Published on September 23, 2020
Breast Cancer and Your Sex Life
The effects of breast cancer treatment on sexual intimacy can be profound. Sex may not be top of mind following breast cancer treatment if you've been thrust into early menopause, have increased menopausal symptoms, or are healing emotionally and physically from surgery, radiation, and chemotherapy, but reclaiming your sensual self can be another way of healing after a breast cancer diagnosis and treatment.
Pain During Sex
Getting used to your body after the trauma of breast cancer can be daunting, and sometimes painful, but with the right help and expert advice sexual activity can be pleasurable again.
One such expert empowering women is Dr. James A. Simon, medical director and founder of IntimMedicine Specialists, a medical practice in Washington, D.C., for women, men and couples across the reproductive lifecycle.
Dr. Simon talks about how the body and mind are affected when therapies to treat cancer have sexual side effects, and his team helps women and their partners mitigate these symptoms.
“When reproductive hormones are removed or prohibited by the cancer, there may be consequences,” Dr. Simon said.
But there is good news!
“We now have medications to circumvent, at least to some degree, the low amounts of estrogen in the brain for women’s sexual desire,” he added.
A few years ago, the first medication to treat sexual dysfunction in women was approved by the FDA and erroneously called the “female Viagra.” This is a misnomer. Viagra, which is prescribed for men who cannot attain or sustain an erection, treats erectile dysfunction in men by increasing blood flow to the genitals. Whereas for women, flibanserin (Addyi), works on the part of the brain that helps initiate desire and increase interest in sex.
“Because that’s where sex really is,” Dr. Simon said, “in the brain.” Without sexual desire, sexual response will frequently be lacking. These types of medications help reconnect the brain with the body.
Flibanserin was originally developed as an antidepressant and was later found to have an interesting side effect: it increases sexual desire in premenopausal and postmenopausal women who have noticed a decrease.1
Hormone Treatments: DHEA
Your body naturally makes a hormone called DHEA (dehydroepiandrosterone) in the adrenal glands. DHEA helps produce other hormones, including testosterone and estrogen. Supplemental DHEA is an approved treatment for women with dryness and pain with sex following menopause. While not specifically approved for breast cancer survivors who are experiencing vaginal atrophy symptoms, some experts in the field have recommended DHEA as safe in this setting.
As always, before taking any new medications or supplements, talk to your doctor to get the care that’s right for you.
Current Guidelines to Help Women's Sexual Health
“The American College of Obstetricians and Gynecologists and ASCO, the American Society of Clinical Oncology, have come up with guidelines for patients saying that vaginal estrogen is probably safe and that it can be used in low doses to help with the symptoms of vaginal dryness that can make intercourse really difficult,” said Dr. Kelly Shanahan, a breast cancer advocate who is living with metastatic breast cancer.
“But it's so much more than intercourse,” Dr. Shanahan said during a Patient Power interview with Andrea Hutton, who is also a breast cancer survivor and the author of “Bald Is Better with Earrings – A Survivor’s Guide to Getting Through Breast Cancer.”2
“Because everything is kind of close around there, so low estrogen levels also can lead to thinning of the tissues not only in our vaginas but also in our urinary tract and increase the risk of urinary tract infections. So, a little dab of vaginal estrogen goes a long way to helping us be able to have an intimate sexual life as well as maybe lower our risk of getting bladder infections,” she added.
Additionally, the North American Menopause Society (NAMS) recently updated their statement on the management of the genitourinary syndrome of menopause (GSM). Vulvovaginal atrophy (VVA) is a part of that syndrome.3
“For women with breast cancer, low-dose vaginal estrogen therapy is contraindicated according to FDA class labeling. However, off-label use of several products may be acceptable because of their very low systemic absorption,” the NAMS statement says. “Because this remedy is not in pill format, it doesn’t have to go through the women’s entire digestive system; it’s direct and therefore, considered safe for many.”
A few challenges for treating sexual health in women with breast cancer include the following:
- Some treatments, including aromatase inhibitors like anastrozole (Arimidex), exemestane (Aromasin) and letrozole (Femara), lower estrogen concentrations or antagonize the effects of estrogen.4
- There is limited clinical trial data in treating sexual health in breast cancer patients and survivors.
- A disagreement between the oncology community and other practitioners involved in genitourinary and sexual healthcare.
As more therapies become available and are studied in large groups of patients, more options will become available.
Tips from a Sexual Health Expert
Dr. Simon recommends the following:
- Have an honest conversation with yourself about what is important for your sexual pleasure.
- Include your partner in the discussion and in meetings with your doctors.
- Be open to answering the question, “What aspect of sex is important to me?” It could run the gamut to whatever enables you to connect with your partner on a physical and emotional level.
- If you experience physical pain during any part of intimacy, ask for help.
- Ask how radiation and surgery can affect skin and sensation.
There is life after cancer treatment, and a healthy sex life can be part of that. If you feel uncomfortable discussing sex with your doctor, remember that your trusted medical team got you this far. Let them help you more fully regain aspects of your pre-cancer life, because it is all part of your overall health and well-being.
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1Is there an Equivalent of Viagra for Women? Mayo Clinic.
2Hutton A. Bald is Better with Earrings: A Survivor’s Guide to Getting Through Breast Cancer. Harper Collins. 2015
3The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause: The Journal of The North American Menopause Society. Vol. 27, No. 9, pp. 976-992
4Aromatase Inhibitors. Komen.org.
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