Should Every Woman with Gynecologic Cancer Undergo Routine Screening for Psychological Distress and Sexual Dysfunction?



Arguments in support of and against routine screening for psychological distress, including depression, and sexual dysfunction among women with gynecologic cancer are considered. Proponents of universal screening note the high prevalence of distress and the options for successful treatment of such distress if detected. Patient-initiated or oncologist-determined detection of distress, however, is highly unreliable and the distress of many patients goes unrecognized. Routine use of self-report screening instruments to rapidly and prospectively identify those patients who are struggling with the challenges of cancer diagnosis and treatment is promoted as the most efficient solution to providing equitable access to psychosocial and mental health care in oncology settings. Critics of universal screening point to the absence of data on the practical utility of screening and provide evidence suggesting that screening is an inefficient method of improving patient well-being. Systematic evidence demonstrating the benefits of screening for distress in general or depression specifically are lacking. Potential harms of screening have not been considered. We conclude that stronger, high-level evidence demonstrating that routine screening results in better outcomes is needed before such programs will or should be broadly adopted. In relation to screening for sexual dysfunction, the situation is not much different. Sexual dysfunction is frequent among survivors of gynecologic cancer and is related to emotional changes, as well as physical changes in vaginal function and hormone status, mainly premature menopause. The effects in some patients significantly impair quality of life for years. Patients and physicians are often reluctant to discuss these issues openly; therefore a screening questionnaire would be of benefit to select patients who need further evaluation and treatment. A variety of treatment options have been described. Unfortunately, there is no consensus regarding the best questionnaire to use; reports in the literature often contain only a limited number of patients with various malignancies in different stages of survival, and there are very few randomized studies evaluating treatment outcomes. In addition, only limited resources are available. For these reasons, we conclude that at this time, universal screening cannot be recommended. More research is definitely needed; however, we still encourage physicians to at least ask their patients about sexual function.


Cervical Cancer Endometrial Cancer Sexual Function Sexual Dysfunction National Comprehensive Cancer Network 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Patrick DL, Ferketich SL, Frame PS. National Institutes of Health State-of-the-Science Conference Statement. Symptom management in cancer: pain, depression, and fatigue. J Natl Cancer Inst. 2004;32:9–16.Google Scholar
  2. 2.
    Adler NE, Page AEK. Cancer care for the whole patient: meeting psychosocial health needs. Washington, DC: The National Academies Press; 2007.Google Scholar
  3. 3.
    National Comprehensive Cancer Network. Distress management. Clinical practice guidelines. J Natl Compr Canc Netw. 2003;1:344–74.Google Scholar
  4. 4.
    National Institute for Clinical Excellence. NICE: guidelines on cancer services: improving supportive and palliative care for adults with cancer. London: National Institute for Clinical Excellence; 2004.Google Scholar
  5. 5.
    National Breast Cancer Centre and National Cancer Control Initiative. Clinical practice guidelines for the psychosocial care of adults with cancer. Camperdown: National Breast Cancer Centre; 2003.Google Scholar
  6. 6.
    Palmer SC, Taggi A, DeMichele A, Coyne JC. Is screening effective in detecting untreated psychiatric disorders among newly diagnosed breast cancer patients? Cancer. 2011. doi: 10.1002/cncr.26603.Google Scholar
  7. 7.
    Palmer SC. Clinical trial did not demonstrate benefits of screening patients with cancer for distress. J Clin Oncol. 2011;29:e277–8.PubMedGoogle Scholar
  8. 8.
    Bidstrup PE, Johansen C, Mitchell AJ. Screening for cancer-related distress: summary of evidence from tools to programmes. Acta Oncol. 2011;50:194–204.PubMedGoogle Scholar
  9. 9.
    Palmer SC, Coyne JC. Screening for depression in medical care. Pitfalls, alternatives, and revised priorities. J Psychosom Res. 2003;54:279–87.PubMedGoogle Scholar
  10. 10.
    Garssen B, de Kok E. How useful is a screening instrument? Psychooncology. 2008;17:726–8.PubMedGoogle Scholar
  11. 11.
    Carlson LE, Angen M, Cullum J, Goodey E, Koopmans J, Lamont L, MacRae JH, Martin M, Pelletier G, Robinson J, Simpson JS, Speca M, Tillotson L, Bultz BD. High levels of untreated distress and fatigue in cancer patients. Br J Cancer. 2004;90:2297–304.PubMedCentralPubMedGoogle Scholar
  12. 12.
    Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S. The prevalence of psychological distress by cancer site. Psychooncology. 2001;10:19–28.PubMedGoogle Scholar
  13. 13.
    Derogatis LR, Morrow GR, Fetting J. The prevalence of psychiatric disorders among cancer patients. JAMA. 1983;249:751–7.PubMedGoogle Scholar
  14. 14.
    Fallowfield L, Ratcliffe D, Jenkins V, Saul J. Psychiatric morbidity and its recognition by doctors in patients with cancer. Br J Cancer. 2001;84:1011–5.PubMedCentralPubMedGoogle Scholar
  15. 15.
    Osborn RL, Demoncada AC, Feuerstein M. Psychosocial interventions for depression, anxiety and quality of life in cancer survivors: meta-analyses. Int J Psychiatry Med. 2006;36:13–34.PubMedGoogle Scholar
  16. 16.
    Jacobson PB, Jim HS. Psychosocial interventions for anxiety and depression in adult cancer patients: achievements and challenges. CA Cancer J Clin. 2008;58:214–30.Google Scholar
  17. 17.
    Andrykowski MA, Manne SL. Are psychological interventions effective and accepted by cancer patients? I. Standards and levels of evidence. Ann Behav Med. 2006;32:93–7.PubMedGoogle Scholar
  18. 18.
    Hersch J, Juraskova I, Price M, Mullan B. Psychosocial interventions and quality of life in gynaecological cancer patients: a systematic review. Psychooncology. 2009;18:795–810.PubMedGoogle Scholar
  19. 19.
    Manne SL, Rubin S, Edelson M, Rosenblum N, Bergman C, Hernandez E, Carlson J, Rocereto T, Winkel G. Coping and communication-enhancing intervention versus supportive counseling for women diagnosed with gynecological cancers. J Consult Clin Psychol. 2007;75:615–28.PubMedGoogle Scholar
  20. 20.
    León-Pizarro C, Gich I, Barthe E, Rovirosa A, Farrús B, Casas F, Verger E, Biete A, Craven-Bartle J, Sierra J, Arcusa A. A randomized trial of the effect of training in relaxation and guided imagery techniques in improving psychological and quality-of-life indices for gynecologic and breast brachytherapy patients. Psychooncology. 2007;16:971–9.PubMedGoogle Scholar
  21. 21.
    Petersen RW, Quinlivan JA. Preventing anxiety and depression in gynaecological cancer: a randomised controlled trial. BJOG. 2002;109:386–94.PubMedGoogle Scholar
  22. 22.
    Brown L, Kroenke K, Theobald DE, Wu J, Tu W. The association of depression and anxiety with health-related quality of life in cancer patients with depression and/or pain. Psychooncology. 2010;19:734–41.PubMedCentralPubMedGoogle Scholar
  23. 23.
    Spiegel D, Giese-Davis J. Depression and cancer: mechanisms and disease progression. Biol Psychiatry. 2003;54:269–82.PubMedGoogle Scholar
  24. 24.
    Kissane D. Beyond the psychotherapy and survival debate: the challenge of social disparity, depression and treatment adherence in psychosocial cancer care. Psychooncology. 2009;18:1–5.PubMedGoogle Scholar
  25. 25.
    Satin JR, Linden W, Phillips MJ. Depression as a predictor of disease progression and mortality in cancer patients: a meta-analysis. Cancer. 2009;115:5349–61.PubMedGoogle Scholar
  26. 26.
    Breitbart W, Rosenfeld B, Pessin H. Depression, hopelessness, and desire for hastened death in terminally ill. JAMA. 2000;284:2907–11.PubMedGoogle Scholar
  27. 27.
    Kondryn HJ, Edmondson CL, Hill J, Eden TO. Treatment non-adherence in teenage and young adult patients with cancer. Lancet Oncol. 2011;12:100–8.PubMedGoogle Scholar
  28. 28.
    Greer JA, Pirl WF, Park ER, Lynch TJ, Temel JS. Behavioral and psychological predictors of chemotherapy adherence in patients with advanced non-small cell lung cancer. J Psychosom Res. 2008;65:549–52.PubMedGoogle Scholar
  29. 29.
    DiMatteo MR, Lepper HS, Croghan MD. Depression is a risk factor for noncompliance with medical treatment. Arch Intern Med. 2000;160:2101–7.PubMedGoogle Scholar
  30. 30.
    Froijd C, Lampic C, Larsson G, von Essen L. Is satisfaction with doctors’ care related to health-related quality of life, anxiety and depression among patients with carcinoid tumours? A longitudinal report. Scand J Caring Sci. 2009;23:107–16.Google Scholar
  31. 31.
    Von Essen L, Larsson G, Oberg K, Sjödén PO. ‘Satisfaction with care’: associations with health-related quality of life and psychosocial function among Swedish patients with endocrine gastrointestinal tumours. Eur J Cancer Care (Engl). 2002;11:91–9.Google Scholar
  32. 32.
    Frick E, Tyroller M, Panzer M. Anxiety, depression and quality of life of cancer patients undergoing radiation therapy: a cross-sectional study in a community hospital outpatient centre. Eur J Cancer Care (Engl). 2007;16:130–6.Google Scholar
  33. 33.
    Alacacioglu A, Binicier O, Gungor O, Oztop I, Dirioz M, Yilmaz U. Quality of life, anxiety, and depression in Turkish colorectal cancer patients. Support Care Cancer. 2010;18:417–21.PubMedGoogle Scholar
  34. 34.
    Carlson LE, Bultz B. Benefits of psychosocial oncology care: improved quality of life and medical cost offset. Health Qual Life Outcomes. 2003;1:8.PubMedCentralPubMedGoogle Scholar
  35. 35.
    Simpson JSA, Carlson LE, Trew M. Impact of a group psychosocial intervention on health care utilization by breast cancer patients. Cancer Pract. 2001;9:19–26.PubMedGoogle Scholar
  36. 36.
    Keller M, Sommerfeldt S, Fischer C, Knight L, Riesbeck M, Lowe B, Herfarth C, Lehnert T. Recognition of distress and psychiatric morbidity in cancer patients: a multi-method approach. Ann Oncol. 2004;15:1243–9.PubMedGoogle Scholar
  37. 37.
    Söllner W, DeVries A, Steixner E, Lukas P, Sprinzl G, Rumpold G, Maislinger S. How successful are oncologists in identifying patient distress, perceived social support, and need for psychosocial counselling? Br J Cancer. 2001;84:179–85.PubMedCentralPubMedGoogle Scholar
  38. 38.
    Merckaert I, Libert Y, Razavi D. Communication skills training in cancer care: where are we and where are we going? Curr Opin Oncol. 2005;17:319–30.PubMedGoogle Scholar
  39. 39.
    Merckaert I, Libert Y, Delvaux N, Marchal S, Boniver J, Etienne A, Klastersky J, Reynaert C, Scalliet P, Slachmuylder J, Razavi D. Factors that influence physicians’ detection of distress in patients with cancer: can a communication skills training program improve physicians’ detection? Cancer. 2005;105:411–21.Google Scholar
  40. 40.
    Elit L, Trim K, Mand-Bains IH, Sussman J, Grunfeld E. Job satisfaction, stress and burnout among Canadian gynecologic oncologists. Gynecol Oncol. 2004;94:134–9.PubMedGoogle Scholar
  41. 41.
    Stafford L, Judd F. Mental health and occupational wellbeing of Australian gynaecologic oncologists. Gynecol Oncol. 2010;116:526–32.PubMedGoogle Scholar
  42. 42.
    Holland JC. History of psycho-oncology: overcoming attitudinal and conceptual barriers. Psychosom Med. 2002;64:206–21.PubMedGoogle Scholar
  43. 43.
    Detmar SB, Aaronson NK, Wever LD, Muller MJ, Schornagel JH. How are you feeling? Who wants to know? Patients’ and oncologists’ preferences for discussing health-related quality-of-life issues. J Clin Oncol. 2000;18:3295–301.PubMedGoogle Scholar
  44. 44.
    Weinberger MI, Roth AJ, Nelson CJ. Untangling the complexities of depression diagnosis in older cancer patients. Oncologist. 2009;14:60–6.PubMedCentralPubMedGoogle Scholar
  45. 45.
    Extermann M, Hurria A. Comprehensive geriatric assessment for older patients with cancer. J Clin Oncol. 2007;25:1824–31.PubMedGoogle Scholar
  46. 46.
