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14-06-2016 | Gynecologic cancers | Book chapter | Article

9. Psychosexual Issues and Quality of Life after Oncologic Pelvic Surgery, with Focus on Cervical Cancer

Authors: Alessandra Graziottin, MD, Monika Lukasiewicz, MD

Publisher: Springer International Publishing

Abstract

The extraordinary progress in oncologic surgery has blessed patients with a “second life.” The minimally invasive surgery has the ambitious goal of maximizing the benefits in terms of health expectancy, a challenge far beyond the goal of increasing life expectancy.
Literature
1.
Lukasiewicz M, Graziottin A. Women’ sexuality after gynecologic cancers. In: Studd J, Seang LT, Chervenak FA, editors. Current progress in obstetrics and gynaecology, vol. 2. 2nd ed. Mumbai: Kothari Medical; 2015 (accepted, in press).
2.
Graziottin A, Lukasiewicz M. Female sexual dysfunction and premature menopause. In: Lipshultz L, Pastuszek A, Perelman M, Giraldi AM, Buster J, editors. Sexual health in the couple: management of sexual dysfunction in men and women. Verlag, New York: Springer; 2015 (accepted, in press).
3.
Lindau ST, Gavrilova N, Anderson D. Sexual morbidity in very long survivors of vaginal cancer: a comparison to national norms. Gynecol Oncol. 2007;106(2):413–8.PubMedPubMedCentralCrossRef
4.
Ferlay J, Shin HR, Bray F, et al. Internet. Lyon: International Agency for Research on Cancer; 2010. Available from: http://​globocan.​iarc.​fr.
5.
Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62:10–29.PubMedCrossRef
6.
Jemal A, Bray F, Cencer MM, et al. Global center statistics. CA Cancer J Clin. 2011;61:69–90.PubMedCrossRef
7.
Carter J, Stabile C, Gunn A, et al. The psychical consequences of gynecologic cancer surgery and their impact on sexual, emotional, and quality of life issues. J Sex Med. 2013;10(1):21–34.PubMedCrossRef
8.
Graziottin A, Serafini A. HPV infection in women: psychosexual impact of genital wart and intraepithelial lesions. J Sex Med. 2009;6(3):633–64.PubMedCrossRef
9.
Maguire R, Kotronoulas G, Simpson M, et al. A systematic review of the supportive care needs of women living with and beyond cervical cancer. Gynecol Oncol. 2015;136(3):478–90.PubMedCrossRef
10.
Juraskova I, Butow P, Robertson R, et al. Post-treatment sexual adjustment following cervical and endometrial cancer: a qualitative insight. Psychooncology. 2003;12(3):267–79.PubMedCrossRef
11.
Bifulco G, De Rosa N, Tornesello ML, et al. 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.PubMedCrossRef
12.
Ekwell E, Ternestedt B, Sorbe B. Important aspects for health care for women with gynecologic cancer. Oncol Nurs Inf Forum. 2003;30:313–9.CrossRef
13.
Kennedy V, Abramsohn E, Makelarski J, et al. Can you ask? We just did! Assessing sexual function and concerns in patients presenting for initial gynecologic oncology consultation. Gynecol Oncol. 2015;137(1):119-24. doi: 10.​1016/​j.​ygyno.​2015.​01.​451. Epub 2015 Jan 9.
14.
Graziottin A, Gambini D. Female sexual dysfunction: treatment. In: Bø K, Berghmans B, Mørkved S, Van Kampen M, editors. Evidence-based physical therapy for the pelvic floor – bridging science and clinical practice. 2nd ed. Oxford: Elsevier; 2015 (accepted, in press).
15.
Anderson B, Woods X, Copeland L. Sexual self-schema and sexual morbidity among gynecological cancer survivors. J Consult Clin Psychol. 1997;65:221–9.CrossRef
16.
White ID. The assessment and management of sexual difficulties after treatment of cervical and endometrial malignancies. Clin Oncol (R Coll Radiol). 2008;20(6):488–96.CrossRef
17.
Tierney DK. Sexuality: a quality-of-life issue for cancer survivors. Semin Oncol Nurs. 2008;24:71–9.PubMedCrossRef
18.
