Introduction: Oncology patients often present to healthcare providers with a history of pre-existing psychiatric conditions. Associated treatments are well known to impact sexual functioning. The identification of these confounding conditions and medications is an integral part of the comprehensive management of sexual dysfunction in oncology patients.
Aim: To report the prevalence of psychiatric diagnoses and agents in an oncology sexual health clinic.
Methods: A retrospective review was performed using 204 sequential charts of patients who attended the Sexual Health Program at Memorial Sloan-Kettering Cancer Center from March 2003 through August 2004.
Main outcome measures: All patients were evaluated by a sexual medicine gynecologist and received an extensive medical history, psychosexual assessment, and a focused gynecologic examination.
Results: Fourteen patients (7%) did not have cancer and were excluded from further analysis. Of the remaining 190 patients, the median age at initial visit was 48 years (range 22-76) and the majority of patients were menopausal (87%). The most common diagnosis was breast cancer (44%). One hundred twenty-eight patients (67%) had prior pelvic surgery and 43 (23%) had prior pelvic radiation. The most frequently encountered sexual complaints were dyspareunia (65%), vaginal dryness (63%), hypoactive desire disorder (46%), and orgasmic dysfunction (7%). At initial presentation, 52 patients (27%) reported having a prior or concurrent psychiatric diagnosis and 72 (38%) were taking an anti-depressant and/or an anxiolytic. Treatment recommendations for sexual dysfunction consisted of psychosexual counseling, psychiatric referral, vaginal moisturizers and lubricants, hormonal therapy with minimally absorbed vaginal estrogen suppositories, vaginal dilators, and/or skilled exercise.
Conclusion: Psychiatric conditions are commonly encountered in the oncology population as are the medications to treat them. Because it is well established that these medications are often implicated in sexual dysfunction, further research is needed to determine the mechanism of action within the desire pathway of the cancer patient and treatment of such disorders.