Can we talk about sex? Feasibility of universal sexual health screening for BRCA1/2 patients
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BACKGROUND: Risk-reducing salpingo-oophorectomy for ovarian cancer risk reduction in individuals with BRCA1/2 pathogenic variants can cause sexual dysfunction, yet sexual health discussions between patients and providers remain limited. AIM: We describe the feasibility of universal sexual health screening and rates of sexual health dysfunction among individuals with BRCA1/2 pathogenic variants. METHODS: Patients with BRCA1/2 pathogenic variants presenting to an outpatient gynecologic oncology clinic from January 2022 to February 2023 were offered a sexual health screener. The screener combined a validated, single-item sexual dysfunction assessment with three additional questions exploring discussions of sexual health with healthcare providers, desire for information about sexual health, and preferred methods for delivery of information. OUTCOMES: The primary outcome was the proportion of patients who completed the sexual health screener and the secondary outcomes included rate of sexual dysfunction and impact of patient characteristics on sexual dysfunction. RESULTS: Among 103 patients offered the sexual health screening, 100% completed it. Median age was 42 years (range 25-84). Eighty three (81%) patients self-identified as White, 32 (31%) patients had a history of cancer, 42 (41%) had undergone risk-reducing salpingo-oophorectomy, and 47 (46%) were pre-menopausal. Thirty seven (36%) patients screened positive for sexual dysfunction. Among patients with premature menopause following salpingo-oophorectomy, 6/15 (40%) on hormone replacement therapy reported sexual dysfunction versus 6/10 (60%) not on hormone replacement therapy (P = .43). Across all patients, 38 (37%) had never previously discussed sexual health concerns with a provider. There were no significant differences in sexual dysfunction rates based on any measured patient characteristics. CLINICAL IMPLICATIONS: Universal sexual health screening for individuals with BRCA1/2 pathogenic variants is feasible and may provide an avenue for more in-depth discussion with at-risk patients, who may not have previously discussed this issue with their medical team. STRENGTHS AND LIMITATIONS: Our study found that it was feasible to administer a sexual health screening tool among an at-risk patient population in a clinical setting. Generalizability may be limited due to the composition of our cohort, which was small, majority White and non-Hispanic, and from a single institution. CONCLUSION: Providers should consider implementing standardized sexual health screening practices among patients with BRCA1/2 pathogenic variants.