Female sexual dysfunction is very common after cancer treatment. Two-thirds of the 7 million female cancer survivors in the United States were treated for breast, gynecologic, bladder, or colorectal malignancies,1 and at least 50% experience long-term, severe sexual problems.2-4 The most common dysfunctions are vaginal dryness, pain, and decreased sexual desire.2,5,6 The risk of sexual dysfunction is increased by abrupt ovarian failure,5,6 severe vaginal atrophy from using aromatase inhibitors,7 direct genital damage from pelvic radiation therapy,8-10 and genital graft-versus-host disease.11 Urinary and fecal incontinence often lead to avoidance of sexual contact.12
The recent NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Survivorship advocate systematic assessment of female sexual function and referral for multidisciplinary treatment (to view the most recent version of these guidelines, visit NCCN. org).13 Unfortunately, women with cancer report few satisfying discussions about sexuality.14,15 Fewer than 20% of sexually dysfunctional women treated for cancer seek professional help,3,16,17 and distress over sexual dysfunction ranks high in surveys of unmet needs of cancer survivors.18,19 Only a few gynecologists and mental health professionals have expertise in managing relevant physical symptoms of sexual dysfunction20,21 or in providing evidence-based cognitive behavioral treatment.22-24 Furthermore, insurance coverage is poor, especially for mental health services.
An Internet-based intervention may be a cost-effective way for oncology settings to comply with the new guidelines. The authors recently showed that an Internet-based intervention for couples after prostate cancer treatment using e-mail contact with a therapist was as effective in improving sexual function as 3 in-person sessions of cognitive-behavioral therapy.25 Pilot studies with Internet-based interventions for female sexual dysfunction have shown promise for healthy women26 and in gynecologic cancer survivors.27,28 The authors created a Web site, Tendrils: Sexual Renewal for Women After Cancer, and tested a prototype in a randomized trial, comparing use on a self-help basis or supplemented with sexual counseling. The authors hypothesized that both groups would improve on self-report measures of sexual function and satisfaction, but that the counseled group would have a significantly larger gain.
This research was funded by a grant from the National Cancer Institute, CA4R4212932 (Schover, Principal Investigator) and was also supported in part by The University of Texas MD Anderson Cancer Center Support Grant, CA016672. Drs. Schover and Martinetti may receive compensation from future commercialization of the intervention. Preliminary results were presented at the 6th Biennial Cancer Survivorship Research Conference, June, 2012, Arlington, VA. The remaining authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors.
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