A clear and well-documented gender bias exists in the evaluation of sexual outcomes for women undergoing urologic surgery. Due to the anatomic template of anterior exenteration, women are commonly left with side effects that include sexual dysfunction and the perpetuated effects of surgical menopause.
To present evaluation and treatment recommendations for female sexual dysfunction treatment and evaluation, in addition to surgical templates during radical cystectomy (RC).
This article reviews current literature regarding sexual function and RC with urinary diversion in female bladder cancer patients. Furthermore, this review will provide a review of techniques for organ and neurovascular preservation, along with novel vaginal reconstruction templates. Our review will further focus on emerging technology, including minimally invasive surgery and organ and nerve preservation, directed at preservation of female sexual function.
Clinically, studies have demonstrated that females who have undergone genitalia-sparing and neurovascular preservation during RC regained sexual activity earlier than patients undergoing traditional RC. If organ and nerve preservation is not feasible due to involvement of trigone or bladder neck, vaginal reconstruction can mitigate the sexual dysfunction that results from a loss of the anterior vagina during a standard RC.
Female sexual dysfunction is associated with high levels of patient distress and is best comanaged with a multidisciplinary treatment approach, including preoperative counseling, intraoperative nerve, and organ preservation, and postoperative interventions to mitigate sexual side effects. Davis L, Isali I, Prunty M, et al. Female Sexual Function Following Radical Cystectomy in Bladder Cancer. Sex Med Rev 2021;XX:XXX-XXX.
Sexual medicine reviews. 2022 Jan 03 [Epub ahead of print]
Laura Davis, Ilaha Isali, Megan Prunty, Adam Calaway, Kirtishri Mishra, April Miller, Rachel Pope, Diana Magee, Alberto Castro Bigalli, Nannan Thirumavalavan, Lee Ponsky, Laura Bukavina
Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA., Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Comprehensive Cancer Center, Case Western Reserve School of Medicine, Cleveland, OH, USA., Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Reproduction Biology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA., Fox Chase Cancer Center, Division of Urologic Oncology, Philadelphia, PA, USA., Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Fox Chase Cancer Center, Division of Urologic Oncology, Philadelphia, PA, USA. Electronic address: .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/34992003