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Treatment Side Effects – Sexual Difficulties

Treatment for advanced breast cancer can cause sexual difficulties, including loss of a desire for sex, pain during intercourse, difficulties achieving orgasm, numbness or pain in the genitals, and problems with fertility. In addition, having breast cancer and undergoing treatment may cause significant emotional or psychosocial effects, which can impact a woman’s desire or ability to engage in sexual activity.1,2

Sexual dysfunction may be caused by multiple factors in women receiving treatment for breast cancer, and it can have a significant impact on quality of life and intimate relationships. Some side effects of treatment may go away after the treatment is completed, but other sexual side effects may impact a woman even after treatment is complete.3

Breast cancer treatment may cause menopause

Some treatments for breast cancer can suppress a woman’s natural hormones, including some chemotherapy medications, hormone therapy, or surgical removal of the ovaries (oophorectomy). These treatments may prematurely cause a woman to go into menopause (called cancer therapy-induced menopause).4 Menopause can cause symptoms such as hot flashes, vaginal dryness, and vaginal atrophy (thinning of the vaginal lining, drying, and irritation of the vagina due to the loss of estrogen).5,6 Treatment options for breast cancer including surgery, chemotherapy, and hormone therapy can increase the likelihood of vaginal atrophy. Vaginal atrophy can cause a lack of lubrication during intercourse, making intercourse painful.6 The premature loss of sexual function that comes with breast cancer therapy-induced menopause can be devastating for women.3

In addition, some of the medications commonly used to treat certain menopausal symptoms in women who have had treatment for breast cancer – including selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) – can themselves cause sexual side effects, such as reduced libido (desire for sex) and difficulty achieving orgasm. Some of these side effects can potentially be reduced by your healthcare professional lowering the dosage of the medication.3

Body image challenges

Many treatments for breast cancer can negatively impact a woman’s body image. Surgery can cause scarring and discomfort, and chemotherapy can cause fatigue, nausea, hair loss, and weight gain. Hormone therapy and aromatase inhibitors can potentially prematurely cause menopause, adding to a rapidly changing body. Women undergoing treatment for breast cancer may no longer see themselves as a sexual being, compounding the physical difficulties that also cause sexual dysfunction.3

Treatment for sexual dysfunction

While it may be difficult or uncomfortable to bring up the topic of sexual difficulties, it is important for women to speak to their doctors about all the side effects they are experiencing. There are several treatment options available which can help reduce or minimize the impact of these side effects, including3,7:

  • Vaginal moisturizers or lubricants, which work best when used regularly
  • Topical lidocaine, for vaginal pain relief
  • Fractional carbon dioxide laser therapy, which delivers controlled energy to vaginal tissue and stimulates the tissue to create more collagen, muscle tone, and lubrication (potentially available through a clinical trial

Communication with a partner is also key. Women may want to discuss with their intimate partner the challenges they are experiencing and how their partner can help them. Staying open to new ways of exploring intimacy can be helpful.

  1. Cancer treatment: fertility and sexual side effects in women. MedlinePlus, U.S. National Library of Medicine. Available at https://medlineplus.gov/ency/patientinstructions/000840.htm. Accessed 8/7/18.
  2. Boswell EN, Dizon DS. Breast cancer and sexual function. Translational Andrology and Urology. 2015;4(2):160-168. doi:10.3978/j.issn.2223-4683.2014.12.04.
  3. Taylor CE, Meisel JL. Management of breast cancer therapy-related sexual dysfunction. Oncology (Williston Park). 2017 Oct;31(10):726-729.
  4. http://www.cancernetwork.com/breast-cancer/management-breast-cancer-therapyrelated-sexual-dysfunction.
  5. Wiśniewska I, Jochymek B, Lenart-Lipińska M, Chabowski M. The pharmacological and hormonal therapy of hot flushes in breast cancer survivors. Breast Cancer (Tokyo, Japan). 2016;23:178-182. doi:10.1007/s12282-015-0655-2.
  6. Nelson R. Managing menopause symptoms after breast cancer. Medscape. Available at https://www.medscape.com/viewarticle/884647. Accessed 8/7/18.
  7. