Terri L. Woodard

Brain activation patterns in women with acquired hypoactive sexual desire disorder and women with normal sexual function: a cross-sectional pilot study

OBJECTIVE To examine and compare brain activation patterns of premenopausal women with normal sexual function and those with hypoactive sexual desire disorder (HSDD) during viewing of validated sexually explicit film clips. DESIGN Cross-sectional pilot study. SETTING University-based clinical research center. PATIENT(S) Premenopausal women. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Areas of brain activation during viewing of sexually explicit film clips. RESULT(S) Women with normal sexual function showed significantly greater activation of the right thalamus, left insula, left precentral gyrus, and left parahippocampal gyrus in comparison with women with HSDD, who exhibited greater activation of the right medial frontal gyrus and left precuneus regions. CONCLUSION(S) Women with HSDD may have alterations in activation of limbic and cortical structures responsible for acquiring, encoding, and retrieving memory, the processing and memory of emotional reactions, and areas responsible for heightened attention to ones own physical state.

Breast Cancer, BRCA Mutations, and Attitudes Regarding Pregnancy and Preimplantation Genetic Diagnosis

BACKGROUND Women with premenopausal breast cancer may face treatment-related infertility and have a higher likelihood of a BRCA mutation, which may affect their attitudes toward future childbearing. METHODS Premenopausal women were invited to participate in a questionnaire study administered before and after BRCA genetic testing. We used the Impact of Event Scale (IES) to evaluate the pre- and post-testing impact of cancer or carrying a BRCA mutation on attitudes toward future childbearing. The likelihood of pursuing prenatal diagnosis (PND) or preimplantation genetic diagnosis (PGD) was also assessed in this setting. Univariate analyses determined factors contributing to attitudes toward future childbearing and likelihood of PND or PGD. RESULTS One hundred forty-eight pretesting and 114 post-testing questionnaires were completed. Women with a personal history of breast cancer had less change in IES than those with no history of breast cancer (p = .003). The 18 BRCA-positive women had a greater change in IES than the BRCA-negative women (p = .005). After testing, 31% and 24% of women would use PND and PGD, respectively. BRCA results did not significantly affect attitudes toward PND/PGD. CONCLUSION BRCA results and history of breast cancer affect the psychological impact on future childbearing. Intentions to undergo PND or PGD do not appear to change after disclosure of BRCA results. Additional counseling for patients who have undergone BRCA testing may be warranted to educate patients about available fertility preservation options.

Prolonging Reproductive Life after Cancer: The Need for Fertoprotective Therapies

The survival rate of reproductive-age patients with cancer is increasing, reflecting the advent of better and more efficient therapies. Cancer survivors seek the resumption of a normal and healthy life, which often includes starting a family. Unfortunately, many cancer treatments increase the risk of premature ovarian insufficiency (POI) and infertility. Assisted reproductive technologies (ART) can address infertility, but fail to preserve the natural function of the ovaries as a source of hormones that regulate many aspects of womens health. The advancement of fertoprotective technologies is hindered by our lack of understanding of oocyte biology and their sensitivity to cancer therapies. Because many cancer treatments cause DNA damage, apoptosis is thought to be the major mechanism eliminating damaged oocytes. Indeed, recent studies in mice demonstrate that targeting proteins involved in apoptosis protects oocytes and prevents infertility in females exposed to radiation. Therefore, a better appreciation of oocyte response to radiation and anticancer drugs will uncover new targets for the development of specialized therapies to prevent ovarian failure. We make a case here for the necessity of such fertoprotective treatments. We review recent findings that have significantly advanced our understanding of how cancer therapies induce apoptotic death in oocytes, and how we could use this knowledge to design better fertoprotective treatments.

Novel Psychological Intervention for Decision Support in Women Considering Fertility Preservation Before Cancer Treatment

Decisions about fertility preservation in young adults with cancer are often made under conditions of high subjective stress and time pressure. In women, these decisions are further complicated by the invasiveness of fertility preservation procedures, concerns about health risks of these procedures, and financial barriers. This article describes the rationale for and development of a brief decision support and stress management intervention for women aged 18-40 who are considering fertility preservation before cancer treatment. Case examples from participants are provided to illustrate the potential applicability of the intervention to survivors in a variety of circumstances.

Factors influencing fertility-sparing treatment for gynecologic malignancies: A survey of Society of Gynecologic Oncology members

OBJECTIVES This study aims to examine practice patterns of gynecologic oncologists (GO) regarding fertility-sparing treatments (FST) for gynecology malignancies and explores attitudes toward collaboration with reproductive endocrinologists (RE). METHODS An anonymous 23-question survey was sent to 1087 GO with a 14.0% completion rate. Descriptive statistics, Fishers exact test, and Chi-square tests were used for data analysis. RESULTS The majority of GOs offer FST for gynecologic malignancies. Providers seeing larger numbers of reproductive age women were more likely to consider cancer prognosis (p<0.03) and cancer stage (p<0.01) as key factors. Providers in the Midwestern US considered socioeconomic status more often when offering FST than those in the South (p<0.04). Those practicing in urban settings were more likely to feel that collaborating with a RE prior to treatment could improve treatment planning for women considering FST (p<0.02). Finally, providers in urban or suburban areas more often felt collaboration with a RE improves pregnancy outcomes in women who pursue FST (p<0.01, p<0.02) compared to rural practitioners. CONCLUSIONS While FST offers women the chance to pursue pregnancy after cancer, there are minimal data on factors that influence whether FST is offered and if collaboration with a RE is sought in the management of these patients. The number of reproductive age women seen, geographic location, and practice setting are important variables that may influence current practice. Understanding these factors can help identify opportunities to improve oncologic and reproductive outcomes of this patient population.

