For Teachers & Professionals

Female cancer and Sexuality Part 1: Clinical inquiry regarding female sexual health

Sexual health is an important part of life and it’s more than just sex. It is the physical, psychological, emotional, and social aspects of sex. How you see yourself, how your partner sees you, starting and maintaining sexual relationships, and the importance of sex to your quality of life are all part of your sexual health. Cancer and its treatment(s) can affect female sexual health in various ways, depending also on multiple factors. These include the type of cancer and its treatment(s), the amount (dose) of treatment, the length (duration) of treatment, the patient’s age at the time of treatment, the amount of time that has passed since treatment, and other personal health factors. By providing healthcare professionals with a concise and efficient tool for clinical inquiry and useful material resources, it is believed that barriers addressing sexual and vaginal health after cancer will be eliminated. Clinicians must address sexual health with a clear picture of the intervention in mind. This can be done through the 5 A’s Model. The 5A's model (Ask, Advise, Assess, Assist and Arrange Follow-up) for communication is a useful outline for communication about sexual health in medical settings that extends the well-known PLISSIT model.

ASK Just asking can already be a validation for the woman. “If I am asked about this, it exists”. It can be helpful to start with a simple statement such as “Many women who have gone through similar cancer treatment notice changes in sexual function or vaginal health.”

ADVISE This is a brief but important opportunity to advise women that the problems can be addressed. For example, “Fortunately there are lots of resources for women with your concerns.”

ASSESS Various tools can be used to assess the problem that concerns the female cancer patient or survivor populations. These could be questionnaires such as the Female Sexual Function Index (FSFI), or the Sexual Function Questionnaire. Else standardised assessment tools enable clinical research, but they tend to be too lengthy and time and labour-intensive for routine use in a busy clinical practice. In addition, because a sexual function inventory such as the FSFI was not specifically developed for cancer survivors, there are particular challenges for female cancer survivors that may not be adequately captured in this general measure. In 2004, an international collaboration of sexual medicine experts created consensus guidelines regarding the clinical evaluation of sexual dysfunction in women. Members of the Scientific Network on Female Sexual Health and Cancer, have adapted this brief screening checklist to be used either as a self-report checklist or as a springboard for guiding clinical conversations about treatment-related sexual problems between female cancer survivors and their healthcare providers. It is important to notice that the first two questions are “Are you satisfied with your sexual function?” and “Do you have any concerns about vaginal health?”. Clinicians can decrease both the stigma associated with sexual dysfunction and signal the importance of self-care regardless of current sexual activity or partner status. Vaginal health has implications for overall well-being. Another tip provided in the checklist is: if the woman answers that she has stopped having intercourse, the provider shall reassure her and make further questions to investigate if she recalls what kind of concerns and problems have led her to stop having sex.

ASSIST By providing patients with education, information and resources, patients become more knowledgeable and feel more competent. It may be useful to have additional referral sources for counselling, pelvic physical therapy, urogynecological consult, etc. In fact, collaborative relationships within one's institution or a community-based setting should be cultivated.

ARRANGE A FOLLOW-UP Follow-ups are needed to follow the course of the problem, eventual worsening or resolution. Arranging a follow-up might facilitate the initiating inquiry at the next visit.