Addressing Female Sexual Function after Cancer by Internists and Primary Care Providers
Journal of Sexual Medicine (Impact Factor: 3.15). 02/2013; 10(S1). DOI: 10.1111/jsm.12027
Introduction. There are now almost 14 million cancer survivors in the United States, and for the majority of survivors, the bulk of post-cancer medical care is provided by community primary care providers (PCPs). Sexual dysfunction is one of the most common and distressing quality of life issues facing female cancer survivors yet it has become increasingly evident that women's cancer-related sexual dysfunction often goes unaddressed, including in primary care treatment setting. Aim. Building on a model that calls for an integrative approach to treatment, the aim is to concisely review barriers and challenges of managing cancer-related female sexual dysfunction for PCPs and to offer specific and effective strategies that PCPs may use to treat common sexual problems in their female cancer survivors. Methods. Literature was reviewed for relevant publications on the topic of treating cancer-related sexual dysfunction and primary care, and interviews were conducted with experts on state-of-the-art methods for treating cancer-related sexual dysfunction. Main Outcome Measure. Clinical evidence that demonstrates the effectiveness of simple strategies to manage cancer-related female sexual dysfunction. Results. Cancer-related female sexual dysfunction does not seem to be appropriately acknowledged and addressed in primary care treatment settings. There is evidence to show that simple and effective strategies exist to ameliorate many of these problems. Conclusions. PCPs provide the bulk of survivorship care and are therefore in a critical position to initiate assessment and treatment for female survivors with cancer-related sexual dysfunction. Although PCPs are in need of increased support and preparation to manage this aspect of survivorship care, simple and effective strategies are available for PCPs to offer women as part of their clinical practice. Bober SL, Carter J, and Falk S. Addressing female sexual function after cancer by internists and primary care providers.
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ABSTRACT: The introduction of phosphodiesterase type 5 inhibitors has revolutionized the armamentarium of clinicians in the field of sexual medicine. However, pharmacotherapy as a stand-alone treatment option has been criticized, particularly by psychosocial therapists, as incomplete. Specifically, it is widely argued that drug treatment alone often does not meet the standards of biopsychosocial (BPS) therapy. A literature review was performed to explore the role of the biopsychosocial paradigm in the treatment of sexual dysfunction and outline some of the key challenges and possible shortcomings in the current application of biopsychosocial treatment. Published treatment outcomes of integrative biopsychosocial clinical practice, including medical outcomes, psychological and relational factors, treatment of comorbid conditions, cost of treatment, and treatment efficacy, were investigated. Using Medline, PubMed, and EMBASE databases, a literature search for articles published from January 1, 1980, to March 1, 2013, was performed, examining current approaches to the biopsychosocial model of sexual dysfunction and sexual medicine. Data were reviewed and combined, allowing characterization of current treatment approaches and recommendations for clinical practice and future research. The biopsychosocial model of treatment appears to have an intuitively obvious meaning (i.e., treatment of all three facets of the patient's biological-psychological-social condition). However, research suggests that clear treatment algorithms are still in development. By virtue of the ongoing development of biopsychosocial methods in sexual medicine, new models and research initiatives may be warranted. The evidence identified allows for characterization of some of the current clinical, professional, financial, and systemic challenges to biopsychosocial treatment, with the aim of helping identify possible directions for future research. Implementation of biopsychosocial treatment, though mandated by process-of-care guidelines, may be limited in the field of sexual health owing to resource limitations, limitations in physician training curricula, and structural obstacles preventing interdisciplinary collaboration. Nonetheless, a number of current treatment developments are biopsychosocially integrative, and a number of established models are biopsychosocially informed. These models and concrete strategies may provide a way forward for developing further initiatives to advance BPS treatment. Berry MD and Berry PD. Contemporary treatment of sexual dysfunction: Reexamining the biopsychosocial model. J Sex Med **;**:**-**.Journal of Sexual Medicine 08/2013; 10(11). DOI:10.1111/jsm.12273 · 3.15 Impact Factor
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ABSTRACT: The goal of this project was to investigate the contentious issue of a possible effect of endocrine therapy (ET) on sexual dysfunction (SD) in postmenopausal early stage breast cancer survivors. To date, few studies have assessed sexual functioning prior to initiating ET and none have taken sexual distress into account when reporting the prevalence of ET-induced SD. We report the findings of a study on the change in SD (defined as experiencing sexual problems causing distress) during the first 6 months of ET usage. Between January 2009 and May 2011, 118 patients entered the study and 66 completed questionnaires prior to initiation of ET and after 6 months of use. Sexual functioning (SF) was evaluated with the female sexual function index while sexual distress was assessed with the female sexual distress scale (FSDS-R). Gynecological symptoms were measured with the FACT-B ES subscale. Over time, the level of gynecological symptoms increased (p < 0.001), whereas no decline in SF was observed. The percentage of women who reported experiencing at least one sexual problem (85 %) and the percentage who were sexually distressed (30 %) remained the same across time. Importantly, the change in the prevalence of SD between baseline (24 %) and 6 months (29 %) was not statistically significant. Women experiencing SD at baseline were more likely to experience SD after 6 months of ET usage (OR = 7.4, 95 % CI = 1.5-36.9) than women who had no SD prior to initiating ET. The observation that SF remained stable across time is encouraging news. However, longer follow-up and the inclusion of women who were premenopausal at diagnosis are needed to determine the potential influence of extended duration of ET (e.g., at least 5 years) on SD. Further studies, including assessing the impact of early identification of patients at risk of developing SD and timely intervention, are warranted.Breast Cancer Research and Treatment 08/2013; 141(1). DOI:10.1007/s10549-013-2659-y · 3.94 Impact Factor
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ABSTRACT: There are multiple barriers that limit patients and primary care physicians (PCPs) from discussing sexual dysfunctions (SDs) during medical appointments. Exploring patient preferences in discussing SDs with PCPs may help address some barriers, which can improve doctor-patient communication about SDs, delivery of health care, and patient quality of life. A sample (n=108) of adult patients from an urban primary care clinic completed a 5--10 minute anonymous opinion questionnaire about their preferences in discussing SDs with PCPs. The majority of participants agreed that PCPs should give information to all patients (74%), ask all patients (69%), and have questions on medical history forms (55%) about SDs. Fifty-eight (58%) participants preferred to start the conversations about SDs with PCPs themselves, but all of these participants did not object to PCPs asking them about SDs. Participants who had ever experienced SD symptoms were more likely to want questions on medical history forms and for PCPs to ask about SDs. Participants preferred discussions about SDs with PCPs through various means (ie, medical history forms, medical appointments). Although participants were divided on who (patient versus PCP) should start conversations about SDs, the majority of participants did not object to PCPs inquiring about SDs during office visits or on medical history forms. Patients in poorer health and with self-reported SDs may need PCPs to inquire about SDs. Recommendations to improve health care delivery are suggested, including PCPs inquiring about SDs with all patients, especially with individuals in poorer health or with histories of SDs.Family medicine 02/2014; 46(2):124-8. · 1.17 Impact Factor
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