Dr. Warner Huh (Host): Hello, everyone. It's Dr. Warner Huh again, the chair of the Department of OB-GYN here at the University of Alabama in Birmingham, and would like to welcome you to this monthly episode of Women's Health with Dr. Huh.

So with me today, super excited about our guest speaker, Dr. Christina Wilson, who is going to talk to us about sexual health and cancer survivorship, something that I have to deal with every day in my practice. And Dr. Wilson is an Assistant Professor in the School of Nursing, but also an Assistant Professor in the Division of Gynecologic Oncology in the Department of OB-GYN. She's one of our many awesome certified nurse practitioners in the Division of Gynecologic Oncology, and she runs our Sexual Health and Cancer Survivorship Clinic in the division.

The reason I'm really excited about this is that Dr. Wilson is literally one of a handful of experts in the US in the area of sexual health and cancer survivorship. So, I'm beyond thrilled that she's with us today. So, welcome, Dr. Wilson.

Christina Wilson, PhD: Thank you so much. It's wonderful to be here.

Host: So, I would say more so than ever, patients particularly with gynecological cancers are survivors. Literally, many of them are in remission and following really lengthy, difficult treatments. And their quality of life is now central to how they live their lives following their cancer diagnosis. And one of the topics that often up in our clinics is sexual health. And sometimes this takes a back burner while they're getting treated. And when they go into remission, this commonly comes up and, you know, we talk about this at length. We know for a fact, and for our listeners, that when patients are treated with surgery or chemotherapy and/or radiation therapy, it can have a profound negative impact on their sexual function, which is the reason why we're talking about this today.

So Dr. Wilson, one of the things I thought you may want to comment on for our listeners is really, A, how common is this in women with gynecologic malignancies, and why do you think this is important to discuss and maybe create some awareness to our listeners?

Christina Wilson, PhD: Absolutely. So, sexual health is not just the ability to function, but it also encompasses sexuality and how one feels about themselves. Both of these are integral parts of quality of life, and they affect cancer patients just as much as they affect the general population. And specifically, those with gynecologic cancers, those affecting the reproductive system, we know that it can not only affect sexuality, but it'll affect the function as well. And up to about 85% of these survivors can experience issues with this.

Host: Well, I didn't realize it was actually that high. So when these patients are referred to you, how do you typically evaluate patients that come to your clinic? Can you just kind of kind of take us through that process?

Christina Wilson, PhD: Sure. So when a patient is arriving in my clinic, whether they're referred by someone or they self-refer, I first take a look at their background. I look at their type of cancer. I look at the treatments they've had, as you mentioned, surgery, radiation, chemotherapy, even hormonal therapy, depending upon what it is, can all affect their sexual function and their sexuality. So, I take a look at that.

And then, when I meet with the patient, I confirm. I confirm what they've had, how that's impacted them. I also look at have they had previous sexual health issues or previous gynecologic issues that may have impacted them. Because a previous issue with sexual health could also let me know that maybe this is something that's been ongoing prior.

I also look at the medical and surgical history that they've had, because we know that certain medications, as well as surgery, not just those for cancer, can impact this as well. And then, I typically do a physical exam and I look for any factors that could be contributing to sexual function specifically.

Host: So in light of that, like in a very broad sense, can you comment on just the general categories of treatment and management options for patients? Is there really anything out there that you're really excited about in particular?

Christina Wilson, PhD: Let me first kind of talk about the general categories and what we've got out there. A lot of people don't realize that there actually are options to help with sexual health and sexual functioning and sexuality.

First of all, there's counseling. So, talking to someone can actually be very beneficial for these things. There's medications, both over-the-counter as well as prescription medications, physical therapy, and even some medical devices can really help patients with these sexual health concerns.

In terms of things I'm excited about, I'm excited to see that this is starting to become a topic and starting to be brought to light and made aware. And so, we've had quite a few studies in the last five to seven years that are looking at other medications, other devices that could be used to improve sexual health in general, but even more so sexual health in the cancer survivorship setting.

Host: So, I'm going to add some additional color to that because I was hoping that you would bring this up. One of the major reasons why we're having this topic on our monthly podcast is because not that it was a taboo topic, but we just never talked about it. Like literally, you know, it was pushed aside and maybe it was pushed aside because we were focusing so much on their cancer diagnosis and treatment or sometimes we just were felt uncomfortable bringing it up in clinic. But like I'm just so thrilled that the fact that we're talking about this is a huge step in the right direction. But not only that, we're scientifically and programmatically looking at treatment modalities that improve the quality of life of women with gynecological malignancies. That is a huge quantum leap, particularly over the last decade. I know you and I have worked on projects together, but it's really cool to me for us to be talking about this so openly. And I just know like in the next 10 years that this will be a staple discussion that we have pretty much with all patients, basically. So again, kudos to you for bringing that up. I think it's immensely important.

