- Cancer survivors have many complaints not addressed by their physicians
Janelle Yates, Senior Editor (Web Exclusive, July 2011)
- How to talk to patients about sex
Barbara S. Levy, MD (Web Audio, September 2010)
- Sexual dysfunction: What can you do for your patients?
Barbara S. Levy, MD (Update, September 2010)
Sexual dysfunction is common among women in the United States. One recent study put the prevalence of distressing sexual dysfunction at 22.2%.1 When cancer enters the picture, that percentage rises—dramatically. A 2010 survey from the Lance Armstrong Foundation found that 46% of people affected by cancer report problems with sex after treatment.2
In this article, I highlight three recent studies that explore the sexual effects of cancer and its treatment:
- a prospective cohort study showing that a majority of women treated for breast cancer experience sexual dysfunction afterward
- two longitudinal studies of women affected by gynecologic cancer, which show significant disruption of sexual function in the short and long term.
I also present the experiences of two cancer survivors who volunteered to relate their stories so that you might develop a better understanding of some of the challenges they face about their sexual function.
Sexual function deteriorates in many women after they are treated for breast Ca
Panjari M, Bell RJ, Davis SR. Sexual function after breast cancer. J Sex Med. 2011;8(1):294–302.
According to this prospective cohort study from Australia, a majority of women report significant sexual dysfunction after treatment for breast cancer—even when their sexual function was good, and satisfying, at the time of diagnosis (TABLE).
The Health and Wellbeing after Breast Cancer Study enrolled 1,684 Australian women within 12 months of their first diagnosis of invasive breast cancer. Each woman completed a questionnaire at the time of enrollment, and will complete annual follow-up questionnaires for 5 years to assess the impact of invasive breast cancer on physical, psychological, and socioeconomic wellbeing. Embedded within the 12-month questionnaire was the validated Menopause-Specific Quality of Life Questionnaire (MENQOL), which was used in this study to explore the sexual consequences of the diagnosis and treatment of invasive breast cancer.
Of the initial cohort, 1,011 women completed the 12-month questionnaire. These were women younger than 70 years who had a sexual partner and no evidence of active breast cancer. The authors describe the women in this cohort as representative of all women in Victoria, Australia, who have a new diagnosis of invasive breast cancer, in regard to both age (mean, 59 ± 11 years) and the stage of tumor (stage I, 48%; stage II–IV, 52%) at diagnosis.
Of this group, 70% were treated with lumpectomy and radiation therapy, and 30% were treated with mastectomy (2.6% with bilateral mastectomy). Of the women who underwent mastectomy, 9.6% had reconstructive surgery during the first year after diagnosis.
Forty-nine percent of women were treated with tamoxifen, and 28.2% were treated with an aromatase inhibitor.
After breast Ca, women experience low desire and less frequent sexual activity – as well as distress over both outcomes
|Decreased sexual activity||72.5%||21.1%|
|Distressed by sexual function||49.1%||8.1%|
|Seeking increase in desire||64.1%||19.9%|
|Source: Panjari et al.|
More than two thirds of women reported sexual dysfunction 12 months after treatment
At baseline, 83% of women described their prediagnosis sexual function as good and satisfying. Twelve months later, 70% reported significant sexual dysfunction, and 77% reported vasomotor symptoms.
Women who reported new-onset sexual dysfunction were more likely to:
- have become menopausal since diagnosis
- experience hot flashes or night sweats
- be treated with an aromatase inhibitor.
There was no association between sexual dysfunction and stage of disease at diagnosis; type of surgery (lumpectomy or mastectomy); breast reconstruction; lymphedema; or axillary dissection.
Vasomotor symptoms in women taking endocrine therapy were associated with sexual dysfunction
Further analysis demonstrated that, among women who experienced vasomotor symptoms, those taking an aromatase inhibitor were more than three times as likely to report sexual dysfunction (odds ratio [OR], 3.49; 95% confidence interval [CI], 1.72–7.09), compared with women who were not on endocrine therapy—and those taking tamoxifen were almost twice as likely to report sexual dysfunction (OR, 1.73; 95% CI, 1.04–2.89). Chemotherapy was not independently related to sexual dysfunction.
In summary: 70% of women who were free of breast cancer 1 year after enrollment reported bothersome sexual consequences of their disease and its treatment; 77% reported vasomotor symptoms. Women who were rendered menopausal and those who experienced vasomotor symptoms while taking an aromatase inhibitor were at high risk of sexual dysfunction.
Be aware of the side effects of breast cancer and its treatment, and not only prepare your patients for the likely consequences but also make yourself knowledgeable about strategies to ameliorate their vaginal dryness and to improve elasticity and arousal for them.
Proactive stretching, use of vaginal dilators and topical oils, and, most important, psychological strategies to help your patients and their partners adjust to the inevitable physical changes will go a long way toward improving their sexual experiences.