    Ell K, Sanchez K, Vourlekis B, Lee P-J, Dwight-Johnson M, Lagomasino I, Muderspach L, Russell C. Depression, correlates of depression, and receipt of depression care among low-income women with breast or gynecological cancer. J Clin Oncol. 2005;23:3052–60.PubMedCentralPubMedGoogle Scholar
  47. 47.
    Coyne JC, Palmer SC, Shapiro PJ, Thompson R, DeMichele A. Distress, psychiatric morbidity, and prescriptions for psychotropic medications in a breast cancer waiting room sample. Gen Hosp Psychiatry. 2004;26:121–8.PubMedGoogle Scholar
  48. 48.
    Vodermaier A, Linden W, Siu C. Screening for emotional distress in cancer patients: a systematic review of assessment instruments. J Natl Cancer Inst. 2009;101:1464–88.PubMedCentralPubMedGoogle Scholar
  49. 49.
    Meijer A, Roseman M, Milette K, Coyne JC, Stefanek ME, Ziegelstein RC, Arthurs E, Leavens A, Palmer SC, Stewart DE, de Jonge P, Thombs BD. Depression screening and patient outcomes in cancer: a systematic review. PLoS One. 2011;6:e27181.PubMedCentralPubMedGoogle Scholar
  50. 50.
    Thombs BD, Arthurs E, El-Baalbaki G. Risk of bias from inclusion of patients who already have diagnosis of or are undergoing treatment for depression in diagnostic accuracy studies of screening tools for depression: systematic review. BMJ. 2011;343:d4825.PubMedCentralPubMedGoogle Scholar
  51. 51.
    Pyne JM, Rost KM, Farahati F. One size fits some: the impact of patient treatment attitudes on the cost effectiveness of a depression primary-care intervention. Psychol Med. 2005;35:839–54.PubMedGoogle Scholar
  52. 52.
    Nutting PA, Rost KM, Dickinson M. Barrier to initiating depression treatment in primary care practice. J Gen Intern Med. 2002;17:103–11.PubMedCentralPubMedGoogle Scholar
  53. 53.
    Baas KDW KA, van Weert H. Screening for depression in high-risk groups: prescriptive cohort study in general practice. Br J Psychiatry. 2009;194:399–403.Google Scholar
  54. 54.
    Mitchell AJ. Short screening tools for cancer-related distress: a review and diagnostic validity meta-analysis. J Natl Compr Canc Netw. 2010;8:487–94.PubMedGoogle Scholar
  55. 55.
    Baker-Glenn E, Park B, Granger L, Symonds P, Mitchell AJ. Desire for psychological support in cancer patients with depression or distress: validation of a simple help question. Psychooncology. 2011;20:525–31.PubMedGoogle Scholar
  56. 56.
    Carlson LE, Groff LS, Maciejewski O, Bultz B. Screening for distress in lung and breast cancer outpatients: a randomized controlled trial. J Clin Oncol. 2010;28:4884–91.PubMedGoogle Scholar
  57. 57.
    Merckaert I, Libert Y, Messin S, Milani M, Slachmuylder JL, Razavi D. Cancer patients’ desire for psychological support: prevalence and implications for screening patients’ psychological needs. Psychooncology. 2010;19:141–9.PubMedGoogle Scholar
  58. 58.
    Sollner W, Maislinger S, Konig A. Providing psychosocial support for breast cancer patients based on screening for distress within a consultation-liaison service. Psychooncology. 2004;13:893–7.PubMedGoogle Scholar
  59. 59.
    National Collaborating Centre for Mental Health. The NICE guideline on the management and treatment of depression in adults (updated edition). London: National Institute for Health and Clinical Excellence; 2010.Google Scholar
  60. 60.
    Stafford L, Judd F. Long-term quality of life in Australian women previously diagnosed with gynaecologic cancer. Support Care Cancer. 2011;19:2047–56.PubMedGoogle Scholar
  61. 61.
    Mitchell AJ. Pooled results from 38 analyses of the accuracy of the distress thermometer and other ultra-short methods of detecting cancer-related mood disorders. J Clin Oncol. 2007;25:4670–81.PubMedGoogle Scholar
  62. 62.
    Ng CG, Boks MP, Zainal NZ, De Wit NJ. The prevalence and pharmacotherapy of depression in cancer patients. J Affect Disord. 2011;131:1–7.PubMedGoogle Scholar
  63. 63.