Gilbert E, Ussher JM, Perz J. Sexuality after gynecological cancer: a review of the material, intrapsychic, and discursive aspects of treatment on women’s sexual-wellbeing. Maturitas. 2011;70:42–57.PubMedCrossRef
19.
Lammerink E, de Bock G, Pras E, et al. Sexual functioning of cervical cancer survivors: a review with a female perspective. Maturitas. 2012;72:296–304.PubMedCrossRef
20.
Abbott-Anderson K, Kwekeboom KL. A systematic review of sexual concerns reported by gynecological cancer survivors. Gynecol Oncol. 2012;124:477–89.PubMedCrossRef
21.
Cleary V, Hegarty J, McCarthy G. Sexuality in Irish women with gynecologic cancer. Oncol Nurs Forum. 2011;38:E87–96.PubMedCrossRef
22.
Harter P, Schrof I, Karl LM, et al. Sexual function, sexual activity and quality of life in women with ovarian and endometrial cancer. Geburtshilfe Frauenheilkd. 2013;73:428–32.PubMedPubMedCentralCrossRef
23.
Vaidakis D, Panoskaltsis T, Poulakaki N, et al. Female sexuality after female cancer treatment: a clinical issue. Eur J Gynaecol Oncol. 2014;35:635–40.PubMed
24.
Bergmark K, Avall-Lundqvis E, Dickman PW, et al. Vaginal changes and sexuality in woman with a history of cervical cancer. N Engl J Med. 1999;340:1383–9.PubMedCrossRef
25.
Bergmark K, Avall-Lundqvist E, Dickman P, et al. Patient-rating of distressful symptoms after treatment for early cervical cancer. Acta Obstet Gynecologia Scand. 2002;443–450.
26.
Jensen PT, Groenvold M, Klee MC, et al. Early-stage cervical carcinoma, radical hysterectomy, and sexual function. A longitudinal study. Cancer. 2004;100:97–106.PubMedCrossRef
27.
Frumovitz M, Sun CC, Schover LR, et al. Quality of life and sexual functioning in cervical cancer survivors. J Clin Oncol. 2005;23:7428–36.PubMedCrossRef
28.
Tangjitgamol S, Manusirivithaya S, Hanprasertpong J. Sexual dysfunction in Thai women with early-stage cervical cancer after radical hysterectomy. Int J Gynecol Cancer. 2007;17:1104–12.PubMedCrossRef
29.
Park SY, Bae DS, Nam JH, et al. Quality of life and sexual problems in disease-free survivors of cervical cancer compared with the general population. Cancer. 2007;110:2716–25.PubMedCrossRef
30.
Donovan KA, Taiaferro LA, Alvarez EM, et al. Sexual health in women treated for cervical cancer. Characteristics and correlates. Gynecol Oncol. 2007;104:428–34.PubMedCrossRef
31.
Burns M, Costello J, Ryan-Woolley B, et al. Assessing the impact of late treatment effects in cervical cancer: an exploratory study of women’s sexuality. Eur J Cancer Care. 2007;16:364–72.CrossRef
32.
Pieterse QD, Kenter GG, Maas CP, et al. Self-reported sexual, bowel and bladder function in cervical cancer patients following different treatment modalities: longitudinal prospective cohort study. Int J Gynecol Cancer. 2013;23:1717–25.PubMedCrossRef
33.
Vistad I, Cvancarova M, Fossa SD, et al. Post radiotherapy morbidity in long-term survivors after locally advanced cervical cancer: how well do physicians’ assessments agree with those of their patients? J Radiat Oncol Biol Phys. 2008;5:1334–42.
34.
Greimel ER, Winter R, Kapp KS, et al. Quality of life and sexual functioning after cervical cancer treatment: a long-term follow-up study. Psychooncology. 2009;18:476–82.PubMedCrossRef
35.
Carter J, Sonoda Y, Baser RE, et al. A 2-year prospective study assessing the emotional, sexual, and quality of life concerns of women undergoing radical trachelectomy versus radical hysterectomy for treatment of early-stage cervical cancer. Gynecol-Oncol. 2010;119:358–65.PubMedPubMedCentralCrossRef
36.
