According to Basson (2006), the management of sexual desire and arousal disorders in women includes psychological and pharmacologic interventions.
There are a number of different psychological interventions that may be helpful for breast cancer survivors with sexual desire and arousal disorders.
Cognitive behavioral therapy is used to identify and modify factors contributing to sexual dysfunction. Such factors may include maladaptive thoughts, unreasonable expectations, and insufficient nongenital physical stimulation. These sessions vary in number and usually include both partners in order to work on strategies to improve the couple’s emotional closeness and communication and to improve erotic stimulation (Basson, 2006).
Sexual therapy is similar to cognitive behavioral therapy but includes sensate focus techniques that are used to change the focus from a performance goal-that is, orgasm-to giving pleasure through touch. Although one study reported that women treated with a combination of behavioral and sexual therapy had improved sexual and marital satisfaction (Trudel et al., 2001), there are few data on the efficacy of such interventions among breast cancer survivors.
Short-term psychotherapy could be utilized to explore poor sexual selfimage and nonsexual experiences in childhood that could affect current sexual function. There are, however, few data to support the benefit of this therapy (Heiman, 2002).
If the breast cancer survivor with sexual dysfunction is known or thought to have a mood disorder such as depression or anxiety, we engage our colleagues in the Department of Psychiatry to ensure that the disorder is appropriately managed. They review the woman’s medications to ensure that they are not contributing to sexual dysfunction. A small, short-term study of bupropion (Wellbutrin) in nondepressed, premenopausal women found an increase in arousability and sexual response but not in initial desire (Segraves et al., 2004).