at presentation, low-dose vaginal estrogen can be used. For women with hormone receptor—positive breast cancer who are symptomatic and not responding to conservative measures, low-dose vaginal estrogen can be considered after a thorough discussion of risks and benefits.
Lidocaine can also be offered for persistent introital pain and dyspareunia. For women with current or a history of breast cancer who are on aromatase inhibitors and have not responded to previous treatment, clinicians may offer vaginal dehydroepiandrosterone. Finally, clinicians may offer the selective estrogen receptor modulator ospemifene Osphena to postmenopausal women without current or a history of breast cancer who are experiencing dyspareunia, vaginal atrophy, or other vaginal pain.
Clinicians should offer pain relievers to women on aromatase inhibitors who are experiencing arthralgia that interferes with intimacy. This is particularly important for women treated with pelvic or vaginal radiation therapy. Ideally, benefit is greatest when started early and should not be recommended based on sexual activity or sexual orientation but, rather, to all women at risk for vaginal changes to be proactive in their sexual and vulvovaginal health.
Ethiopia, Kenya, Tanzania and Uganda. The Southern African Development Community.
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