Data aid in treatment for vulvovaginal health, sexual function after cancer

Kathryn Flynn, PhD, of the Department of Medicine in the Division of Hematology and Oncology at the Medical College of Wisconsin, and colleagues collected data from 100 postmenopausal patients from Memorial Sloan Kettering Cancer Center with history of endometrial or breast cancer who sought treatment for vulvovaginal symptoms.

Researchers performed a single-site, single-arm prospective trial where they collected data from standard gynecologic examinations. The exams were designed to evaluate sexual function, outcome measures of vulvovaginal pain and dryness as reported by clinicians (ClinRO), and patient-reported outcomes (PROs) of sexual function, including PROMIS Sexual Function and Satisfaction (SexFS) lubrication, clitoral discomfort, labial discomfort, and vaginal discomfort, and Female Sexual Function Index (FSFI) pain and lubrication.

One hundred women participated at baseline, and 77 remained 12 to 14 weeks in. The mean age of women was 55 years (range, 31-78). Sixty-eight percent were partnered, 77% were White, and 60% were sexually active. Seven percent of women were in menopause for more than 1 year, 48% between 1 and 5 years, and 45% for less than 5 years, they said.

Authors analyzed between the different measures, the baseline, and time points and reported that ClinRO and PRO variables all had positive relationships as expected. However, they noted that the relationship strength greatly differed. They reported that at 12 to 14 weeks, “there were medium-to-large correlations between ClinRO vaginal dryness and SexFS Lubrication (0.64), ClinRO vulvar dryness and SexFS Lubrication (0.46), ClinRO vulvar discomfort and SexFS Labial Discomfort (0.70), and ClinRO vulvar discomfort and SexFS Clitoral Discomfort (0.43).” Researchers said that “the correlations between the exam variables and the corresponding PRO scores were small (range, 0.01-0.27),” with 1 exception.

Among study strengths, researchers said use of the specialized gynecologic exam to evaluate sexual function was comprehensive and standardized. “This allowed for a relatively granular analysis of the relationships between exam findings and patient-reported experiences,” authors said.

Another strength of the study was the use of PROMIS and FSFI PRO measures, which researchers said provide a great amount of valid evidence. Study limitations included a small sample size. Flynn emphasized that for providers in practice, the most important takeaway is that in the diagnosis and treatment of sexual dysfunction after cancer, PRO measures offer “a unique and important complement to clinical measures.”

She said this study is significant because researchers described the correlations between vulvovaginal health from clinician interviews, clinical gynecologic exams, and patient self-reported vulvar and vaginal discomfort with sexual activity among survivors of cancer.

“Our study used high-quality measures, and we found that the clinician-reported and patient-reported scores were moderately correlated with each other but distinct from clinical gynecologic exam findings,” she said.

Regarding next steps, Flynn said findings needed to be confirmed using other samples, including those involving women who have not had cancer treatment.

“The magnitudes of the relationships documented here are consistent with the idea that sexual function is influenced by a host of biological, psychosocial, and environmental factors,” investigators said.