Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Overview of sexual dysfunction in female cancer survivors

Sandy J Falk, MD, FACOG
Section Editor
Patricia A Ganz, MD
Deputy Editor
Sadhna R Vora, MD


Early detection and treatment of cancer continue to advance, and the number of cancer survivors continues to increase. It is estimated that as of January 2014, there were 14.5 million people with a history of cancer in the United States, and the number is expected to increase to 19 million by 2024 [1].

For female cancer survivors, gynecologic issues are a major concern and many of these issues impact sexual function. Sexual health conditions that affect women during or after cancer treatment may be considered according to the same categories as female sexual dysfunction in the general population. The American Psychiatric Association defines the following female sexual disorders: sexual interest/arousal, orgasmic, and genito-pelvic pain/penetration [2]. Each of these categories of function can be impacted by cancer and its treatments.

The general approach to sexual health issues associated with cancer treatment involves patient education, screening, diagnosis, and management.

This topic will review sexual health issues in women diagnosed with and treated for cancer. Female sexual dysfunction in general and fertility preservation in cancer patients are discussed separately. (See "Sexual dysfunction in women: Epidemiology, risk factors, and evaluation" and "Sexual dysfunction in women: Management" and "Fertility preservation in patients undergoing gonadotoxic treatment or gonadal resection".)