Aerts L, Enzlin P, Verhaeghe J, et al. Long-term sexual functioning in women after surgical treatment of cervical cancer stages IA to IB: a prospective controlled study. Int J Gynecol Cancer. 2014;24:1527–34.PubMedCrossRef
37.
Carmack Taylor CL, Basen-Engquist K, Shinn EH. Predictors of sexual functioning in ovarian cancer patients. J Clin Oncol. 2004;22:881–9.PubMedCrossRef
38.
Liavaag A, Dorum A, Bjoro T, et al. A controlled study of sexual activity and functioning in epithelial ovarian cancer survivors: a therapeutic approach. Gynecol Oncol. 2008;108:348–54.PubMedCrossRef
39.
Gershenson DM, Miller AM, Champion VL, et al. 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.PubMedCrossRef
40.
Likes WM, Stegbauer C, Tillmanns T, et al. Pilot study of sexual function and quality of life after excision for vulvar intraepithelial neoplasia. J Reprod Med. 2007;52:23–7.PubMed
41.
Kim SI, Lee Y, Lim MC, et al. Quality of life and sexuality comparison between sexually active ovarian cancer survivors and healthy women. J Gynecol Oncol. 2015;26(2):148–54.PubMedPubMedCentralCrossRef
42.
Aerts L, Enzlin P, Verhaeghe J, et al. Psychologic, relational, and sexual functioning in women after surgical treatment of vulvar malignancy: a prospective controlled study. Int J Gynecol Cancer. 2014;24:372–80.PubMedCrossRef
43.
Onujiogu N, Johvson T, Seo S, et al. Survivals of endometrial cancer: who is at risk of sexual dysfunction? Gynecol Oncol. 2011;123:356–9.PubMedCrossRef
44.
Aerts L, Enzlin P, Verhaeghe J, et al. Sexual functioning in women after surgical treatment for endometrial cancer: a prospective controlled study. J Sex Med. 2015;12:198–209.PubMedCrossRef
45.
Rowlands IJ, Lee C, Beesley VL, Australian National Endometrial Cancer Study Group, et al. Predictors of sexual well-being after endometrial cancer: results of a national self-report survey. Support Care Cancer. 2014;22:2715–2.PubMedCrossRef
46.
Ye S, Yang J, Cao D, et al. Quality of life and sexual function of patients following radical hysterectomy and vaginal extension. J Sex Med. 2014;11:1334–42.PubMedCrossRef
47.
Pieterse QD, Maas CP, Ter Kuile MM, et al. An observational longitudinal study to evaluate micturition, defecation, and sexual function after radical hysterectomy with pelvic lymphadenectomy for early-stage cervical cancer. Int J Gynecol Cancer. 2006;16:1119–29.PubMedCrossRef
48.
Likic IS, Kadija S, Ladjevic NG, Stefanovic A, et al. Analysis of urologic complications after radical hysterectomy. Am J Obstet Gynecol. 2008;199:644.PubMedCrossRef
49.
Ditto A, Martinelli F, Borreani C, et al. Quality of life and sexual, bladder, and intestinal dysfunctions after class III nerve-sparing and class II radical hysterectomies. A questionnaire-based study. Int J Gynecol Cancer. 2009;19:953–7.PubMedCrossRef
50.
Reid GC, DeLancey JO, Hopkins MP, et al. Urinary incontinence following radical vulvectomy. Obstet Gynecol. 1990;75:852–8.PubMed
51.
Ryan M, Stainton MC, Jaconelli C, et al. The experience of lower limb lymphedema for women after treatment for gynecologic cancer. Oncol Nurs Forum. 2003;30:417–23.PubMedCrossRef
52.
Tiwari A, Myint F, Hamilton G. Management of lower limb lymphoedema in the United Kingdom. Eur J Vasc Endovasc Surg. 2006;31:311–5.PubMedCrossRef
53.
Pieterse QD, Ter Kuile MM, Deruiter MC, Maas CP, et al. Vaginal blood flow after radical hysterectomy with and without nerve sparing. A preliminary report. Int J Gynecol Cancer. 2008;18:576–83.PubMedCrossRef
54.
