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SAN ANTONIO -- Despite the fact that both men and women who receive brachytherapy for prostate or cervical cancer may experience some degree of sexual dysfunction, physicians are much less likely to engage in discussions about sexual health with women than with men, according to research presented here.

A single-center study found a striking difference in how often sexual health was discussed with men and women at their initial consult -- 89% of men compared with just 13% of women (P<0.001), reported Jamie Takayesu, MD, of the University of Michigan Rogel Cancer Center in Ann Arbor.

Furthermore, none of the women who had cervical cancer had their sexual health assessed with a patient-reported outcomes (PRO) tool, compared with 81% of men with prostate cancer.

"And this was despite the fact that women were on average almost 20 years younger than their male counterparts," Takayesu observed during a press briefing at the American Society for Radiation Oncology (ASTRO) annual meeting.

The impetus for this work, Takayesu said, was a prior study at her institution showing that 63% of women think they should be asked about their sexual health on a routine basis.

"In my own clinical experience I felt we weren't really meeting their need," she said. "I've had many conversations with men about their erectile function, and I really wasn't having that same conversation with women."

The current study, a retrospective review of patients treated with brachytherapy at the University of Michigan Rogel Cancer Center, included 126 women with cervical cancer and 75 men with prostate cancer. Takayesu pointed out that brachytherapy is commonly used in both of these cancers and that up to 90% of women will experience a degree of sexual dysfunction (most commonly changes to vaginal tissue and dryness that can cause pain and discomfort), while about 50% of men will experience sexual dysfunction after treatment.

In addition to determining how many men and women were engaging in discussions about sexual health with clinicians, Takayesu and her colleagues also examined how often sexual health was assessed in clinical trials nationwide by analyzing studies in the NIH Clinical Trials Database.

The study showed that of 78 trials that involved brachytherapy for prostate cancer and 53 for cervical cancer, prostate cancer trials were significantly more likely to include sexual function as a primary or secondary endpoint (17% vs 6%, P=0.04), and more likely to include overall quality of life as an endpoint (37% vs 11%, P=0.01).

Why are women less likely to be asked about their sexual health? "There are, of course, a lot of confounding factors," Takayesu said. "Prostate cancer patients, in general, tend to live longer ... and have many more types of treatments that are offered to them. So sexual function does become a way for them to stratify which treatment is best for them. But, I do think there are a lot of steps to be made in improving how we approach sexual health in women."

She noted, for example, that at her institution standardized PROs are being implemented in the radiation oncology clinic, and that educational efforts are underway both in radiation oncology and gynecology, and within other specialties, "to try to manage the sexual dysfunction these women are experiencing."

"It's also important to look at some of the implicit biases and social constructs that are impacting doctors' -- or any providers' -- discussions of female sexual health," Takayesu said, adding that once female sexual health becomes a more important part of the discussion, radiation oncologists can address how treatments can be altered to reduce sexual toxicity, and what kind of therapies can be added to address female sexual dysfunction.

Commenting on the study, the chair of ASTRO's Council on Health Equity, Diversity and Inclusion, Iris C. Gibbs, MD, of Stanford Medicine in California, said that an important aspect of care "is really about how we view patients in that lens through which we approach their overall outcome."

"And they are in need of bias mitigation," Gibbs added. "Dr. Takayesu's study turns that lens back on us as providers to be more inclusive and to recognize the potential for the sexual morbidity of our treatment -- for all genders."

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