What Women Want: Radical Cystectomy and Perioperative Sexual Function Educational Needs

Westerman, Mary E.; Bree, Kelly; Kokorovic, Andrea; Frank, J. Howard; Wang, Xin Shelly; Kamat, Ashish M.; Dinney, Colin P.N.; Navai, Neema

doi:10.1016/j.urology.2021.06.012

Cited by 11 publications

(14 citation statements)

References 28 publications

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“…Moreover, they desired conversations on this topic to specifically be initiated by their doctor. Similar findings were reported by Westerman et al [44] in which 55% of women reported no preoperative counseling on SF prior to RC. Only 32% said that their doctor discussed their sexual health after surgery.…”

Section: Survivorship and Patient Reported Outcomessupporting

confidence: 89%

“…However, a new online pharmacy, cost-plus drugs (https://costplusdrugs.com/) has vaginal estrogen available at very affordable prices. Various formulations are detailed in Table 2 [44]. For women with a history of hormone positive breast cancer, a nonestrogen formulation of intravaginal DHEA may be used with similar efficacy.…”

Section: Cancer Survivorship and Sexual Functionmentioning

confidence: 99%

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Radical cystectomy and women's sexual health – can we do better?

Escott

Avulova

Bree

et al. 2022

Current Opinion in Urology

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Purpose of reviewFemale sexual function after radical cystectomy is a crucial, but historically overlooked component of bladder cancer survivorship. This review focuses on recent studies, which have investigated pelvic health and sexual function after radical cystectomy. We discuss modifiable factors, which may contribute to decreased sexual function after radical cystectomy and techniques, which may lead to improved outcomes.Recent findingsSexual function is important to women and there is a significant desire (and unmet need) for more perioperative counseling and discussion regarding sexual function changes and quality of life impacts. Sexual function may be altered due to a combination of hormonal changes from ovarian removal, anatomic changes from vaginal alteration, and sensation changes due to damage to the neurovascular bundle. Techniques to preserve these structures have been developed.SummarySexual function is an important component of survivorship and increasing attention is being focused on this area. Long term studies with objective measures are needed for to compare various techniques and ensure oncologic safety. Ovarian preservation, anterior vaginal wall preservation, and vaginal estrogen replacement should be carefully considered for most patients.

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Section: Survivorship and Patient Reported Outcomessupporting

confidence: 89%

Section: Cancer Survivorship and Sexual Functionmentioning

confidence: 99%

Radical cystectomy and women's sexual health – can we do better?

Escott

Avulova

Bree

et al. 2022

Current Opinion in Urology

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“…A study recently stressed the psychological and health concerns in women who undergo RC (123). Nevertheless, more than half of the women did not receive preoperative counseling regarding possible sexual function changes or reported that it was inadequately provided (123,124). In this regard, women were even less likely to be counseled regarding sexual function pre-and postoperatively compared to men (125).…”

Section: Postoperative Sexual Recoverymentioning

confidence: 99%

Radical cystectomy and urinary diversion in women: techniques, outcomes, and challenges—a narrative review

Deimling¹,

Laukhtina²,

Pradère³

et al. 2022

Transl Androl Urol

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Background and Objective: Standard radical cystectomy (RC) in women includes the removal of the bladder, urethra, uterus with the adnexa, and the anterior vaginal wall, thereby severely affecting the urinary, sexual, and reproductive system. To limit these detrimental effects, organ-sparing, including nerve-sparing approaches, have been developed. Health-related quality of life (HRQOL) and functional outcomes are, indeed, becoming increasingly central to the shared decision-making with the patient. The objectives of this narrative review are: (I) to review the current status of RC in women, including the use of different urinary diversions (UDs); (II) to discuss organ-sparing approaches and their impact on oncological and functional outcomes in women; (III) to discuss the impact of RC on HRQOL and sexual function in women.Methods: We performed a non-systematic literature review of the available publications in the PubMed database.

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“…12,29,30,35 It is clear that across all of the cystectomy patients, there was a decrease in sexual activity and sexual satisfaction post-operatively. 11,12,[29][30][31][32]46 Common themes from each of the studies include loss of desire/libido, orgasmic disorders, vaginal dryness, dyspareunia, difficult intromission, reduced clitoral sensation, psychological concerns related to diagnosis and body image. There were reports of differing degrees of symptom distress associated with changes in sexual function and intimacy; however, many women expressed a preference to maintain their sexual function.…”

Section: Discussionmentioning

confidence: 99%

Female sexual function in bladder cancer: A review of the evidence

et al. 2022

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Background Bladder cancer (BC) treatments are known to be invasive; nevertheless, research into the long‐term effects is limited and in the context of sexual function often male focussed. Female sexual dysfunction (FSD) has been reported in up to 75% of female patients. This systematic scoping review examines the literature on sexual consequences of BC in female patients. Objective This study aimed to systematically evaluate the evidence on female sexual function in BC to identify areas of unmet need and research priorities. Evidence Acquisition We performed a critical review of PubMed, PsychMed, CINAHL, MEDLINE and the Cochrane Library in March 2020 according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) extension for Scoping Reviews statement following Levac et al. methodology. Identified reports were reviewed according to the Critical Appraisal Skills Programme (CASP) criteria. 45 publications were included. Evidence Synthesis There was an inconsistent use of patient‐reported outcome measures (PROMs), with commonly used PROMs having a narrow symptom focus. However, common symptoms emerged: loss of desire, orgasmic disorders, vaginal dryness, dyspareunia, difficult intromission, reduced clitoral sensation, psychological concerns related to diagnosis, fear of contamination and body image. Sexual activity was reduced in most groups, despite women expressing a motivation to retain sexual function. The degree of symptom distress associated with FSD is underreported. Evidence emerged regarding a gap for women in clinician counselling and follow‐up. Conclusions The patient's perspective of FSD in BC patients is poorly understood and under‐addressed in clinical practice. There have been very few qualitative studies of FSD in BC. Any intervention designed to address the problem must start with greater understanding of both the patients' and clinicians' perspective. Lay Summary We examined the evidence on sexual consequences of BC in women. It is apparent that despite common themes of sexual dysfunction emerging, the problem is poorly understood and addressed in clinical practice.

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What Women Want: Radical Cystectomy and Perioperative Sexual Function Educational Needs

Cited by 11 publications

References 28 publications

Radical cystectomy and women's sexual health – can we do better?

Radical cystectomy and women's sexual health – can we do better?

Radical cystectomy and urinary diversion in women: techniques, outcomes, and challenges—a narrative review

Female sexual function in bladder cancer: A review of the evidence

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