Laterza RM, Sievert KD, de Ridder D, et al. Bladder function after radical hysterectomy for cervical cancer. Neurourol Urodyn. 2015;34:309–15.PubMedCrossRef
55.
Bogani G, Serati M, Nappi R, et al. Nerve-sparing approach reduces sexual dysfunction in patients undergoing laparoscopic radical hysterectomy. J Sex Med. 2014;11:3012–20.PubMedCrossRef
56.
Katz A, Njuguna E, Rakowsky E, et al. Early development of vaginal shortening during radiation therapy for endometrial or cervical cancer. Int J Gynecol Cancer. 2001;11:234–5.PubMedCrossRef
57.
Nout RA, van de Poll-Franse LV, Lybeert ML, et al. Long-term outcome and quality of life of patients with endometrial carcinoma treated with or without pelvic radiotherapy in the postoperative radiation therapy in endometrial carcinoma 1 (PORTEC-1) trial. J Clin Oncol. 2011;29:1692–700.PubMedCrossRef
58.
Katz A. Interventions for sexuality after pelvic radiation therapy and gynecological cancer. Cancer J. 2009;15:45–7.PubMedCrossRef
59.
Kylstra WA, Leenhouts GHMW, Everaerd W, et al. Sexual outcomes following treatment for early stage gynecological cancer: a prospective multicenter study. Int J Gynecol Cancer. 1999;9:387–95.PubMedCrossRef
60.
Stead ML, Fallofield L, Selby P, et al. Psychosexual function and impact of gynecological cancer. Best Pract Res Clin Obstet Gynaecol. 2007;21:309–20.PubMedCrossRef
61.
Soothill K, Morris SM, Harman J, et al. The significant unmet needs of cancer patients: probing psychosocial concerns. Support Care Cancer. 2001;9:597–605.PubMedCrossRef
62.
Sekse RJ, Gjengedal E, Råheim M. Living in a changed female body after gynecological cancer. Health Care Women Int. 2013;34:14–33.PubMedCrossRef
63.
Schover LR. Premature ovarian failure and its consequences: vasomotor symptoms, sexuality, and fertility. J Clin Oncol. 2008;26:753–8.PubMedCrossRef
64.
Graziottin A. Effect of premature menopause on sexuality. Womens Health. 2007;3:455–74.
65.
Graziottin A. Menopause and sexuality: key issues in premature menopause and beyond. In: Creatsas G, Mastorakos G, editors. Women’s health and disease. Ann N Y Acad Sci. 2010;1205:254–61; available at: www.​alessandragrazio​ttin.​it.
66.
Oonk MH, van Os MA, de Bock GH, et al. A comparison of quality of life between vulvar cancer patients after sentinel lymph node procedure only and inguinofemoral lymphadenectomy. Gynecol Oncol. 2009;113:301–5.PubMedCrossRef
67.
Janda M, Obermair A, Cella D, et al. Vulvar cancer patients’ quality of life: a qualitative assessment. Int J Gynecol Cancer. 2004;14:875–81.PubMedCrossRef
68.
Weijmar Schultz WC, van de Wiel HB, Bouma J, et al. Psychosexual functioning after the treatment of cancer of the vulva. A longitudinal study. Cancer. 1990;66:402–7.PubMedCrossRef
69.
Huang JJ, Chang NJ, Chou HH, et al. Pedicle perforator flaps for vulvar reconstruction – new generation of less invasive vulvar reconstruction with favorable results. Gynecol Oncol. 2015;137:66–72.PubMedCrossRef
70.
Graziottin A. The biological basis of female sexuality. Int Clin Psychopharm. 1998;13 Suppl 6:15S–22.CrossRef
71.
Graziottin A, Skaper SD, Fusco M. Inflammation and chronic pelvic pain: a biological trigger for depression in women? J Depression Anxiety. 2013;3:142–50.
72.
Laviano A, Seelaender M, Rianda S, et al. Neuroinflammation: a contributing factor to the pathogenesis of cancer cachexia. Crit Rev Oncol. 2012;17:247–51.CrossRef
73.
