Gynaecological cancer and sexual functioning: Does treatment modality have an impact?

Sexual dysfunction(s) are common after treatment of gynaecological cancer. At present, hardly any randomized studies have evaluated the effect of different treatment regimes on the sexual functioning of gynaecological cancer patients. During the past decade there has been more focus on evaluating complications along with survival. Our primary knowledge on the impact of gynaecological cancer treatment on female sexual functioning mainly derive from observational studies. The focus of the present paper is to give an update on potential physiological effects of different treatments on the sexual functioning of gynaecological cancer patients. While radical pelvic surgery may be associated with a substantial risk of acute complications due to haemorrhage, tissue oedema, nerve injury, infection and haematoma formation, pelvic radiotherapy causes acute negative effects on mucous membranes in the vagina, the bladder and the rectum, and on the skin. Both treatments have been shown to have a negative impact on sexual functioning, especially in cervical cancer patients. However, most studies agree that in the longer run, patients who are treated with surgery experience less sexual dysfunction than those who are given radical chemo-irradiation or combined surgery and chemo-irradiation. In the future, randomized controlled studies will hopefully clarify the effect of different combination treatment modalities on the sexual functioning of gynaecological cancer patients. An empathic attitude and willingness to discuss sexual issues with the patient and her partner is recommended as well the use of local estrogens or the nonhormonal lubricant Replens, and a vaginal dilator after brachytherapy. (C) 2007 Elsevier Masson SAS. All rights reserved.