1. Fuerst, Mark L.

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ORLANDO, FL-In contrast to other widely available cancer care products, sexual aids and resources are rarely available at cancer centers nationwide, according to a new study.

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Treatment-related sexual dysfunction is a significant and distressing problem for many cancer survivors. National Comprehensive Cancer Network (NCCN) treatment guidelines recommend therapeutic aids for sexual health rehabilitation, such as vaginal dilators, moisturizers, and vacuum erection devices. However, cancer survivors are often uncomfortable or uninformed about how and where to obtain sexual aids.


Studies suggest that sexual dysfunction is one of the most common and distressing consequences of treatment, affecting between 50 percent and 90 percent of adult survivors, depending on type of treatment. A new study of 25 leading cancer centers found that 87 percent of the centers reported having no sexual aids available on site for men, and 72 percent reported having no aids for women, noted lead author Sharon Bober, PhD, a psychologist at the Dana-Farber Cancer Institute in Boston, during a presscast ahead of the 2018 Cancer Survivorship Symposium (Abstract 134).


"There are many types of cancer treatments that can affect sexual health, for example, surgery or radiation to the pelvic region, which occur frequently with gynecologic or genitourinary cancers, or chemotherapy that causes sudden, premature menopause," Bober noted. "Guidelines advocate for doctors to inquire about sexual function, but unfortunately, that seldom happens."


Study Details

The researchers contacted staff at 25 NCI-designated cancer centers/NCCN member institutions about the availability of sexual aids and resources for survivors. Potential sources of aids and resources at each center, such as custom boutiques and specialty retail shops, were identified using the phone and internet. Staff members at the boutiques was queried by phone to see if they had sexual aids available for men and, in a separate call, for women. If the centers did not have sexual aids available, there was a follow-up call to see if they had recommendations for how survivors could access those resources.


Of the 25 centers contacted, 23 responded about aids for men, and 22 responded about aids for women. The majority of centers (72%) reported no therapeutic aids available for women. The staff was uncomfortable when asked about further resources, such as pamphlets, said Bober. Results were similar for men-87 percent of centers had no sexual aids, and only one center had three or more products.


One center carried a vacuum device and two had penile support rings. Six centers had some aids for women, most commonly reported were personal lubricants, moisturizers, and dilators. One center stood out, having several types of aids for men and women. If a center had no aids, their recommendations were usually for people to do an internet search or visit a local pharmacy to obtain the aids.


"By and large, medical professionals do not regularly talk about sexual health, and we know that distressing problems are not consistently addressed," Bober noted. "We need to normalize these conversations, and providing sexual aids is one step toward treating sexual health like any other aspect of survivorship care. It should be no different than providing wigs and head coverings to women who have lost their hair due to chemotherapy. It's important to give patients the message that regaining sexual health is a perfectly valid and life-affirming aspect of regaining overall quality of life."


Next Steps

The researchers plan to query the other 44 NCI-designated cancer centers to see what products they are selling and perhaps conduct patient surveys to find out what types of resources are most useful for survivors.


"What we really need to do is go to the centers that are successfully providing sexual health products and find out how they promote and provide resources to their patients. We can't keep the conversation at the 10,000-foot level-we need to talk concretely about how to partner with providers to make sexual health resources, including sexual health aids, available so cancer survivors can get the help that they need," said Bober.


The one center that had an extensive list of products and resources for men and women could potentially serve as a model, she said. "The scarcity of sexual aids underscores the cultural taboos around cancer-related sexual dysfunction, as does the discomfort of responders. More availability of sexual aids at cancer centers would likely promote sexual rehabilitation. Providers may be more likely to recommend aids, and patients would have greater access," Bober explained.


ASCO Expert Timothy Gilligan, MD, MSc, Associate Professor of Medicine at the Cleveland Clinic Taussig Cancer Institute, commented: "Cancer can disrupt sex lives of patients. All too often, medical professionals don't take into account the sexual health of cancer survivors. This study illuminates how far we still have to go in this area. We have to be more diligent as physicians in helping our patients find the best tools and resources to be sexually healthy."


Mark L. Fuerst is a contributing writer.