Sexual issues are more common among female cancer survivors. In the general population, 40 percent of women have sexual complaints, although a clinical diagnosis of sexual dysfunction requires that the sexual issue is associated with personal distress, and this is not assessed in most studies [3,4]. (See "Sexual dysfunction in women: Epidemiology, risk factors, and evaluation", section on 'Epidemiology' and "Sexual dysfunction in women: Epidemiology, risk factors, and evaluation", section on 'Diagnostic criteria'.)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Dec 16, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. DeSantis CE, Lin CC, Mariotto AB, et al. Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin 2014; 64:252.
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th, American Psychiatric Association, Arlington, VA 2013.
  3. Shifren JL, Monz BU, Russo PA, et al. Sexual problems and distress in United States women: prevalence and correlates. Obstet Gynecol 2008; 112:970.
  4. Laumann EO, Nicolosi A, Glasser DB, et al. Sexual problems among women and men aged 40-80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Int J Impot Res 2005; 17:39.
  5. Andersen BL, Anderson B, deProsse C. Controlled prospective longitudinal study of women with cancer: I. Sexual functioning outcomes. J Consult Clin Psychol 1989; 57:683.
  6. Stewart DE, Wong F, Duff S, et al. "What doesn't kill you makes you stronger": an ovarian cancer survivor survey. Gynecol Oncol 2001; 83:537.
  7. Stavraka C, Ford A, Ghaem-Maghami S, et al. A study of symptoms described by ovarian cancer survivors. Gynecol Oncol 2012; 125:59.
  8. Vaz AF, Pinto-Neto AM, Conde DM, et al. Quality of life and menopausal and sexual symptoms in gynecologic cancer survivors: a cohort study. Menopause 2011; 18:662.
  9. Harter P, Schrof I, Karl LM, et al. Sexual Function, Sexual Activity and Quality of Life in Women with Ovarian and Endometrial Cancer. Geburtshilfe Frauenheilkd 2013; 73:428.
  10. Raggio GA, Butryn ML, Arigo D, et al. Prevalence and correlates of sexual morbidity in long-term breast cancer survivors. Psychol Health 2014; 29:632.
  11. Barni S, Mondin R. Sexual dysfunction in treated breast cancer patients. Ann Oncol 1997; 8:149.
  12. Bregendahl S, Emmertsen KJ, Lindegaard JC, Laurberg S. Urinary and sexual dysfunction in women after resection with and without preoperative radiotherapy for rectal cancer: a population-based cross-sectional study. Colorectal Dis 2015; 17:26.
  13. Aerts L, Christiaens MR, Enzlin P, et al. Sexual functioning in women after mastectomy versus breast conserving therapy for early-stage breast cancer: a prospective controlled study. Breast 2014; 23:629.
  14. Ganz PA, Desmond KA, Belin TR, et al. Predictors of sexual health in women after a breast cancer diagnosis. J Clin Oncol 1999; 17:2371.
  15. Ganz PA, Rowland JH, Desmond K, et al. Life after breast cancer: understanding women's health-related quality of life and sexual functioning. J Clin Oncol 1998; 16:501.
  16. Krychman ML, Carter J, Aghajanian CA, et al. Chemotherapy-induced dyspareunia: a case study of vaginal mucositis and pegylated liposomal doxorubicin injection in advanced stage ovarian carcinoma. Gynecol Oncol 2004; 93:561.
  17. Bergmark K, Avall-Lundqvist E, Dickman PW, et al. Vaginal changes and sexuality in women with a history of cervical cancer. N Engl J Med 1999; 340:1383.
  18. Baumgart J, Nilsson K, Evers AS, et al. Sexual dysfunction in women on adjuvant endocrine therapy after breast cancer. Menopause 2013; 20:162.
  19. Marino JL, Saunders CM, Emery LI, et al. Nature and severity of menopausal symptoms and their impact on quality of life and sexual function in cancer survivors compared with women without a cancer history. Menopause 2014; 21:267.
  20. Park J, Kim TH, Lee HH, et al. Gynecologic complication of chronic graft-versus-host disease: Vaginal obstruction. Obstet Gynecol Sci 2013; 56:277.
  21. Rodolakis A, Thomakos N, Harhalakis N, et al. Complete vaginal obstruction with hematometra after hematopoietic stem cell transplantation for chronic myeloid leukemia: a case report. J Reprod Med 2007; 52:959.
  22. De Pas TM, Mandalà M, Curigliano G, Peccatori F. Acute vulvar vestibulitis occurring during chemotherapy with cryptophycin analogue LY355703. Obstet Gynecol 2000; 95:1030.
  23. Straub RH. The complex role of estrogens in inflammation. Endocr Rev 2007; 28:521.
  24. Begovic-Juhant A, Chmielewski A, Iwuagwu S, Chapman LA. Impact of body image on depression and quality of life among women with breast cancer. J Psychosoc Oncol 2012; 30:446.
  25. http://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf (Accessed on December 03, 2014).
  26. Hill EK, Sandbo S, Abramsohn E, et al. Assessing gynecologic and breast cancer survivors' sexual health care needs. Cancer 2011; 117:2643.
  27. Moreira ED Jr, Brock G, Glasser DB, et al. Help-seeking behaviour for sexual problems: the global study of sexual attitudes and behaviors. Int J Clin Pract 2005; 59:6.
  28. Falk SJ, Dizon DS. Sexual dysfunction in women with cancer. Fertil Steril 2013; 100:916.
