Sexual health is a vital part of life, impacting physical and emotional well-being and interpersonal relationships. However, women living with breast cancer may be uncomfortable bringing up the topic of sexual health with their oncologist and healthcare team. Body image and sexual dysfunction problems are some of the most common and enduring challenges following breast cancer treatment and were therefore addressed during a session and in research presented at the virtual 2020 San Antonio Breast Cancer Symposium.
Ann H. Partridge, MD, MPH, Founder and Director, Program for Young Women with Breast Cancer, Dana-Farber Cancer Institute, Boston, MA, discussed a recent study of young breast cancer survivors in which the majority met criteria for having sexual problems, but few received any support.1 The study stressed that better monitoring and screening are necessary to optimize the quality of sexual life following breast cancer treatment, and that a majority of survivors have sexual problems but did not receive support for them.
Breast cancer treatment causes substantial body-image changes, as patients deal with the impact of breast loss, scarring, pain, loss of sensation, and hair loss, as well as hormonal, skin, and weight changes. An extensive literature documents feelings of negative body image following breast cancer treatment, particularly surgery. Data show the impact on relationships that present as depression, sexual difficulties, body-image distress, and marital difficulties.
There are many barriers to discussing sexual health. While our culture is saturated with sex, frank conversation about sex is not adequately encouraged. Some doctors use checklists, educational materials, and appropriate referrals to specialists to communicate optimally about sexual health.
Dr Partridge concluded that body-image problems and sexual dysfunction are 2 of the most commonly enduring challenges following breast cancer. Bridging communication between clinicians and patients is a critical part of survivorship. Several research studies about the impact of breast cancer treatment on sexual health may foster growing awareness, and novel interventions may provide more solutions for patients.
It should be stressed that aromatase inhibitors, such as Soltamox (tamoxifen), have been associated with sexual problems including vaginal dryness, sexual pain known as dyspareunia, and decreased libido or interest in sex. Recognizing the need for increased awareness and study on this issue, Heidi Worth, MD, of the University of Tennessee in Knoxville, and her colleagues discussed the impacts of adjuvant treatment on breast cancer and sexual function in high-risk menopausal women. Their research team is conducting a study using different questionnaires before beginning treatment, and again 6 months and 1 year after beginning treatment. They hope to get 42 patients in total to participate in the study.
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