2024 SOGC, 2024 NCCN, 2022 ESO-ESMO, and 2018 ASCO: a comparison of female cancer survivorship guidelines for the management of sexual health concerns.

purposeFemale cancer survivors often experience sexual dysfunction, which is a significant and increasingly recognized aspect of survivorship. This review compares guidelines from the American Society of Clinical Oncology (ASCO), the European School of Oncology-European Society of Medical Oncology (ESO-ESMO), the National Comprehensive Cancer Network (NCCN), and the Society of Obstetricians and Gynaecologists of Canada (SOGC) for managing sexual health symptoms.

methodsThe most recent guidelines from ASCO, ESO-ESMO, NCCN, and SOGC were examined and compared. The recommendations were grouped by type of sexual dysfunction: vaginal dryness, low sex drive, pain, orgasmic dysfunction, and psychological concerns.

resultsAll guidelines strongly recommend non-hormonal therapies (i.e., lubricants or moisturizers) as first-line treatments for managing vaginal dryness. If unsuccessful, there is consensus for low-dose estrogen creams, tablets, capsules, or rings as second-line treatments. Multidisciplinary care is also recommended by all, including psychosocial and relationship counselling, specialist referrals, and cognitive behavioral therapy to address psychological concerns. ASCO, NCCN, and SOGC recommend vaginal dilators, and pelvic physical therapy for relieving pain. ASCO recommends any kind of stimulation (including masturbation) to improve sexual response, while NCCN and SOGC recommend the use of sexual aids (e.g., vibrators) to enhance arousal. Although all guidelines, except ESO-ESMO, include recommendations for androgens, bupropion, flibanserin, bremelanotide, and buspirone for low sex drive, there is limited data.

conclusionThere is consensus among guidelines on certain sexual health recommendations, with some variation. Additional research is needed on pharmacological interventions and types of counselling to strengthen their evidence.