So on a related note, I think one of the things our listeners may be thinking about, or they may think about it after the question, is how do you look at it from the partner's perspective when you do these evaluations, whether it's medical, social, and you're talking about treatment options. How and when do you bring the partner into this conversation in the valuation?

Christina Wilson, PhD: I think that's a great question. And I think it's a question that requires the patient's thought process too. So if you're talking about treatment options before the patient undergoes treatment and there are multiple options, asking the patient, "Are you interested in having your partner be a part of this discussion? There are implications for sexual health. Is that something you would want them engaged in?"

When patients come to me at my stage in the game, when I go in for the initial history, sometimes patients have brought their partners. Sometimes their partners are in the waiting room and sometimes partners aren't. And if a patient mentions that their partner's in the waiting room or that their partner's here, but if they need to leave, they can, I open it up to the patient and I say, "What's your comfort level? Do you want them here?" Because getting the patient's perspective first is important. Having that patient-centered care and patient-centered approach is what matters. And so, they could really, really value what their partner has to say about this, or they could say, "No, I'm worried about survival. And if one of these has a better chance of survival, that's what I'm worried about," if it's in the pre-treatment setting. If it's in the post-treatment setting, I've had patients say, "My partner understands and they know that this is going to take time and we're going to work on me." Or I've had people who say, "Can you explain what's going on from a perspective of the cancer to my partner because they don't understand what these treatments have really done to my body?"

Host: That's a great response. And just to kind of recapture that for the listeners, again, I think it's important to start with what the patient wants and what their desires and perspective is and then bringing in or not bringing in the partner at some point. But I just want the listeners to recognize that the involvement of the partner in some circumstances is really important and is actually helpful. But in other circumstances, it can be detrimental. But, you know, they're a part of the equation, not the part of the equation for all patients, correct?

Christina Wilson, PhD: Absolutely.

Host: Yeah. So as I mentioned earlier, I think we're beyond lucky to have someone with your expertise and interest in this area and, you know, UAB is one of the few sites in the US that actually has devoted providers and researchers in this space. But in communities that don't have this level of expertise, what can you tell providers and oncologists? And what can they do to help the patients in this regard, if you could provide some general recommendations?

Christina Wilson, PhD: Sure. First, thank you. And I'm happy to be here and be able to serve this community as well. So first, starting the conversation, you mentioned it yourself, that it can be a difficult topic for providers, for oncologists, for even those in the primary care survivorship space to talk about. And things show that patients want us to talk about it, and then it shows that clinicians or oncologists want the patient to bring it up. And so, just creating a safe space and saying if you have any concerns about your sexual health or just general health concerns ranging from symptoms that can impact your treatment or symptoms that may be long lasting, and mentioning this among a list of things can really just open that conversation and make patients feel like they've been heard.

So, first is letting patients feel like they've been heard. Secondly, I follow clinical guidelines. And so, there are clinical guidelines put out by the National Comprehensive Cancer Network, by the American Society of Clinical Oncology, by The American College of Obstetrics and Gynecology, all of these put out recommendations and I follow those guidelines in terms of what I offer to patients. And so, looking at those guidelines and treating the symptom.

Host: Yeah, I think that's perfect. I think that's great. I think we need to do a better job at educating oncologists and providers as being the front line on this. I'm hoping that maybe in the near future, you and I have a slightly different podcast that's directed to the provider. But for this podcast, really for the general public, I just wanted to make sure what it is exactly that you do, what you're excited about, and how you kind of target the issue related to sexual health and function and cancer survivors. But again, we can have a completely different podcast that is more specific about what those recommendations are.

I don't know if you had any further closing thoughts or comments about this topic before we sign off.

Christina Wilson, PhD: I am just happy to be here, happy to bring awareness to this. Like I said, up to 85% of patients experience this. And so, think about the number that you see. I saw before I started doing sexual health specifically that brought it up, it's very few. So, know that there are more people out there experiencing this than you think. So, just opening the door can really make a difference. And if you are a patient with these issues, talk to your providers. Let them know. They care and they want to make a difference.

Host: Yeah. And as I say to a lot of my patients, I know it because they don't bring it up, doesn't mean that they don't have a problem, right? And it's really important for our listeners, probably all our patients, that they obviously advocate for themselves. And if it's a concern, you just need to bring it up with your doctor and take it from there. But if it's not said, we kind of move on. I'm not so sure that's the right way to approaching this really important topic.

So, I want to again thank Dr. Wilson for coming today to talk about sexual function and health and how it relates to cancer survivorship with me today. It's a really important topic. And again, I can't say enough great things about the expertise that she brings to UAB and the Birmingham community, as well as the state of Alabama.

And as always, please rate this podcast and we welcome any comments, particularly on topics that you are interested in. And so for more information on gynecologic cancer care here at UAB and as part of the O'Neal Conference Cancer Center, including our sexual health clinic that Dr. Wilson oversees, and other clinical services that UAB Medicine provides, please check out uabmedicine.org. But until next time, we'll see you next month. Hope you're enjoying the fall and hope you all have a wonderful day. Take care. Peace out.