191 Comparing Provider-Led Sexual Health Counseling of Male and Female Radical Cystectomy Patients

Abstract

Radical cystectomy (RC) for bladder cancer can significantly affect the sexual health and function of patients. The goal of our study was to characterize provider practice regarding sexual health counseling of RC patients and whether practice differs between male and female patients. We conducted a national survey of members of the Society of Urologic Oncology to assess topics included in sexual health counseling of male and female patients and identify barriers to counseling female patients about sexual health. For each sexual health topic, the frequency of non-routine sexual health counseling of preoperative and postoperative female versus male patients was compared using chi-squared tests. A total of 168 of 723 members responded to our survey. Overall, the mean age was 44.6 + 11.0 years, 7.8% were female, 69.6% had completed a urologic oncology fellowship, and 68.1% were in academic practice. The median time in practice was 9 years (interquartile range [IQR]: 4-17). The median number of female RC’s performed in the 12 months preceding the survey was 5 (IQR: 3-10). When comparing preoperative counseling of female versus male patients who were known to be sexually active prior to RC, the majority of providers did not provide routine counseling about sexual orientation (74.8% vs. 75.8%, respectively, p=0.9), partner sexual dysfunction (79.4% vs. 75.8%, respectively, p=0.8), or referral options to psychological and sexual health services (85.5% vs. 77.4%, respectively, p=0.6) (Figure 1). Additionally, providers were significantly more likely to not provide routine preoperative counseling about certain topics to sexually active female compared to male patients, including baseline sexual dysfunction (60.8% vs. 20.8%, respectively, p<0.001), the risk of sexual dysfunction after RC (20.0% vs. 7.3%, respectively, p=0.01), and the potential for a nerve-sparing approach (70.8% vs. 36.0%, respectively, p=0.002) (Figure 1). Additionally, 41.2% of urologists did not routinely inform sexually active female patients about the potential for pelvic organ-preserving RC. In the postoperative setting, providers were significantly more likely to not provide routine counseling about sexual health and dysfunction after RC with sexually active female patients compared to sexually active male patients (42.6% vs. 21.1%, respectively, p=0.01). When asked about barriers to discussing sexual health with female patients, 67.0% listed older patient age, 62.3% said there was not enough time, and 49.1% listed uncertainty about patients’ baseline sexual function. However, 93.3% reported that sexual health counseling was within the scope of their urologic oncology practice.