Obesity, Fertility Preservation and Gynecologic Cancers

A small but significant number of gynecologic cancers are diagnosed in women less than 40 years old. Many of these women will have not started or fulfilled their plans to have children and will desire to preserve their fertility, in spite of their cancer diagnosis. The field of Oncofertility utilizes multidisciplinary collaboration between reproductive medicine specialists and oncology providers to inform patients of the potential for cancer-related infertility and present options for fertility preservation (FP) while balancing disease treatment and fertility goals.

Pathways: patient-centred decision counselling for women at risk of cancer-related infertility: a protocol for a comparative effectiveness cluster randomised trial

Introduction National guidelines recommend that all reproductive-age women with cancer be informed of their fertility risks and offered referral to fertility specialists to discuss fertility preservation options. However, reports indicate that only 5% of patients have consultations, and rates of long-term infertility-related distress remain high. Previous studies report several barriers to fertility preservation; however, initial success has been reported using provider education, patient decision aids and navigation support. This protocol will test effects of a multicomponent intervention compared with usual care on women’s fertility preservation knowledge and decision-making outcomes. Methods and analysis This cluster-randomised trial will compare the multicomponent intervention (provider education, patient decision aid and navigation support) with usual care (consultation and referral, if requested). One hundred newly diagnosed English-speaking women of reproductive age who are at risk of cancer-related infertility will be recruited from four regional oncology clinics. The Pathways patient decision aid website provides (1) up-to-date evidence and descriptions of fertility preservation and other family-building options, tailored to cancer type; (2) structured guidance to support personalising the information and informed decision-making; and (3) a printable summary to help women prepare for discussions with their oncologist and/or fertility specialist. Four sites will be randomly assigned to intervention or control groups. Participants will be recruited after their oncology consultation and asked to complete online questionnaires at baseline, 1 week and 2 months to assess their demographics, fertility preservation knowledge, and decision-making process and quality. The primary outcome (decisional conflict) will be tested using Fisher’s exact test. Secondary outcomes will be assessed using generalised linear mixed models, and sensitivity analyses will be conducted, as appropriate. Ethics and dissemination The University of Texas MD Anderson Cancer Center provided approval and ongoing review of this protocol. Results will be presented at relevant scientific meetings and submitted for publication in a peer-reviewed journal. Trial registration number NCT03141437; Pre-results.

Female Sexual Function in Childhood, Adolescent, and Young Adult Cancer Survivors

Female survivors of childhood, adolescent, and young adult cancers are at risk of impaired sexual functioning. Cancer and cancer treatment may alter normal sexual development and predispose women to sexual problems through both physiologic and psychosocial mechanisms. Sexual problems are classified as sexual dysfunction disorders when they meet the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), and cause significant distress. There are a number of effective treatments for female sexual dysfunction, though few have been rigorously evaluated in women with a history of cancer. By recognizing sexual health as a pertinent survivorship issue and through regular screening, healthcare providers can play an important role in optimizing sexual well-being in this patient population.

Sexual and Reproductive Dysfunction in Young Female Cancer Patients

Purpose of ReviewThis review summarizes the current literature about sexual and reproductive dysfunction in female cancer survivors and points toward future directions for research.Recent FindingsSexual dysfunction is a common condition seen in this population and as the incidence of survivorship grows, so will its prevalence. It is a comorbidity that has a significant effect on the quality of life. While research in this area is emerging, patients are still underserved in both recognition and treatment.SummaryResearch has conclusively shown that female sexual dysfunction after cancer is a major medical issue. Future steps should be taken to educate both medical providers and the public to improve screening and recognition, targeting early treatment with implementation of multidisciplinary care. While several single treatments have shown promise, optimal outcomes will ultimately be achieved through an approach that specifically addresses a patient’s medical, social, and psychological needs.

Is estrogen exposure a protective factor for pancreatic neuroendocrine tumours in female patients with multiple endocrine neoplasia syndrome type 1

Pancreatic neuroendocrine tumours (PNETs) are the most common cause of death in patients with multiple endocrine neoplasia type 1 (MEN1). Women have been shown to have improved survival, which may suggest a possible protective effect of female sex hormones. The aim of this study was to evaluate the relationship between estrogen exposure and PNET tumourigenesis, tumour growth and survival in female MEN1 patients with these tumours.