  29. Wiggins DL, Wood R, Granai CO, Dizon DS. Sex, intimacy, and the gynecologic oncologists: survey results of the New England Association of Gynecologic Oncologists (NEAGO). J Psychosoc Oncol 2007; 25:61.
  30. Boehmer U, Potter J, Bowen DJ. Sexual functioning after cancer in sexual minority women. Cancer J 2009; 15:65.
  31. White ID, Allan H, Faithfull S. Assessment of treatment-induced female sexual morbidity in oncology: is this a part of routine medical follow-up after radical pelvic radiotherapy? Br J Cancer 2011; 105:903.
  32. Krychman ML, Katz A. Breast cancer and sexuality: multi-modal treatment options. J Sex Med 2012; 9:5.
  33. Basson R, Schultz WW. Sexual sequelae of general medical disorders. Lancet 2007; 369:409.
  34. Basson R. Clinical practice. Sexual desire and arousal disorders in women. N Engl J Med 2006; 354:1497.
  35. Pumo V, Milone G, Iacono M, et al. Psychological and sexual disorders in long-term breast cancer survivors. Cancer Manag Res 2012; 4:61.
  36. Aerts L, Enzlin P, Vergote I, et al. Sexual, psychological, and relational functioning in women after surgical treatment for vulvar malignancy: a literature review. J Sex Med 2012; 9:361.
  37. Dorjgochoo T, Kallianpur A, Zheng Y, et al. Impact of menopausal symptoms on quality of life 6 months after systemic breast cancer treatment: results from the Shanghai Breast Cancer Survival Study. Breast Cancer Res Treat 2010; 119:725.
  38. Goetsch MF, Lim JY, Caughey AB. Locating pain in breast cancer survivors experiencing dyspareunia: a randomized controlled trial. Obstet Gynecol 2014; 123:1231.
  39. Herbenick D, Reece M, Hensel D, et al. Association of lubricant use with women's sexual pleasure, sexual satisfaction, and genital symptoms: a prospective daily diary study. J Sex Med 2011; 8:202.
  40. Bygdeman M, Swahn ML. Replens versus dienoestrol cream in the symptomatic treatment of vaginal atrophy in postmenopausal women. Maturitas 1996; 23:259.
  41. Nachtigall LE. Comparative study: Replens versus local estrogen in menopausal women. Fertil Steril 1994; 61:178.
  42. Fraunholz IB, Schopohl B, Falk S, Boettcher HD. Cytohormonal status and acute radiation vaginitis. Front Radiat Ther Oncol 2002; 37:112.
  43. Hope ME, Farmer L, McAllister KF, Cumming GP. Vaginismus in peri- and postmenopausal women: a pragmatic approach for general practitioners and gynaecologists. Menopause Int 2010; 16:68.
  44. Melnik T, Hawton K, McGuire H. Interventions for vaginismus. Cochrane Database Syst Rev 2012; 12:CD001760.
  45. Bahng AY, Dagan A, Bruner DW, Lin LL. Determination of prognostic factors for vaginal mucosal toxicity associated with intravaginal high-dose rate brachytherapy in patients with endometrial cancer. Int J Radiat Oncol Biol Phys 2012; 82:667.
  46. Mirabeau-Beale K, Hong TS, Niemierko A, et al. Clinical and treatment factors associated with vaginal stenosis after definitive chemoradiation for anal canal cancer. Pract Radiat Oncol 2015; 5:e113.
  47. Eltabbakh GH, Piver MS, Hempling RE, Shin KH. Excellent long-term survival and absence of vaginal recurrences in 332 patients with low-risk stage I endometrial adenocarcinoma treated with hysterectomy and vaginal brachytherapy without formal staging lymph node sampling: report of a prospective trial. Int J Radiat Oncol Biol Phys 1997; 38:373.
  48. Hartman P, Diddle AW. Vaginal stenosis following irradiation therapy for carcinoma of the cervix uteri. Cancer 1972; 30:426.
  49. Lee SJ, Vogelsang G, Gilman A, et al. A survey of diagnosis, management, and grading of chronic GVHD. Biol Blood Marrow Transplant 2002; 8:32.
  50. Riera C, Deroover Y, Marechal M. Severe vaginal chronic graft-versus-host disease (GVHD): two cases with late onset and literature review. Eur J Gynaecol Oncol 2010; 31:703.
  51. Spiryda LB, Laufer MR, Soiffer RJ, Antin JA. Graft-versus-host disease of the vulva and/or vagina: diagnosis and treatment. Biol Blood Marrow Transplant 2003; 9:760.
  52. Lotery HE, Galask RP. Erosive lichen planus of the vulva and vagina. Obstet Gynecol 2003; 101:1121.
  53. Segraves RT, Clayton A, Croft H, et al. Bupropion sustained release for the treatment of hypoactive sexual desire disorder in premenopausal women. J Clin Psychopharmacol 2004; 24:339.
  54. Safarinejad MR, Hosseini SY, Asgari MA, et al. A randomized, double-blind, placebo-controlled study of the efficacy and safety of bupropion for treating hypoactive sexual desire disorder in ovulating women. BJU Int 2010; 106:832.
  55. Nurnberg HG, Hensley PL, Heiman JR, et al. Sildenafil treatment of women with antidepressant-associated sexual dysfunction: a randomized controlled trial. JAMA 2008; 300:395.
  56. Morone G, Iosa M, Fusco A, et al. Effects of a multidisciplinary educational rehabilitative intervention in breast cancer survivors: the role of body image on quality of life outcomes. ScientificWorldJournal 2014; 2014:451935.
  57. Lehmann V, Hagedoorn M, Tuinman MA. Body image in cancer survivors: a systematic review of case-control studies. J Cancer Surviv 2015; 9:339.
  58. Bober SL, Carter J, Falk S. Addressing female sexual function after cancer by internists and primary care providers. J Sex Med 2013; 10 Suppl 1:112.