    Detmar SB, Muller MJ, Schornagel JH, Wever LD, Aaronson NK. Health-related quality-of-life assessments and patient-physician communication: a randomized controlled trial. JAMA. 2002;288:3027–34.PubMedGoogle Scholar
  64. 64.
    Velikova G, Booth L, Smith AB, Brown PML, Lynch P, Brown JM, Selby PJ. Measuring quality of life in routine oncology practice improves communication and patient well-being. J Clin Oncol. 2004;22:714–24.PubMedGoogle Scholar
  65. 65.
    McLachlan SA, Allenby A, Matthews J, Wirth A, Kissane D, Bishop M. Randomized trial of coordinated psychosocial interventions based on patient self-assessments versus standard care to improve the psychosocial functioning of patients with cancer. J Clin Oncol. 2001;19:4117–25.PubMedGoogle Scholar
  66. 66.
    Boyes A, Newell S, Girgis A, McElduff P, Sanson-Fisher R. Does routine assessment and real-time feedback improve cancer patients’ psychosocial well-being? Eur J Cancer Care. 2006;15:163–71.Google Scholar
  67. 67.
    Maunsell E, Brisson J, Deschenes L, Frasure-Smith N. Randomized trial of a psychologic distress screening program after breast cancer. J Clin Oncol. 1996;14:2745–55.Google Scholar
  68. 68.
    Rosenbloom SK, VIctorson DE, Hahn EA, Peterman AH, Cella D. Assessment is not enough: a randomized controlled trial of the effects of HRQL assessment on quality of life and satisfaction in oncology clinical practice. Psychooncology. 2007;16:1069–79.PubMedGoogle Scholar
  69. 69.
    Jacobsen PB. Screening for psychological distress in cancer patients: challenges and opportunities. J Clin Oncol. 2007;25:4526–7.PubMedGoogle Scholar
  70. 70.
    Kelly CM, Juurlink DN, Gomes T, Duong-Hua M, Pritchard KI. Selective serotonin reuptake inhibitors and breast cancer mortality in women receiving tamoxifen: a population based cohort study. BMJ. 2010;340:c693.PubMedCentralPubMedGoogle Scholar
  71. 71.
    Yap KY, Ho YX, Chui WK, Chan A. Harnessing the internet cloud for managing drug interactions with chemotherapy regimens in patients with cancer suffering from depression. Acta Oncol. 2010;49:1235–45.PubMedGoogle Scholar
  72. 72.
    Saylor MS, Smetana RF. Potential for drug-drug interactions in treating cancer-related nausea and distress. J Oncol Pharm Pract. 2011;17:403–8.PubMedGoogle Scholar
  73. 73.
    Schneider S, Moyer A, Knapp-Oliver S, Sohl S, Cannella D, Targhetta V. Pre-intervention distress moderates the efficacy of psychosocial treatment for cancer patients: a meta-analysis. J Behav Med. 2010;33:1–14.PubMedCentralPubMedGoogle Scholar
  74. 74.
    Mitchell AJ, Kaar S, Coggan C, Herdman J. Acceptability of common screening methods used to detect distress and related mood disorders – preferences of cancer specialists and non-specialists. Psychooncology. 2007;17:226–36.Google Scholar
  75. 75.
    Pirl WF, Muriel A, Hwang V, Kornblith A, Greer J, Donelan K, Greenberg DB, Temel J, Schapira L. Screening for psychosocial distress: a national survey of oncologists. J Support Oncol. 2007;5:499–504.PubMedGoogle Scholar
  76. 76.
    Grover S, Hill-Kayser CE, Vachani C, Hampshire MK, DiLullo GA, Metz JM. Patient reported late effects of gynecological cancer treatment. Gynecol Oncol. 2012;124:399–403.PubMedGoogle Scholar
  77. 77.
    Abbott-Anderson K, Kwekkeboom KL. A systematic review of sexual concerns reported by gynecological cancer survivors. Gynecol Oncol. 2011;214:477–89.Google Scholar
  78. 78.
    Burns M, Costello J, Ryan-Woolley B, Davidson S. Assessing the impact of late treatment effects in cervical cancer: an exploratory study of women’s sexuality. Eur J Cancer Care (Engl). 2007;16:364–72.Google Scholar
  79. 79.
    Donovan KA, Taliaferro LA, Alvarez EM, Jacobsen PB, Roetzheim RG, Wenham RM. Sexual health in women treated for cervical cancer: characteristics and correlates. Gynecol Oncol. 2007;104:428–34.PubMedGoogle Scholar
  80. 80.
