Physical examination of the female cancer patient with sexual concerns: What oncologists and patients should expect from consultation with a specialist

Abstract

Answer questions and earn CME/CNE Sexual concerns are prevalent in women with cancer or cancer history and are a factor in patient decision making about cancer treatment and risk-reduction options. Physical examination of the female cancer patient with sexual concerns, regardless of the type or site of her cancer, is an essential and early component of a comprehensive evaluation and effective treatment plan. Specialized practices are emerging that focus specifically on evaluation and treatment of women with cancer and sexual function problems. As part of a specialized evaluation, oncologists and their patients should expect a thorough physical examination to identify or rule out physical causes of sexual problems or dysfunction. This review provides oncology professionals with a description of the physical examination of the female cancer patient with sexual function concerns. This description aims to inform anticipatory guidance for the patient and to assist in interpreting specialists' findings and recommendations. In centers or regions where specialized care is not yet available, this review can also be used by oncology practices to educate and support health care providers interested in expanding their practices to treat women with cancer and sexual function concerns. CA Cancer J Clin 2016;66:241-263. © 2016 American Cancer Society.

Keywords: cancer; female; physical examination; sexual dysfunction; survivorship.

Figure 1

Scientific Network on Female Sexual Health and Cancer Survey Respondent Provider and Practice Characteristics

Figure 2

Diagram of genital anatomy to be used with the patient during physical examination

Figure 3

Vulvar Pain Mapping and Visual Analogue Scale a. Systematic Vulvar Pain Mapping Tool to be used by the provider b. Adapted Visual Analogue Scale to be used by the patient during assessment Legend: Figure 3a. is for examiner reference. Figure 3b. is for patient reference during the examination. The patient is provided a laminated copy of the visual analog pain scale. She is instructed that she will feel a light touch with the cotton swab at several different points on the vulva. Each time she feels a touch with the swab, she is instructed to rate the quality of the sensation. “Zero” means touch, but no pain. “Ten” means worst possible pain. If a patient offers a fractional number such as “2.5,” the examiner records the nearest whole number (in this example, 3). Each time vulvar mapping is performed, the examiner refers to the vulvar image to ensure the vulvar sensation points are assessed and recorded in the medical record in the order A–H.

Figure 4

Photographs of potential physical examination findings a. Contact Dermatitis Legend: This image shows vulvar and vestibular erythema, patchy areas of vulvar lichenification, perianal maculopapular erythematous rash, a hemorrhoid, and a flat, pigmented, regular macule of the left lateral vulva. b. Vulvar Atrophy Legend: This image shows vulvovaginal atrophy and vaginal introital stenosis in a patient who had completed 5 years of tamoxifen therapy and was taking an aromatase inhibitor. c. Graft-Versus-Host Disease Legend: This image shows a scaly, erythematous rash affecting the vulva, perineum and perianal region in a patient with probable graft-versus-host disease. For a full description of potential findings, please see Vogelsang GB, Pavletic SZ. Chronic Graft Versus Host Disease: Interdisciplinary Management. Cambridge University Press; 2009. d. Breast Reconstruction Post-Mastectomy Legend: This image shows a reconstructed left breast and nipple with healing scars and a lower abdominal scar resulting from breast reconstruction using the deep inferior epigastric perforator flap. e. Breast Nipple Scar Legend: This image shows a right mastectomy scar with absence of the right nipple areolar complex.