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Sexual Dysfunction after Cancer

Posted 4/11/2016

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  This is an ongoing and favorite topic. It is also, sadly, one that never has many answers. Most of us would agree that a cancer diagnosis and treatment don't help one's sexuality. This is finally starting to get more attention and discussion, but the studies, to date, help better understand the prevalence and the possible reasons, but don't have much to say about solutions.

  The short primer would say that sexuality/intimacy may be damaged by surgery, drugs (chemotherapy and hormonal therapy and targeted therapies), radiation, and one's general self-image and comfort with womanliness or manliness. Especially for people whose cancer precludes the safe use of estrogen afterwards, there is not much to offer.

  This is a report from Medscape about a recent presentation at the recent National Comprehensive Cancer Network (NCCN)'s annual meeting. Here is the start and a link to read more:

NCCN Scrutinizes Sexual Dysfunction in Cancer Survivors

HOLLYWOOD, Florida — Sexual dysfunction is a common problem among cancer survivors and is likely to remain an important survivorship issue until data from evidence-based interventions emerge that can really help both men and women, experts said here at the National Comprehensive Cancer Network (NCCN) 21st Annual Conference.
For the first time, the NCCN guidelines mention two new agents: ospemifene (Osphena, Shionogi & Co, Inc) for vaginal dryness and flibanserin (Addyi, Sprout Pharmaceuticals) for lack of libido in women.
"But I can't use these drugs because they are not indicated for my cancer patients," Michelle Melisko, MD, from the University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, told Medscape Medical News.
Sexual dysfunction is likely to become more prevalent in young breast cancer survivors with increasing use of ovarian suppression, said Dr Melisko, whose practice focuses on breast cancer treatment and research.
She cited one study (Raggio GA et al, Psychol Health. 2014;29:632-650) that assessed 83 breast cancer survivors at a median of 7 years after their diagnosis.
The study assessed demographics; treatment information; sexual activity; sexual function, using the Female Sexual Function Index (FSFI); body image; and distress, using the Female Sexual Distress Scale–Revised.
The results showed that 77% of all women and 60% of the sample who were sexually active reported sexual dysfunctio nbased on the FSFI.
"Their body satisfaction was worse than normal values, mastectomy was associated with worse sexual and body change distress, and posttreatment weight gain also predicted greater body dissatisfaction and body change stress," Dr Milesko said.
A greater number of younger women are being treated with longer courses of aromatase inhibitors, "so we will be seeing more vaginal dryness and sexual complaints," she said.
Some nonhormonal options to address vaginal dryness include coconut oil, olive oil, mineral oils, vaginal lubricants for sexual activity, and topical vitamins D and E. In one recent trial of 44 women, topical vitamin D reduced pain during intercourse and decreased vaginal pH compared with placebo after 8 weeks (Rad P, Iran J Nurs Midwifery Res.
2015;20:211-215).

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