{"doi":"10.1093/jsxmed/qdaf322","title":"Facing the challenges in implementing sexual health guidelines for cancer survivors","abstract":"Sexual dysfunction is a common, persistent, and distressing sequela of cancer. This is due to both the psychological impacts of a cancer diagnosis and side effects of related procedures and treatments. Given that unresolved sexual problems can have devastating effects on the lives of patients and their partners, multiple organizations such as the National Comprehensive Cancer Network, American Cancer Society, American Society of Clinical Oncology, and American Urological Association provide guidance on diagnosis and treatment of sexual dysfunction in their cancer treatment guidelines. Recommendations include urging oncologists to refer patients to sexual medicine specialists and/or sex therapists (psycho-oncologists). However, studies demonstrate that sexual health frequently goes unaddressed in cancer care, and many patients and partners report unmet sexual health needs. This is unfortunate and surprising given the existence of multiple effective treatments for sexual dysfunction (psychotherapy, medications, surgery, and sexual aids). These gaps in care are, in part, a manifestation of larger trends within medicine. Specifically, relegation of sexual health to the field’s margins combined with poor adherence to evidence-based guidelines in real-world practice settings. Indeed, a critical step in improving sexual health outcomes after cancer is to address widespread barriers to implementing sexual health clinical practice guidelines. Although there is a dearth of studies focused on this, studies in other areas have examined intrinsic and extrinsic factors leading to guideline-discordant care. A recent systematic metareview included 25 systematic reviews of barriers and facilitators of clinical practice guideline implementation across multiple specialties. Intrinsic barriers to guideline implementation included a lack of clarity and strength of evidence, while external barriers were time constraints, lack of provider knowledge, and inadequate organizational and leadership support.1 Overcoming these barriers is key to incorporating guideline recommendations into practice. Alternatively, facilitators of guideline implementation included presenting guidelines in a concise, user-friendly, and digital format to providers and patients; developing educational programs to improve provider knowledge; and having multidisciplinary teams, automated reminders, and support from administrators.1 Basing implementation strategies on frameworks such as the Knowledge-to-Action or Action, Actor, Context, Target, Time (AACTT) frameworks enables high degrees of specification for who needs to do what differently and in what contexts for guideline recommendations to be implemented in practice. Using implementation frameworks, models, and theories supports measurement of clinical effectiveness and implementation outcomes, while taking into consideration multilevel factors and rich clinical contexts contributing to implementation success or failure, all in support of generalizable knowledge.2 For example, the AACTT framework facilitates identification of specific behaviors (eg, intervention targets) that need to be changed to improve guideline adherence and factors influencing these behaviors across various providers and settings so strategies can be specific and, ideally, causally related to the outcomes. With respect to sexual health, there are unique barriers to guideline implementation. One major barrier is the diffuse nature of sexual health recommendations for patients with cancer. Many recommendations are scattered across various sources and may be overlooked if they are buried within cancer site-specific guidelines covering all aspects of cancer care. Other sexual health recommendations are non-specific and contained within broader cancer survivorship guidelines applied to any patient with cancer. Given that each treatment and cancer type is associated with unique side effects, the former may not be adequately addressed. Finally, guidelines that","journal":"The Journal of Sexual Medicine","year":2025,"id":587688,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9602,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":578342,"name":"Daniela Wittmann","orcid":"0000-0002-9201-7269","position":1,"is_corresponding":false},{"id":511541,"name":"Ted A. Skolarus","orcid":"0000-0002-5859-8151","position":2,"is_corresponding":false},{"id":6020,"name":"Christian J. Nelson","orcid":"0000-0003-2141-6489","position":3,"is_corresponding":false},{"id":364977,"name":"Stacy Loeb","orcid":"0000-0003-3933-9207","position":4,"is_corresponding":false},{"id":1503752,"name":"John P Mulhall","orcid":null,"position":5,"is_corresponding":false},{"id":1049644,"name":"Natasha Gupta","orcid":"0000-0003-2782-415X","position":0,"is_corresponding":true}],"reference_count":4,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T02:59:39.958043Z","pmid":"41489196","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}