    Kysa M, Christie KM, Meyerowitz BE, Maly RC. Depression and sexual adjustment following breast cancer in low-income Hispanic and non-Hispanic White women. Psychooncology. 2010;19:1069–77.Google Scholar
  81. 81.
    Serati M, Salvatore S, Uccella S, Laterza RM, Cromi A, Ghezzi F, Bolis PJ. Sexual function after radical hysterectomy for early-stage cervical cancer: is there a difference between laparoscopy and laparotomy? J Sex Med. 2009;6:2516–22.PubMedGoogle Scholar
  82. 82.
    Pieterse QD, Maas CP, ter Kuile MM, Lowik M, van Eijkeren MA, Trimbos JB, Kenter GG. An observational longitudinal study to evaluate miction, defecation, and sexual function after radical hysterectomy with pelvic lymphadenectomy for early-stage cervical cancer. Int J Gynecol Cancer. 2006;16:1119–29.PubMedGoogle Scholar
  83. 83.
    Vistad I, Fosså SD, Dahl AA. A critical review of patient-rated quality of life studies of long-term survivors of cervical cancer. Gynecol Oncol. 2006;102:563–72.PubMedGoogle Scholar
  84. 84.
    Juraskova I, Butow P, Bonner C, Robertson R, Sharpe L. Sexual adjustment following early stage cervical and endometrial cancer: prospective controlled multi-centre study. Psychooncology. 2013;22:153–9.PubMedGoogle Scholar
  85. 85.
    Onujiogu N, Johnson T, Seo S, Mijal K, Rash J, Seaborne L, Rose S, Kushner DM. Survivors of endometrial cancer: who is at risk for sexual dysfunction? Gynecol Oncol. 2011;123:356–9.PubMedGoogle Scholar
  86. 86.
    Becker M, Malafy T, Bossart M, Henne K, Gitsch G, Denschlag D. Quality of life and sexual functioning in endometrial cancer survivors. Gynecol Oncol. 2011;121:169–73.PubMedGoogle Scholar
  87. 87.
    Nout R, Putter H, Jurgenliemk-Schulz I, Jobsen J, Lutgens L, van der Steen-Banasik E, Mens J, Slot A, Stenfert Kroese M, Nijman H, van de Poll-Franse L, Creutzberg C. Five-year quality of life of endometrial cancer patients treated in the randomised post operative radiation therapy in endometrial cancer (PORTEC-2) trial and comparison to norm data. Eur J Cancer. 2012;48:1638–48.PubMedGoogle Scholar
  88. 88.
    Liavaag AH, Dørum A, Bjøro T, Oksefjell H, Fosså SD, Tropé C, Dahl AA. A controlled study of sexual activity and functioning in epithelial ovarian cancer survivors. A therapeutic approach. Gynecol Oncol. 2008;108:348–54.PubMedGoogle Scholar
  89. 89.
    Gershenson DM, Miller AM, Champion VL, Monahan PO, Zhao Q, Cella D, Williams SD, Gynecologic Oncology Group. Reproductive and sexual function after platinum-based chemotherapy in long-term ovarian germ cell tumor survivors: a Gynecologic Oncology Group Study. J Clin Oncol. 2007;25:2792–7.PubMedGoogle Scholar
  90. 90.
    Sun CC, Bodurka DC, Weaver CB, Rasu R, Wolf JK, Bevers MW, Smith JA, Wharton JT, Rubenstein EB. Rankings and symptom assessments of side effects from chemotherapy: insights from experienced patients with ovarian cancer. Support Care Cancer. 2005;13:219–27.PubMedGoogle Scholar
  91. 91.
    Aerts L, Enzlin P, Vergote I, Verhaeghe J, Poppe W, Amant F. Sexual, psychological, and relational functioning in women after surgical treatment for vulvar malignancy: a literature review. J Sex Med. 2012;9:361–7.PubMedGoogle Scholar
  92. 92.
    Lindau ST, Gavrilova N, Anderson D. Sexual morbidity in very long term survivors of vaginal and cervical cancer: a comparison to national norms. Gynecol Oncol. 2001;106:413–8.Google Scholar
  93. 93.
