Sexuality and Breast Cancer Survivorship - Key Practice Points

1 Studies suggest that sexuality in some women may be altered by breast cancer diagnosis and treatment.

2 Inquiring about topics such as menopausal status, birth control, vaginal dryness, and dyspareunia provides an opportunity to show the patient that her healthcare team members consider topics influencing sexuality to be important.

3 In breast cancer survivors with desire or arousal disorders, information should be obtained through interviews with the couple (i.e., the woman and her partner) as well as from each partner in separate interviews.

The information obtained from the separate interviews should include the partner's assessment of the problem and information about sexual response with self-stimulation; past sexual experiences; developmental history; past or current sexual, emotional, or physical abuse; and physical health (especially conditions that can lead to debility and fatigue, impaired mobility, or difficulties with self-image). In addition, each partner's mood should be assessed.

The components of the physical examination that could be important in diagnosing and treating sexual dysfunction in a woman are examination of the external genitalia, examination of the introitus, full bimanual examination, and nongenital physical examination.

4 The management of sexual desire and arousal disorders in women includes psychological and pharmacologic interventions.

5 In general, we do not routinely use systemic estrogen therapy or use testosterone alone or in combination with estrogen for the treatment of sexual dysfunction in breast cancer patients.

6 Further data are needed on the use of phosphodiesterase inhibitors such as sildenafil for female sexual dysfunction.

7 Vaginal estrogen therapy should be used with caution in breast cancer survivors taking aromatase inhibitors.

Karin M. E. Hahn
The University of Texas, Department of Breast Medical Oncology

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