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Purpose The adaptation of the Cancer Care Ontario (CCO) guideline Interventions to Address Sexual Problems in People With Cancer provides recommendations to manage sexual function adverse effects that occur as a result of cancer diagnosis and/or treatment. Methods ASCO staff reviewed the guideline for developmental rigor and updated the literature search. An ASCO Expert Panel ( Table A1 ) was assembled to review the guideline content and recommendations. Results The ASCO Expert Panel determined that the recommendations from the 2016 CCO guideline are clear, thorough, and based upon the most relevant scientific evidence. ASCO statements and modifications were added to adapt the CCO guideline for a broader audience. Recommendations It is recommended that there be a discussion with the patient, initiated by a member of the health care team, regarding sexual health and dysfunction resulting from cancer or its treatment. Psychosocial and/or psychosexual counseling should be offered to all patients with cancer, aiming to improve sexual response, body image, intimacy and relationship issues, and overall sexual functioning and satisfaction. Medical and treatable contributing factors should be identified and addressed first. In women with symptoms of vaginal and/or vulvar atrophy, lubricants in addition to vaginal moisturizers may be tried as a first option. Low-dose vaginal estrogen, lidocaine, and dehydroepiandrosterone may also be considered in some cases. In men, medication such as phosphodiesterase type 5 inhibitors may be beneficial, and surgery remains an option for those with symptoms or treatment complications refractory to medical management. Both women and men experiencing vasomotor symptoms should be offered interventions for symptomatic improvement, including behavioral options such as cognitive behavioral therapy, slow breathing and hypnosis, and medications such as venlafaxine and gabapentin.Additional information is available at: www.asco.org/survivorship-guidelines and www.asco.org/guidelineswiki .

BACKGROUND:The Female Sexual Function Index (FSFI) is the most commonly used self-report instrument to measure sexual functioning among women cancer survivors. Despite this, the validity and reliability of the FSFI for use in cancer populations has not been established. METHODS: Data were combined from 3 separate institutional review board-approved studies of the psychosexual adjustment of women cancer survivors conducted at Memorial Sloan-Kettering Cancer Center. Psychometric analysis was applied to the FSFI responses from 181 women comprising 4 cohorts, including survivors of: gynecologic cancer (all types; 2 cohorts), malignancies requiring bone-marrow/stem cell transplantation, and early stage cervical cancer. RESULTS: A factor analysis supported the subscale structure of the FSFI, yielding results nearly identical to those from the original FSFI validation study. Internal consistency reliability was 0.94 for the FSFI total score and ranged from 0.85 to 0.94 for the domain scores. Corrected item-total correlations ranged from 0.44 to 0.79 for the total score and from 0.62 to 0.88 for the domain scores. FSFI scores were correlated negatively with measures of depression, distress, and menopausal symptoms and were correlated positively with quality of life. FSFI scores exhibited a preliminary ability to discriminate between women based on whether or not they received chemotherapy and/or radiation. CONCLUSIONS: The FSFI demonstrated strong psychometric properties in this study, supporting its continued use for monitoring sexual function and cancer-related dysfunction among sexually active women who are cancer survivors.Cancer 2012;118:4606-18. V C 2012 American Cancer Society.KEYWORDS: women, sexual dysfunctions, physiological, sexual dysfunctions, psychological, survivors, quality of life, psychometrics, questionnaires, self-report. INTRODUCTIONFemale sexual dysfunction (FSD) is quite common among women who have survived cancer, 1-5 and the most commonly used measure to assess sexual functioning in this population is the Female Sexual Function Index (FSFI). 6 However, the FSFI originally was developed and validated in healthy women, and the validity and reliability of the FSFI in cancer populations has not been established.FSD resulting from cancer may differ qualitatively and quantitatively from FSD experienced in otherwise healthy women. Cancer treatments, including surgery, chemotherapy, radiotherapy, and hormone therapy, can directly affect sexual organs and hormone levels, 1 resulting in vaginal shortening and stenosis, decreased vaginal lubrication and elasticity, as well as disruption of the sexual response cycle. 2 A survey of long-term vaginal and cervical cancer survivors reported rates of FSD well over twice those of matched healthy controls; in particular, survivors had >14 times the odds of dyspareunia compared with controls. 4 FSD also has been identified as a primary source of psychological distress after cervical cancer treatment 7 and as an independent predictor of depressive symptoms. 8 FSD ca...