(013) More Than Just “Vaginal Dryness”: Addressing an Unmet Need for Sexual Health Intervention in Female Cancer Survivors
Authors: Pon F , Satish S , Kobiella E , Shields C , Jeung L , Moore J , Koru-sengul T , Zhao W , Penedo F , Rojas K 
Published: May 2023

Abstract

Introduction
Female sexual dysfunction (FSD) in cancer survivors is underreported and therefore undertreated. While the impact of cancer treatment on sexual health has been investigated through validated patient-reported outcomes, little work has been done to describe genitourinary anatomical changes in women in this population and how these changes relate to sexual function.

Objective
This study aims to 1) describe the population of female cancer survivors seeking treatment for sexual dysfunction through a novel sexual health after cancer program and 2) correlate disruptions in genitourinary exam findings to patient-reported sexual function.

Methods
A retrospective analysis included patients presenting to a sexual health after cancer program at a cancer center in South Florida. Patients received a baseline Female Sexual Function Index (FSFI) and underwent a physical, including abdominopelvic, exam. The FSFI is a validated 19-item survey that assesses desire, arousal, lubrication, orgasm, satisfaction, and pain domains. A total FSFI≤26.55 indicates sexual dysfunction. Genitourinary exam changes were characterized using a novel Adapted Vulvovaginal Exam Score (AVES) which assesses vaginal rugae, vascularity, epithelial integrity, elasticity, and dryness. A high AVES (&gt;3) corresponds to more severe exam disruptions. Mean FSFI total and domain scores were compared between AVES groups (0-3 vs. &gt;3) using t-test. A multivariate binary logistic regression model was fit to identify significant patient factors, treatment characteristics, and FSFI responses associated with high AVES score. Adjusted odds ratios (aOR) and corresponding 95% confidence intervals (95%CI) were calculated.

Results
Between 2020-2021, 139 female cis-gender women with a median age of 46 (range 19-70) at diagnosis were seen in the MUSIC Program that 56.8% identified as Hispanic/Latinx. Most were treated for breast (79.1%) or gynecologic (9.4%) cancer. Common presenting symptoms included vaginal dryness (55%), painful sex (45%), low desire (36%) and hot flashes (22%). Patients who disclosed details about pain (n=62) reported penetration was possible but uncomfortable (14%), possible but painful (58%) or impossible due to pain (11%). Those who disclosed changes with orgasm (n=43, 31%) reported it was more difficult (26%), or impossible (23%). Of those completing the FSFI (n=108, 78%), median Desire Domain score was 1.8 (IQR 1.2), and median Total Score was 9.85 (IQR 13.3), with 97% of patients meeting criteria for FSD. Mean total FSFI score, as well as lubrication, orgasm, satisfaction, and pain domain scores were significantly lower in high AVES. Multivariate analyses revealed that women with poor FSFI satisfaction domain score (&lt;3.6) was significantly more likely to have high AVES (aOR 2.81; 95%CI 1.03-7.65; p=0.044).

Conclusions
The present study characterizes the range of anatomic changes associated with sexual dysfunction in a diverse cohort of female cancer patients. Future work will describe treatment strategies employed and their effectiveness at symptom resolution and quality-of-life improvement to meet the needs of this growing population.

Disclosure
No