Women treated with certain hormone-blocking drugs to stave off breast cancer recurrences are often dissatisfied with their sex lives, a new study from Sweden has found.
More than half of older women treated with aromatase inhibitors said sex was almost always painful and they frequently had insufficient lubrication, researchers reported online in Menopause. In contrast, less than a third of women on tamoxifen reported painful sex.
"We've suspected that the aromatase inhibitors would be more likely to cause sexual dysfunction for quite a while," said Dr Don Dizon, a gynaecologic oncologist from Massachusetts General Hospital in Boston who has studied sexual health in cancer survivors.
Those drugs, he said, block the production of oestrogen. Tamoxifen, on the other hand, just stops the hormone from acting on cells in the breast.
How the study was done
Dr Dizon said it stands to reason that without any oestrogen production, women could see their sex lives suffer. But most don't mention those problems to their doctors, and many oncologists feel uncomfortable discussing sexual health, he said.
For the new study, researchers surveyed 82 women who were taking aromatase inhibitors or tamoxifen. They were between 55 and 70 years old and had been diagnosed two to six years earlier.
Dr Juliane Baumgart of Orebro University Hospital and colleagues compared those women's responses to sexual health surveys from 102 women of the same age who hadn't had breast cancer.
Most women in both the cancer and non-cancer groups said they were sexually active.
What the study found
Among those having sex, 74% of women taking aromatase inhibitors said they always or almost always had trouble with lubrication, compared to 40% to 42% of women who hadn't had breast cancer or those who were treated with tamoxifen.
Painful sex was reported by 57% of sexually active women on aromatase inhibitors, compared to 31% on tamoxifen and 21% or less in the comparison group.
There was not a substantial difference across groups in how many women reported trouble reaching orgasm, but more women taking aromatase inhibitors said they were generally dissatisfied with their sex lives.
Dr Dizon, who wasn't involved in the new study, said it helps illustrate the different ways sexual health may be affected for women on aromatase inhibitors. Most women in the US who get breast cancer after menopause are treated with a five-year course of those drugs, he said.
Oncologists at the very least should be ready to point women to resources where they can get help for sexual problems, Dr Dizon believes.
He tells patients that using vaginal moisturisers and water- or silicone-based lubricants may help alleviate pain during sex. In addition, he said he emphasises the importance of intimacy in relationships.
"As women get treated for cancer we need to think about the toxicities and the long-term side effects, and sexual health is one of those areas that is really important," he said.
"The notion from an oncologist that you're just lucky to be alive is not acceptable."
(Reuters Health, September 2012)
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