Vichaya EG, Chiu GS, Krukowski K, et al. Mechanisms of chemotherapy-induced behavioral toxicities. Front Neurosci. 2015;9:131.PubMedPubMedCentralCrossRef
74.
Graziottin A, Skaper SD, Fusco M. Mast cells in chronic inflammation, pelvic pain and depression in women. Gynecol Endocrinol. 2014;30:472–7.PubMedCrossRef
75.
Kruse JL, Strouse TB. Sick and tired: mood, fatigue, and inflammation in cancer. Curr Psychiatry Rep. 2015;17:555.PubMedCrossRef
76.
Zabora J, BrintzenhofeSzoc K, Curbow B, et al. The prevalence of psychological distress by cancer site. Psychooncology. 2001;10:19–28.PubMedCrossRef
77.
Cella DF, Wiklund I, Shumaker SA, et al. Integrating health-related quality of life into cross-national clinical trials. Qual Life Res. 1993;2:433–40.PubMedCrossRef
78.
Cull A, Cowie V, Farquharson D, et al. Early stage cervical cancer: psychosocial and sexual outcomes of treatment. Br J Cancer. 1993;68:1216–20.PubMedPubMedCentralCrossRef
79.
Simonelli LE, Fowler J, Maxwell GL, et al. Physical sequelae and depressive symptoms in gynecologic cancer survivors: meaning in life as a mediator. Ann Behav Med. 2008;35:275–84.PubMedPubMedCentralCrossRef
80.
Bourgeois-Law G, Lotocki R. Sexuality and gynecological cancer: a needs assessment. Can J Hum Sex Winter. 1999;8:231–40.L.
81.
de Boer AG, Taskila T, Ojajärvi A, et al. Cancer survivors and unemployment: a meta-analysis and meta-regression. JAMA. 2009;301:753–62.PubMedCrossRef
82.
Ross L, Petersen MA, Johnsen AT, et al. Factors associated with Danish cancers’ patients return to work. A rapport from the population-based study “The Cancer Patient’s World”. Cancer Epidemiol. 2011;36(2):222–9.PubMedCrossRef
83.
Massie MJ. Prevalence of depression in patients with cancer. J Natl Cancer Inst Monogr. 2004;(32):57–71. Review.
84.
Correa DD, Hess LM. Cognitive function and quality of life in ovarian cancer. Gynecol Oncol. 2012;124:404–9. Review.PubMedCrossRef
85.
Sonda Y, Abu-Rustum NR, Gemignani ML, et al. A fertility-sparing alternative to radical hysterectomy: how many patients will be eligible? Gynecol Oncol. 2004;95:534–8.CrossRef
86.
Fast Stats; an interactive tool for access to SEER cancer statistics. Surveillance Research Program Cancer. National Cancer Institute. http://​seer.​cancer.​gov/​faststats.
87.
Ng JS, Low JJ, Ilancheran A. Epithelial ovarian cancer. Best Pract Res Clin Obstet Gynaecol. 2012;26:337–45.PubMedCrossRef
88.
Ivanova A, Loo A, Tworoger S, et al. Ovarian cancer survival by tumor dominance, a surrogate for site of origin. Cancer Causes Control. 2015;26:601–8.PubMedPubMedCentralCrossRef
89.
Forner DM, Dakhil R, Lampe B. Quality of life and sexual function after surgery in early stage vulvar cancer. Eur J Surg Oncol. 2015;41:40–5.PubMedCrossRef
90.
Gunderson CC, Nugent EK, Yunker AC, et al. Vaginal cancer: the experience from 2 large academic centers during a 15-year period. Low Genit Tract Dis. 2013;17:409–13.CrossRef
91.
Hawkins Y, Ussher J, Gilbert E, et al. Changes in sexuality and intimacy after the diagnosis and treatment of cancer: the experience of partners in a sexual relationship with a person with cancer. Cancer Nurs. 2009;32:271–80.PubMedCrossRef
92.
Brotto LA, Heiman IR, Goff B, et al. A psychoeducational intervention for sexual dysfunction in women with gynecologic cancer. Arch Sex Behav. 2008;37:317–29.PubMedCrossRef
93.
