Kristin E. Rojas, M.D., FACS, FACOG, assistant professor of surgical oncology in the DeWitt Daughtry Department of Surgery and Sylvester Comprehensive Cancer Center at the University Miami Miller School of Medicine, realized she had struck a chord with women being treated for cancer when she started the Menopause Urogenital Sexual Health and Intimacy Clinic (MUSIC).
An unexpectedly high demand for the MUSIC program among women concerned by vaginal dryness, painful sex, low sexual desire, and more, challenged Dr. Rojas and colleagues to expand the new program right after it opened its doors at Sylvester in 2020.
Dr. Rojas has since expanded the MUSIC program to include two specially trained oncology nurse practitioners to help women with a history of cancer safely maintain sexual health through treatment and beyond.
“MUSIC adds to the comprehensive aspect of survivorship care at Sylvester, making sure that we not only address side effects that we talk about all the time, like hot flashes, joint pain, fatigue, etc., but also the more taboo topics that aren’t always brought up,” Dr. Rojas said.
Referrals to the program include women who are undergoing treatments that trigger menopause or worsen menopausal symptoms. They might silently suffer from symptoms related to genitourinary complaints, such as vaginal dryness, painful sex, or from a global sexual functioning aspect, such as depressed libido.
“One might think that these symptoms only impact gynecologic or breast cancer patients who get estrogen-blocking medication, but it’s also women with other cancer types. In fact, anyone who gets chemotherapy can experience these issues,” she said. “Women who have large abdominal surgery, like a radical hysterectomy or a colectomy, could have sexual function concerns. Anyone who has had their ovaries removed, as well as women who haven’t had surgery or chemotherapy but are coping with the psychologic aspects of the diagnosis—that, too, can influence aspects of intimacy.”
The MUSIC program is part of Sylvester’s focus on quality of life and improving survivorship without increasing the risk of recurrence or inhibiting the efficacy of different cancer treatments. It is one of only a few women’s sexual health programs at cancer centers in the U.S., but Dr. Rojas says that more centers are recognizing the need.
“We offer treatments that are evidence-based, effective, and safe, which is so important for cancer patients,” Dr. Rojas said. “There are many therapies, including laser treatments, that have not been studied, and we don’t know if they’re safe in women with a history of cancer. I’ve seen women with burns and scarring who have gone to med spas and other centers that offer these unapproved treatments. By not addressing these issues and not preemptively preparing patients for what might happen sexually and offering them care, we may unknowingly drive them to fringe treatments that could hurt them or their ability to benefit from cancer treatment.”
MUSIC also serves as a research center for new treatments aimed at addressing women’s sexual health concerns in the setting of cancer. Dr. Rojas recently received funding for a pilot trial to study use of platelet-rich plasma, or PRP, injections into the vulva and vagina for treating painful sex and vaginal dryness. The grant is a Sylvester Survivorship Pilot Award for $30,000, and the study will enroll 20 women with a history of breast cancer who are experiencing vaginal dryness and/or painful sex. The study will include two treatments with PRP injections (with numbing medicine) separated by a month.
“The primary goal of the study is to standardize the way this treatment is given and then monitor the improvement of symptoms,” Dr. Rojas said.
Care guidelines for prostate and other cancers include the importance of addressing the potential impact of cancer treatment on men’s sexual health.
“Oftentimes, men are given options for treatment based on how treatments will impact their sexual health,” Dr. Rojas said. “We’re demonstrating this also is an important option for women undergoing cancer treatment, not only from an equity standpoint but also to make sure these resources are effective and safe for women with cancer. For a long time, we didn’t have solutions for these patients, but that’s changing. It’s important to steer our patients to providers like ours who are oncology clinicians experienced in treating sexual health concerns.”
The MUSIC program is available at Sylvester’s main campus on Mondays and Tuesdays. Dr. Rojas said she plans to expand the program to sites in Broward in the future.
MUSIC patients have one-on-one appointments with the MUSIC team.
“The initial appointments are longer, about an hour, because these issues are often very complicated, and we want to make sure to get the entire picture with regard to symptoms and how to treat these women in the context of their cancer care,” Dr. Rojas said.