Sexual Function Post-Breast Cancer

Abstract

The consequences of estrogen deprivation and therapeutic interventions such as radiation, chemotherapy and surgery have a significant negative impact on libido, sexual arousal, orgasmic function and the ability to have pleasurable intercourse. Evaluation and treatment of female sexual dysfunction is a significant unmet need in the breast cancer survivor in spite of the availability of safe and effective treatments.

Effects of local laser treatment on vulvovaginal atrophy among women with breast cancer: a prospective study with long-term follow-up

“…Contra-indications to laser therapy were ongoing gynaecological bleeding or infection, active genital herpes infection, pregnancy and severe genital prolapse. Laser parameters were those recommended by DEKA: laser energy was set at 26 to 40 W power with a dwell time of 1000 μs and dot spacing of 1000 μm, with increasing stack at each session (1)(2)(3). Women were excluded if they had no breast cancer, if they had abnormal pap smear at baseline, if they were receiving chemotherapy at the beginning of the study or if they had received pelvic radiotherapy.…”

“…Median age at diagnostic is around 60 but 25% of affected women are premenopausal [1]. Women with breast cancer (BC) often suffer from genitourinary syndrome of menopause (GSM), which includes severe vulvovaginal atrophy (VVA) and urinary symptoms, leading to dyspareunia and poor sexual and urinary quality of life [2]. These side effects are linked to endocrine deprivation in relation to chemotherapy, LHRH-agonists induced early menopause and endocrine therapy [3].…”

Sex Hormones Related Ocular Dryness in Breast Cancer Women

“…Medical treatment and surgery related physical changes lead to a negative effect on one's body image, depression and anxiety, as well as partner issues related to physical and hormonal changes. For many women, the consequences of iatrogenic menopause or estrogen deprivation therapy have the greatest negative impact on sexual function [76].…”

Genitourinary syndrome of menopause

“…My plan now, with Virginia’s consent, is to refer her to our specialist pelvic floor physiotherapist for support with pelvic floor relaxation and vaginal dilators and also for psychosexual counselling if required (the waiting time in six months). 5…”

“…A more objective evaluation of vulvovaginal atrophy depends on the measurement of vaginal pH, using low range pH paper (pH is increased) and assessment of vaginal maturation index (VMI) by taking a vaginal smear (increase in parabasal cells and reduction in superficial cells 5 ).…”