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Sex Complaints Common After Breast Cancer

Mastectomy, Aromatase Inhibitors Linked to Sexual Dysfunction

By Salynn Boyles
WebMD Health News

Reviewed by Laura J. Martin, MD

Sept. 23, 2010 -- Loss of libido and difficulty having sex are common complaints among breast cancer survivors, new research confirms.

More than two-thirds of surveyed survivors reported that they were still having sexual function problems two years after diagnosis. Most described their sex lives as satisfying before breast cancer.

Women taking aromatase inhibitors as treatment for their breast cancer reported more sexual problems than women taking tamoxifen.

Body image issues and vaginal dryness related to aromatase inhibitor use were among the most frequently mentioned complaints.

“Sexual problems are among the most common and least talked about side effects of breast cancer treatment,” study co-author Susan R. Davis, MD, of Victoria, Australia's Monash University Medical School tells WebMD.

“About 70% of the women in our study were experiencing a meaningful loss of desire and sexual function a full two years after diagnosis.”

Gynecologist and breast cancer survivor Melanie Bone is surprised the number isn't 100%. Bone, who practices in West Palm Beach, Fla., had a double mastectomy 10 years ago at age 40.

She says her breast cancer was the nail in the coffin of an already strained marriage. Even though she is now happily remarried, Bone acknowledges that she is still having issues related to sexual function.

“From the moment the surgeon takes a knife to your breast -- unless you have superhuman self-esteem -- there is an impact on sexuality,” she tells WebMD.

Even women who have breast-sparing surgery may no longer enjoy having their breasts touched during sex because it reminds them of their cancer and treatment.

“Many of the breast cancer survivors I treat tell me their foreplay no longer involves the breasts,” she says.

The issue of pain related to vaginal dryness during sex may be more easily addressed.

About three out of four breast cancer tumors are estrogen-receptor (ER) positive, meaning that they grow when exposed to the female sex hormone.

These days, nearly all women with ER-positive tumors take estrogen-blocking drugs such as tamoxifen or aromatase inhibitors for several years following initial treatment.

Although tamoxifen can actually cause an increase in vaginal secretions in some women, use of aromatase inhibitors almost always results in extreme vaginal dryness related to estrogen depletion, which can make sex extremely painful.

In the study, which included nearly 1,600 breast cancer survivors with sexual partners recruited within a year of their cancer diagnosis, use of aromatase inhibitors was associated with a more than three-fold increased incidence of sexual function problems.

“Every woman who is put on these drugs should be told it is highly likely they will experience symptoms related to menopause, including vaginal dryness, but that isn't always happening,” Davis says. “And women may be reluctant to talk about the issue with their oncologist.”

Bone recommends topical vaginal estrogen to many of her breast cancer patients.

Although this is somewhat controversial, she says the doses used in most estrogen-containing vaginal creams are very low, and studies show that very little is absorbed systemically.

Davis recommends starting with a non-hormonal lubricant like vegetable oil.

The survey revealed that women who had their breasts removed were twice as likely to report negative feelings about body image as women who had breast-conserving surgeries, even when they had breast reconstruction surgery.

“Reconstruction is major cosmetic surgery and a lot of women end up with pain,” she says.

She says the high incidence of low desire among women who have been treated for breast cancer speaks to the need for effective libido-targeting treatments.

Early last summer, an FDA panel recommended against approval of the drug flibanserin, which has been called the ‘female Viagra,' concluding that two studies failed to show a significant increase in desire among women taking the drug compared to women taking placebo pills.

“I think this drug needs to be studied in women with breast cancer because it is non-hormonal and this is a population with a real need for a libido drug,” she says. “And you are not likely to see a big placebo effect. If it doesn't work, they will tell you.”

SOURCES: Panjari, M., Journal of Sexual Medicine, Sept. 23, 2010; online edition.Susan R. Davis, MD, professor and chair of the department of women's health, Monash University Medical School, Melbourne, Australia.Melanie Bone, MD, gynecologist, West Palm Beach, Fla.News release, Wiley Communications.

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