The review looks at cancer survivorship guidelines for women’s sexual health and finds that all groups agree on using lubricants first, low‑dose estrogen if needed, and counseling or physical therapy for pain. Some guidelines list bremelanotide (pt‑141) as a possible drug for low libido, but they note there isn’t much data yet.

Female cancer survivors often experience sexual dysfunction, which is a significant and increasingly recognized aspect of survivorship. This review compares guidelines from the American Society of Clinical Oncology (ASCO), the European School of Oncology-European Society of Medical Oncology (ESO-ESMO), the National Comprehensive Cancer Network (NCCN), and the Society of Obstetricians and Gynaecologists of Canada (SOGC) for managing sexual health symptoms. The most recent guidelines from ASCO, ESO-ESMO, NCCN, and SOGC were examined and compared. The recommendations were grouped by type of sexual dysfunction: vaginal dryness, low sex drive, pain, orgasmic dysfunction, and psychological concerns. All guidelines strongly recommend non-hormonal therapies (i.e., lubricants or moisturizers) as first-line treatments for managing vaginal dryness. If unsuccessful, there is consensus for low-dose estrogen creams, tablets, capsules, or rings as second-line treatments. Multidisciplinary care is also recommended by all, including psychosocial and relationship counselling, specialist referrals, and cognitive behavioral therapy to address psychological concerns. ASCO, NCCN, and SOGC recommend vaginal dilators, and pelvic physical therapy for relieving pain. ASCO recommends any kind of stimulation (including masturbation) to improve sexual response, while NCCN and SOGC recommend the use of sexual aids (e.g., vibrators) to enhance arousal. Although all guidelines, except ESO-ESMO, include recommendations for androgens, bupropion, flibanserin, bremelanotide, and buspirone for low sex drive, there is limited data. There is consensus among guidelines on certain sexual health recommendations, with some variation. Additional research is needed on pharmacological interventions and types of counselling to strengthen their evidence.