Kathryn E Flynn1, Li Lin2, Jeanne Carter3, Raymond E Baser4, Shari Goldfarb5, Sally Saban3, Kevin P Weinfurt2. 1. Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address: kflynn@mcw.edu. 2. Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA. 3. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY, USA. 4. Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York City, NY, USA. 5. Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York City, NY, USA; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA.
Abstract
BACKGROUND: Tools for diagnosing sexual dysfunction and for tracking outcomes of interest include clinician interviews, physical exam, and patient self-report. Limited work has described relationships among these three sources of information regarding female sexual dysfunction and vulvovaginal health. AIM: We describe correlations among data collected from clinician interviews, clinical gynecological examination, and patient self-report. METHODS: Data are from a single-site, single-arm, prospective trial in 100 postmenopausal patients with a history of breast or endometrial cancer who sought treatment for vulvovaginal symptoms. The trial collected a standardized clinical gynecologic exam, clinician-reported outcome (ClinRO) measures of vulvovaginal dryness and pain, and patient-reported outcome (PRO) measures of sexual function, including PROMIS Sexual Function and Satisfaction (SexFS) lubrication, vaginal discomfort, labial discomfort, and clitoral discomfort and Female Sexual Function Index (FSFI) lubrication and pain. We examined polyserial correlations between measures with bootstrapped 95% confidence intervals from the baseline and 12-14-week timepoints. RESULTS: All of the relationships between the ClinRO variables and the PRO variables were in the expected direction (ie, positive), but the strength of the relationships varied substantially. At 12-14 weeks, there were medium-to-large correlations between ClinRO vaginal dryness and SexFS Lubrication (0.64), ClinRO vulvar dryness and SexFS Lubrication (0.46), ClinRO vulvar discomfort and SexFS Labial Discomfort (0.70), and ClinRO vulvar discomfort and SexFS Clitoral Discomfort (0.43). With one exception, the correlations between the exam variables and the corresponding PRO scores were small (range 0.01-0.27). STRENGTHS & LIMITATIONS: Our study included a comprehensive, standardized gynecologic exam designed specifically to evaluate sexual dysfunction as well as established PRO measures with significant evidence for validity. A limitation of our findings is that the sample size was relatively small, and our sample was restricted to women who received cancer treatments known to have dramatic effects on vulvovaginal tissue quality. CONCLUSION: Patient- and clinician-reported vulvovaginal dryness and discomfort were moderately correlated with each other but not with clinical gynecologic exam findings. Understanding the relationships among these different types of data highlights the distinct contributions of each to understand vulvovaginal tissue quality and patient sexual function after cancer. Flynn KE, Lin L, Carter J, et al. Correspondence Between Clinician Ratings of Vulvovaginal Health and Patient-Reported Sexual Function After Cancer. J Sex Med 2021;18:1768-1774.
BACKGROUND: Tools for diagnosing sexual dysfunction and for tracking outcomes of interest include clinician interviews, physical exam, and patient self-report. Limited work has described relationships among these three sources of information regarding female sexual dysfunction and vulvovaginal health. AIM: We describe correlations among data collected from clinician interviews, clinical gynecological examination, and patient self-report. METHODS: Data are from a single-site, single-arm, prospective trial in 100 postmenopausal patients with a history of breast or endometrial cancer who sought treatment for vulvovaginal symptoms. The trial collected a standardized clinical gynecologic exam, clinician-reported outcome (ClinRO) measures of vulvovaginal dryness and pain, and patient-reported outcome (PRO) measures of sexual function, including PROMIS Sexual Function and Satisfaction (SexFS) lubrication, vaginal discomfort, labial discomfort, and clitoral discomfort and Female Sexual Function Index (FSFI) lubrication and pain. We examined polyserial correlations between measures with bootstrapped 95% confidence intervals from the baseline and 12-14-week timepoints. RESULTS: All of the relationships between the ClinRO variables and the PRO variables were in the expected direction (ie, positive), but the strength of the relationships varied substantially. At 12-14 weeks, there were medium-to-large correlations between ClinRO vaginal dryness and SexFS Lubrication (0.64), ClinRO vulvar dryness and SexFS Lubrication (0.46), ClinRO vulvar discomfort and SexFS Labial Discomfort (0.70), and ClinRO vulvar discomfort and SexFS Clitoral Discomfort (0.43). With one exception, the correlations between the exam variables and the corresponding PRO scores were small (range 0.01-0.27). STRENGTHS & LIMITATIONS: Our study included a comprehensive, standardized gynecologic exam designed specifically to evaluate sexual dysfunction as well as established PRO measures with significant evidence for validity. A limitation of our findings is that the sample size was relatively small, and our sample was restricted to women who received cancer treatments known to have dramatic effects on vulvovaginal tissue quality. CONCLUSION: Patient- and clinician-reported vulvovaginal dryness and discomfort were moderately correlated with each other but not with clinical gynecologic exam findings. Understanding the relationships among these different types of data highlights the distinct contributions of each to understand vulvovaginal tissue quality and patient sexual function after cancer. Flynn KE, Lin L, Carter J, et al. Correspondence Between Clinician Ratings of Vulvovaginal Health and Patient-Reported Sexual Function After Cancer. J Sex Med 2021;18:1768-1774.
Authors: Kevin P Weinfurt; Li Lin; Carrie B Dombeck; Joan E Broderick; Denise C Snyder; Megan S Williams; Maria R Fawzy; Kathryn E Flynn Journal: J Sex Med Date: 2013-06-26 Impact factor: 3.802
Authors: Kathryn E Flynn; Jeanne Carter; Li Lin; Stacy T Lindau; Diana D Jeffery; Jennifer Barsky Reese; Bethanee J Schlosser; Kevin P Weinfurt Journal: Am J Obstet Gynecol Date: 2016-12-14 Impact factor: 8.661
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Authors: Alice K Fortune-Greeley; Kathryn E Flynn; Diana D Jeffery; Megan S Williams; Francis J Keefe; Bryce B Reeve; Gordon B Willis; Kevin P Weinfurt Journal: Qual Life Res Date: 2009-08-12 Impact factor: 4.147
Authors: Kevin P Weinfurt; Li Lin; Deborah Watkins Bruner; Jill M Cyranowski; Carrie B Dombeck; Elizabeth A Hahn; Diana D Jeffery; Richard M Luecht; Susan Magasi; Laura S Porter; Jennifer Barsky Reese; Bryce B Reeve; Rebecca A Shelby; Ashley Wilder Smith; John T Willse; Kathryn E Flynn Journal: J Sex Med Date: 2015-09-07 Impact factor: 3.802
Authors: Diana D Jeffery; Janice P Tzeng; Francis J Keefe; Laura S Porter; Elizabeth A Hahn; Kathryn E Flynn; Bryce B Reeve; Kevin P Weinfurt Journal: Cancer Date: 2009-03-15 Impact factor: 6.860
Authors: Kathryn E Flynn; Bryce B Reeve; Li Lin; Jill M Cyranowski; Deborah Watkins Bruner; Kevin P Weinfurt Journal: Health Qual Life Outcomes Date: 2013-03-11 Impact factor: 3.186