Efficacy and Safety of Treatments to Improve Dyspareunia in Breast Cancer Survivors: A Systematic Review

Abstract

Objective: To analyse all available evidence to validate the effectiveness of a local intervention in the treatment of dyspareunia in breast cancer survivors (BCS). Methods: We searched the Institute of Scientific Information Web of Knowledge, MEDLINE, PubMed, Scopus, and Cochrane databases for all articles published in peer-reviewed journals up to April 2019. The PICOS standards were: (population) BCS with dyspareunia; (intervention) any type of vulvovaginal treatment; (main outcome) frequency and severity of dyspareunia; (study design) clinical studies. Results: The literature search strategy identified 252 articles, of which 233 were excluded at various stages of the search. Finally, we systematically reviewed 19 studies, 8 with local hormonal therapies, 7 with local non-hormonal therapies, 3 with laser therapy, and 1 with other interventions. Of the studies, 7 were randomized control trials and 11 were prospective observations. Most of the interventions were shown to be effective and safe in the improvement of dyspareunia. Conclusion: In addition to the traditional options already analysed in other current reviews, other interesting options are highlighted (such as laser or local dehydroepiandrosterone [DHEA]). Further work on dyspareunia should make use of high-quality trials with large numbers of samples to obtain evidence that could adequately demonstrate key methodological characteristics and harmful effects.

Treatment of Female Sexual Dysfunction Due to Dyspareunia with Solid-State Vaginal Laser and Recombinant Platelet-Derived Epidermal Growth Factors: A Viable Possibility?

“…The benefits of maintaining sexual activity to help improve local vascularization and decrease symptoms of GSM should also be reported. While no randomized controlled trial (RCT) data are available for lasers in these women, case series studies have reported favorable results with no apparent contraindications [22,23].…”

Clinical Practice Strategies to Address Sexual Health in Female Cancer Survivors

“…3,4,39 Nonhormonal topical agents include lubricants, moisturizers, and hyaluronic acid (HA). Polycarbophil-based vaginal moisturizers and HA-based moisturizers are often considered first-line nonhormonal treatments in reviews 1,39,40 and guidelines. 3,4 Efficacy of vaginal moisturizers comes from studies where they serve as a control for trials of other pharmaceutical interventions, and several of these studies have found no differences in patient-reported outcomes around symptoms of VVA when compared with HA or topical hormonal agents.…”

“…3,4 Efficacy of vaginal moisturizers comes from studies where they serve as a control for trials of other pharmaceutical interventions, and several of these studies have found no differences in patient-reported outcomes around symptoms of VVA when compared with HA or topical hormonal agents. [40][41][42] Important information around the use of vaginal moisturizers includes the use of hydrating products, frequent use (nightly), for a sufficient time (up to 12 weeks for initial results), inclusion of the vulvar vestibule and labia in moisturizing, and extended contact with the mucosa (use overnight after any sexual activity). 40 This area is ripe for well-designed comparative effectiveness trials with diverse female cancer survivors and trials designed for early intervention for prevention.…”

“…[40][41][42] Important information around the use of vaginal moisturizers includes the use of hydrating products, frequent use (nightly), for a sufficient time (up to 12 weeks for initial results), inclusion of the vulvar vestibule and labia in moisturizing, and extended contact with the mucosa (use overnight after any sexual activity). 40 This area is ripe for well-designed comparative effectiveness trials with diverse female cancer survivors and trials designed for early intervention for prevention.…”

Sexual Dysfunction in Postmenopausal Women with Breast Cancer on Adjuvant Aromatase Inhibitor Therapy

“…Female sexual dysfunction (FSD) is a highly complex phenomenon and a well-described consequence of comprehensive BC care [6, 7]. The diagnosis of BC itself, aspects of personality, and previous personal and sexual relationships influence the sexual function of patients with BC [8].…”