Thranov I, Klee M. Sexuality among gynecologic cancer patients – a cross-sectional study. Gynecol Oncol. 1994;52:14–9.PubMedCrossRef
94.
Graziottin A. The vagina’ biological and sexual health: the unmet needs. Climacteric. 2015;18 Suppl 1:9–12.PubMedCrossRef
95.
Creasman WT, Henderson D, Hinshaw W, et al. Estrogen replacement therapy in the patient treated for endometrial cancer. Obstet Gynecol. 1986;67:326–30.PubMed
96.
Michaelson-Cohen R, Beller U. Managing menopausal symptoms after gynecologic cancer. Curr Opin Oncol. 2009;21:407–11.PubMedCrossRef
97.
Al-Azzawi F, Bitzer J, Brandenburg U, FSD Education Team, et al. Therapeutic options for postmenopausal female sexual dysfunction. Climacteric. 2010;13:103–20.PubMedCrossRef
98.
Graziottin A, Zanello PP. Pathogenic biofilms: their role in recurrent cystitis and vaginitis (with focus on D-mannose as a new prophylactic strategy). In: Studd J, Seang LT, Chervenak FA, editors. Current progress in obstetrics and gynaecology, vol. 2. 2nd ed. Mumbai: Kothari Medical; 2015 (accepted, in press).
99.
Graziottin A. Recurrent cystitis after intercourse: why the gynaecologist has a say. In: Studd J, Seang LT, Chervenak FA, editors. Current progress in obstetrics and gynaecology, vol. 2. 2nd ed. Mumbai: Suketu P. Kothari – TreeLife Media; 2014. p. 319–36.
100.
Kuiper GG, Carlsson B, Grandien K, et al. Comparison of the ligand binding specificity and transcript tissue distribution of estrogen receptors α and β. Endocrinology. 1997;138:863–70.PubMed
101.
Sites CK. Bioidentical hormones for menopausal therapy. Women’s Health (Lond Engl). 2008;4:163–71.CrossRef
102.
Shanle E, Xu W. Selectively targeting estrogen receptors for cancer treatment. Adv Drug Deliv Rev. 2010;62:1265–76.PubMedPubMedCentralCrossRef
103.
Sarrel PM. Effects of hormone replacement therapy on sexual psychophysiology and behavior in postmenopause. J Womens Health Gend Based Med. 2000;9 Suppl 1:S25–32.PubMedCrossRef
104.
Kotz K, Alexander JL, Dennerstein L. Estrogen and androgen hormone therapy and well-being in surgically postmenopausal women. J Womens Health (Larchmt). 2006;15:898–908. Review.CrossRef
105.
Archer DF. Dehydroepiandrosterone intra vaginal administration for the management of postmenopausal vulvovaginal atrophy. J Steroid Biochem Mol Biol. 2015;145:139–43.PubMedCrossRef
106.
Pluchino N, Drakopoulos P, Bianchi-Demicheli F, et al. Neurobiology of DHEA and effects on sexuality, mood and cognition. J Steroid Biochem Mol Biol. 2015;145:273–80.PubMedCrossRef
107.
Camaschella C. Iron-deficiency anemia. N Engl J Med. 2015;372:1832–43.PubMedCrossRef
108.
Wojciak RW. Effect of short-term food restriction on iron metabolism, relative well-being and depression symptoms in healthy women. Eat Weight Disord. 2014;19:321–7.PubMedCrossRef
109.
Chang S, Wang L, Wang Y, et al. Iron-deficiency anemia in infancy and social emotional development in preschool-aged Chinese Children. Pediatrics. 2011;127(4):e927–33.PubMedCrossRef
110.
Yi S, Nanri A, Poudel-Tandukar K, et al. Association between serum ferritin concentrations and depressive symptoms in Japanese municipal employees. Psychiatry Res. 2011;189:368–72.PubMedCrossRef
111.
Herbert B, Herbert C, Pollatos O, et al. Effect of short-term food deprivation on interoceptive awareness, feelings and autonomic cardiac activity. Biol Psychol. 2011;89:71–9.PubMedCrossRef
112.
Giovannucci E. The epidemiology of vitamin D and cancer incidence and mortality: a review (United States). Cancer Causes Control. 2005;16:83.PubMedCrossRef
113.
