Abstract P4-11-04: Program evaluation of a female sexual medicine and women's health program
Authors: Carter J , Seidel B , Stabile C , Baser R , Eaton A , Goldfarb S , Goldfrank D 
Published: May 2016

Objectives: To evaluate the effectiveness of simple sexual/vaginal health treatment strategies in breast cancer patients/survivors seeking treatment at a female sexual medicine program, and to evaluate compliance and clinical outcomes.

Methods: Demographics, medical information, and clinical assessments from 94 new visits with at least 1 follow-up from 09/12–10/14 were analyzed. The assessment form consists of a clinician evaluation with the Vaginal Assessment Scale (VAS) and Vulvar Assessment Scale (VuAS), and patient-reported outcomes (PROs) including the Sexual Activity Questionnaire (SAQ), Female Sexual Function Index (FSFI), and exploratory items. Compliance with treatment recommendations at the last visit were summarized. Changes from the first to last visit were compared with regard to clinical outcomes (e.g., vaginal pH, moisture), the VAS and VuAS, and the PROs (FSFI, SAQ, and confidence about future sexual activity).

Results: The mean number of visits was 3 (range, 2-7). Mean age was 55.2 years (range, 29-48), 67% (n=63) were married or in an intimate relationship, and 94% (n=88) were menopausal. Seventy-seven percent (n=72) were on some form of active treatment, such as endocrine therapy (89%, 64/72). Only 15% (11/72) reported any hormonal supplementation (e.g., Vagifem).

Treatment strategies included the use of vaginal moisturizers, lubricants with sexual activity, pelvic floor exercises, and dilator therapy. At last visit, 94% (80/85) of the women had complied with the clinical recommendation to moisturize 2 to 5+ times per week. Vaginal pH scores &gt;6.5 declined from 31% (29/93) at Visit 1 to 20% (19/93) at the last visit (p=0.049). Vaginal (VAS) symptoms improved from the first to last visit (mean 1.2 to 0.59, p&lt;0.001) as did the Vulvar (VuAS) symptoms (mean 0.78 to 0.57, p=0.007). Only 17% (15/19) had normal vaginal moisture at Visit 1, compared to 29% (26/90) at the last visit (p=0.04). Sixty-seven percent (59/88) reported performing pelvic floor exercises a few times per week to daily at their last visit. FSFI arousal mean scores improved from the first (mean=2.30) to last visit (mean=2.93) (p=0.003), and urinary incontinence rates declined from the first (58%, 32/55) to last visit (24%, 13/55).

At Visit 1, 51% (43/85) of the women reported current sexual activity with a partner, and sexual activity rates increased over time—61% at last visit (52/85, p=0.049). FSFI total scores significantly improved from the first (mean=12.91) to last visit (mean=17.44) (p&lt;0.001). Confidence about future sexual activity increased from 43% (34/79) at Visit 1 to 67% (53/79) at the last visit (p&lt;0.001). Concerns about sexual/vaginal health (scale of 0-10) decreased over time, with 54% (43/80) rating their concern at 9 or 10 at the first visit and 28% (22/80) at the last visit (p&lt;0.001).

Conclusions: Breast cancer patients/survivors attending our female sexual medicine program reported improvement of vaginal and vulvar symptoms, sexual function and activity, and had clinical improvement over time on vaginal pH and moisture. Preliminary findings suggest that simple strategies, education, and support can improve vaginal/sexual health concerns in cancer survivorship.

Citation Format: Carter J, Seidel B, Stabile C, Baser R, Eaton A, Goldfarb S, Goldfrank D. Program evaluation of a female sexual medicine and women's health program. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-11-04.