    Bifulco G, De Rosa N, Tornesello ML, Piccoli R, Bertrando A, Lavitola G, Morra I, Di Spiezio Sardo A, Buonaguro FM, Nappi C. Quality of life, lifestyle behavior and employment experience: a comparison between young and midlife survivors of gynecology early stage cancers. Gynecol Oncol. 2012;124:444–51.PubMedGoogle Scholar
  94. 94.
    Stead ML, Brown JM, Fallowfield L, Selby P. Lack of communication between healthcare professionals and women with ovarian cancer about sexual issues. Br J Cancer. 2003;88:666–71.PubMedCentralPubMedGoogle Scholar
  95. 95.
    Hill EK, Sandbo S, Abramsohn E, Makelarski J, Wroblewski K, Wenrich ER, McCoy S, Temkin SM, Yamada SD, Lindau ST. Assessing gynecologic and breast cancer survivors’ sexual health care needs. Cancer. 2011;117:2643–51.PubMedCentralPubMedGoogle Scholar
  96. 96.
    Schroder M, Mell LK, Hurteau JA, Collins YC, Rotmensch J, Waggoner SE, Yamada SD, Small Jr W, Mundt AJ. Clitoral therapy device for treatment of sexual dysfunction in irradiated cervical cancer patients. Int J Radiat Oncol Biol Phys. 2005;61:1078–86.PubMedGoogle Scholar
  97. 97.
    Brotto LA, Yule M, Breckon E. Psychological interventions for the sexual sequelae of cancer: a review of the literature. J Cancer Surviv. 2010;4:346–60.PubMedGoogle Scholar
  98. 98.
    Tangjitgamol S, Manusirivithaya S, Hanprasertpong J, Kasemsarn P, Soonthornthum T, Leelahakorn S, Thawaramara T, Lapcharoen O. Sexual dysfunction in Thai women with early-stage cervical cancer after radical hysterectomy. Int J Gynecol Cancer. 2007;17:1104–12.PubMedGoogle Scholar
  99. 99.
    Frumovitz M, Sun CC, Schover LR, Munsell MF, Jhingran A, Wharton JT, Eifel P, Bevers TB, Levenback CF, Gershenson DM, Bodurka DC. Quality of life and sexual functioning in cervical cancer survivors. J Clin Oncol. 2005;23:7428–36.PubMedGoogle Scholar
  100. 100.
    Carter J, Goldfrank D, Schover LR. Simple strategies for vaginal health promotion in cancer survivors. J Sex Med. 2011;8:549–59.PubMedGoogle Scholar
  101. 101.
    Rutledge TL, Heckman SR, Qualls C, Muller CY, Rogers RG. Pelvic floor disorders and sexual function in gynecologic cancer survivors: a cohort study. Am J Obstet Gynecol. 2010;203:514.e1–e7.Google Scholar
  102. 102.
    Plotti F, Sansone M, Di Donato V, Antonelli E, Altavilla T, Angioli R, Panici PB. Quality of life and sexual function after type C2/type III radical hysterectomy for locally advanced cervical cancer: a prospective study. J Sex Med. 2011;8:894–904.PubMedGoogle Scholar
  103. 103.
    Cibula D, Velechovska P, Sláma J, Fischerova D, Pinkavova I, Pavlista D, Dundr P, Hill M, Freitag P, Zikan M. Late morbidity following nerve-sparing radical hysterectomy. Gynecol Oncol. 2010;116:506–11.PubMedGoogle Scholar
  104. 104.
    Butler-Manuel SA, Summerville K, Ford A, Blake P, Riley AJ, Sultan AH, Monga AK, Stanton SL, Shepherd JH, Barton DP. Self-assessment of morbidity following radical hysterectomy for cervical cancer. J Obstet Gynaecol. 1999;19:180–3.PubMedGoogle Scholar
  105. 105.
    Tornatta JM, Carpenter JS, Schilder J, Cardenes HR. Representations of vaginal symptoms in cervical cancer survivors. Cancer Nurs. 2009;32:378–84.PubMedGoogle Scholar
  106. 106.
    Fang CY, Cherry C, Devarajan K, Li T, Malick J, Daly MB. A prospective study of quality of life among women undergoing risk-reducing salpingo-oophorectomy versus gynecologic screening for ovarian cancer. Gynecol Oncol. 2009;112:594–600.PubMedCentralPubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  1. 1.Centre for Women’s Mental Health, Royal Women’s HospitalParkvilleAustralia
  2. 2.Oncology, Carolinas Medical CenterConcordUSA

Personalised recommendations