The present chapter outlines the sexual aftermath of cancer treatment and strategies for improvement. Sexual dysfunction is underdiagnosed and undertreated after surgery, chemotherapy, radiation, and hormone-modulating therapies. The treatment of genitourinary syndrome of menopause (GSM) is multimodal and includes behavioral modifications, local therapy, and physical therapy. Vaginal estrogen should be first-line treatment for GSM in women with hormone non-responsive cancer. For those with ovarian, endometrial, and breast cancer, vaginal estrogen may be considered with persistent symptoms after regular use of non-hormonal moisturizers. As an alternative, vaginal androgens may be of utility in improving libido and vaginal health. The authors do not endorse the use of compounded formulas due to a lack of formula standardization and a dearth of safety and efficacy data. Vaginal lasers, including CO2 lasers, are discouraged after two sham-controlled randomized trials found they were not effective, and adverse events have been reported in women with cancer. Dyspareunia is common, especially if encountered in the setting of radiation-induced vaginal stenosis. Treatment may involve addressing GSM, serial vaginal dilation, pelvic floor therapy, and/or psychological therapy. In those with low sexual desire, filbanserin and bremelanotide are novel FDA-approved therapies with central mechanisms that may change the landscape for treating female sexual desire disorders.

Cancer patients often have a variety of skin eruptions ranging from infections to irritant contact dermatitis. Reviewing gentle skin care and educating patients on potential side effects of various treatments, such as post-radiation dermatitis or vulvovaginal graft-versus-host disease, is beneficial. This chapter will focus on common vulvar conditions that may arise during cancer treatment such as infections (folliculitis, abscesses and furuncles, angioinvasive infections, herpesvirus and candidal infections), primary dermatoses (lichen sclerosus and lichen planus), and therapy side effects (genitourinary syndrome of menopause, lymphedema, acquired lymphatic anomaly, radiation dermatitis and recall, toxic erythema of chemotherapy, and immune-checkpoint inhibitor cutaneous toxicities). Additionally, considerations for vulvar biopsies are discussed.

Gynecologic issues continue throughout a woman’s lifespan. Elderly patients are less likely to report symptoms than younger patients, especially when pertaining to gynecologic concerns and sexual dysfunction. Sensitive history taking with careful attention to risk factors and sexual history is an important part of caring for older women. If a pelvic exam is going to be performed, adjustments may need to be made. This chapter focuses on the most common gynecologic issues of the elderly: vulvovaginitis and other vulvar conditions, menopausal symptoms, pelvic floor prolapse, sexual dysfunction, and gynecologic malignancies.