Healthcare providers can play a major role in helping women with sexual concerns or sexual dysfunction by providing accurate, unbiased sexual health education. Women who were diagnosed at a very young age might have some educational deficits in this area. It is not uncommon for some to have erroneous knowledge and beliefs about sex, including basic anatomy and physiology. Furthermore, societal influences of what “normal” sex and sexuality are can promote unrealistic expectations about how an individual woman’s sex life should be. It is imperative to educate women that “normal” sexual functioning is variable between women and even throughout an individual woman’s life. It should also be emphasized that the overall goal of healthy sexual functioning should be the achievement of sexual satisfaction and that she should be encouraged to define what that means for her as an individual and as part of a couple.

Lifestyle modification should be encouraged, as overall well-being influences sexual functioning. Women should be counseled to adopt healthy lifestyle behaviors, such as smoking cessation, limiting alcohol consumption, exercising most days of the week, getting adequate sleep, eating a healthy diet, and reducing stress as much as possible. The conditions surrounding sexual experiences should be optimized as well. Women should be informed of the importance of adequate sexual stimulation and arousal, which can be achieved with prolonged foreplay and the use of sexual aids. If patients experience difficulty with sexual intercourse, they should be encouraged to explore alternative means of expressing sexual intimacy and incorporate sexual activities that don’t require intercourse. If intercourse is desired, the use of vaginal lubricants and moisturizers can make sexual activity easier and more comfortable.

Significant improvements in sexual function after intervention with traditional sex therapy and/or cognitive-behavioral therapy have been observed [36]. Traditional sex therapy is a behavioral treatment that aims to improve an individual/couple’s erotic experiences while reducing anxiety and self-consciousness about sexual activity [37]. Cognitive-behavioral sex therapy includes traditional behavioral sex therapy components but places a greater emphasis on modifying thought patterns or beliefs that interfere with intimacy and sexual pleasure [37]. Directed masturbation has been demonstrated to be efficacious in the treatment of orgasmic disorders [38–40]. Mindfulness-based cognitive-behavioral treatments have also shown excellent promise for sexual desire problems [41]. Brotto et al. demonstrated that a brief mindfulness-based cognitive-behavioral intervention was successful in improving sexual desire and arousal problems in gynecologic cancer survivors [41]. Finally, a two-session counseling intervention that included education and support regarding cancer and reproductive issues was found to lessen anxiety about sexual and romantic relationships in adolescents and young adults with cancer [41].

Pelvic floor therapy is a type of physical therapy that can help strengthen the muscles of the pelvic floor and increase blood supply and innervation to the pelvic floor muscles. A pelvic floor exercise program has been shown to improve pelvic floor strength and sexual functioning in survivors of gynecologic cancers [42]. Dilator therapy is often recommended to selected patients for the prevention of vaginal stenosis in patients who received pelvic radiotherapy [43]; however, evidence that it prevents vaginal stenosis or improves quality of life is mixed [44]. Adherence to long-term use is often poor [45]. Data on the use of dilators for the treatment of sexual dysfunction in the adolescent population and younger is nonexistent.

For women who are prematurely postmenopausal as a result of their cancer treatment, hormonal replacement therapy can restore the normal hormonal milieu. However, only conjugated equine estrogen and ospemifene are FDA approved for the specific treatment of female sexual dysfunction. Vaginal estrogen can be prescribed in a variety of forms and is effective in the treatment of vulvovaginal atrophy (VVA), a common cause of painful intercourse. However, the use of estrogen in any form in patients with a history of hormone-sensitive cancer is controversial. Ospemifene is a selective estrogen receptor modulator that acts directly on the vulvovaginal tissues to reverse atrophy without exerting estrogenic effects on the uterus and breast; however, it has not been specifically studied in cancer survivors [46]. Finally, vaginal dehydroepiandrosterone has been used for the treatment of VVA; its use is associated with lower levels of systemic estrogen and testosterone, but its long-term safety profile is unknown [47].

The role of testosterone therapy for the treatment of female sexual dysfunction is even more controversial. Although it is not FDA approved for this indication, it is frequently prescribed off label. Testosterone has been shown to improve sexual satisfaction, general well-being, and mood [48]; however, safety concerns such as potential development of breast cancer and negative effects on cardiovascular health have limited its use [35].

Bupropion is a mild dopamine and norepinephrine reuptake inhibitor/nicotinic acetylcholine receptor antagonist that is used as an antidepressant and smoking cessation aid. Prior studies have shown that it is also useful in treated low desire in women [49], including those with SSRI-induced low desire [50, 51], and women receiving adjuvant hormonal therapy for breast cancer [52]. Flibanserin is a 5-HT1A receptor agonist/5-HT2 receptor antagonist that was recently approved by the FDA for the treatment of premenopausal women with hypoactive sexual desire disorder (HSDD) [53, 54]. However, there are no data on its use in cancer survivors.

There are multiple sexual enhancement products that are available over the counter. While most have not been rigorously tested for efficacy and safety, many women with a history of cancer express interest in their use [55]. Most pharmacologic interventions for the treatment of sexual dysfunction have not been tested in cancer survivors [56], highlighting the importance of more research in this area.