Feskanich D, Ma J, Fuchs CS, et al. Plasma vitamin D metabolites and risk of colorectal cancer in women. Cancer Epidemiol Biomarkers Prev. 2004;13:1502.PubMed
114.
Gold PW, Machado-Vieira R, Pavlatou MG. Clinical and biochemical manifestations of depression: relation to the neurobiology of stress. Neural Plast. 2015;2015:581976.PubMedPubMedCentral
115.
Ziegler D, Ametov A, Barinov A, et al. Oral treatment with alpha-lipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 trial. Diabetes Care. 2006;29:2365.PubMedCrossRef
116.
Gorąca A, Huk-Kolega H, Piechota A, et al. Lipoic acid – biological activity and therapeutic potential. Pharmacol Rep. 2011;63:849–58.PubMedCrossRef
117.
Skaper SD, Facci L, Giusti P. Mast cells, glia and neuroinflammation: partners in crime? Immunology. 2014;141:314–27.PubMedPubMedCentralCrossRef
118.
Bakker RM, Vermeer WM, Creutzberg CL, et al. Qualitative accounts of patients’ determinants of vaginal dilator use after pelvic radiotherapy. J Sex Med. 2015;12:764–73.PubMedCrossRef
119.
Carter J, Goldfrank D, Schover LR. Simple strategies for vaginal health promotion in cancer survivors. J Sex Med. 2011;8:549–59.PubMedCrossRef
120.
Bakker RM, ter Kuile MM, Vermeer WM, et al. Sexual rehabilitation after pelvic radiotherapy and vaginal dilator use: consensus using the Delphi method. Int J Gynecol Cancer. 2014;24:1499–506.PubMedCrossRef
121.
Herderschee R, Hay-Smith EC, Herbison GP, et al. Feedback or biofeedback to augment pelvic floor muscle training for urinary incontinence in women: shortened version of a Cochrane systematic review. Neurourol Urodyn. 2013;32:325–9.PubMedCrossRef
122.
Pelletier G, Ouellet J, Martel C, et al. DHEA for postmenopausal women: a review of the evidence. J Sex Med. 2012;9:2525–33.PubMedCrossRef
123.
Badger C, Preston N, Seers K, et al. Physical therapies for reducing and controlling lymphoedema of the limbs. Cochrane Database Syst Rev. 2004;18:CD003141.
124.
Robinson JW. Sexuality and cancer. Breaking the silence. Aust Fam Physician. 1998;27:45–7.PubMed
125.
Ganz PA, Greendale GA, Petersen L, et al. Managing menopausal symptoms in breast cancer survivors: results of a randomized controlled trial. J Nat Cancer Inst. 2000;92:1054–64.PubMedCrossRef
126.
Brotto J, Heiman J. Mindfulness in sex therapy: application for women with sexual difficulties following gynecological cancer. Sex Relat Ther. 2007;22:3–11.CrossRef
127.
Krychman M, Carter J, Amsterdam A. Psychiatric illness presenting with a sexual complaint and management by psychotropic medications: a case report. J Sex Med. 2008;5:223–6.PubMedCrossRef
128.
Bouillet T, Bigard X, Brami C, et al. Role of physical activity and sport in oncology: scientific commission of the National Federation Sport and Cancer CAMI. Crit Rev Oncol Hematol. 2015;94:74–86.PubMedCrossRef
129.
Schmitz KH, Courneya KS, Matthews C, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42:1409.PubMedCrossRef
130.
Rock CL, Doyle C, Demark-Wahnefried W, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012;62:243.PubMedCrossRef
131.
Meyerhardt JA, Mangu PB, Flynn PJ, et al. Follow-up care, surveillance protocol, and secondary prevention measures for survivors of colorectal cancer: American Society of Clinical Oncology clinical practice guideline endorsement. J Clin Oncol. 2013;31:4465.PubMedCrossRef
132.
Kireev RA, Vara E, Viña J, et al. Melatonin and oestrogen treatments were able to improve neuroinflammation and apoptotic processes in dentate gyrus of old ovariectomized female rats. Age (Dordr). 2014;36:9707.CrossRef