27 January, 2020
A comment on Climacteric Editor’s Choice "Sexual quality of life in men and women after cancer" by L. R. Schover
There is a global agreement about the fact that cancers and cancer therapies have a negative impact on the sexual health of men and women with prevalence rates on average of 50-60%. There is also global agreement that patients are very often left alone with their sexual problems and that there is not adequate care. In this review , the physical and psychosocial consequences of cancers and cancer treatment on the sexual life of male and female patients are summarized. The barriers and gaps are described. Lack of information and counseling during oncological care, reluctance of patients to bring up sexual issues in a medical environment, lack of training of oncological professionals, lack of time, lack of education material, non-familiarity with the variety of sexual orientations and preferences, focusing on heterosexual penetrative intercourse, etc.. The review  describes the short history of initiatives in the US to respond to these barriers and gaps. The National Comprehensive Cancer Network (NCCN) issued guidelines (2019 (https://www.nccn.org/professionals/physician_gls/default.aspx#supportive)), ASCO also issued a guideline in 2017 (https://www.asco.org/research-guidelines/quality-guidelines/guidelines/patient-and-survivor-care#/28976) with some agreement on the basic requirements. The cancer team should initiate discussion about sexuality and provide follow-up visits with the possibility to refer to multidisciplinary treatment.
The author  describes the real-life difficulties in meeting these guidelines and proposes a practice-oriented system including the communication techniques to identify sexual concerns and problems by the oncologist. In case of need, an assessment visit by a professional trained in Sexual Medicine (Diagnosis and treatment options and the specific impact of individual cancer) should follow . This visit should lead to a multidisciplinary treatment plan which is based on psychoeducation and according to the individual condition of medical or psychotherapeutic interventions [3-5]. To make this oncosexological care available it is important to create networks between different specialists who have in addition to their specialty some interest and competence in sexual medicine. This is an important review  which can serve as a position paper to describe the requirements of patient-centered psycho-oncological and sexual health care. Our own experience in the Multidisciplinary Center for Sexual Medicine at the University Hospital in Basel (Switzerland) is very much in agreement with the proposed system of care including gynecologists, urologists, psychotherapists, neurologists, pain specialists, physiotherapists with some additional training in sexual medicine [6,7]. Sexual health is addressed in a general way by the treating physician and if problems are mentioned an assessment visit is offered to the cancer patients if desired with their partner. The content of the assessment visit is discussed in the multidisciplinary round table and a treatment plan elaborated .
Professor emeritus of Gynaecology & Obstetrics, University of Basel
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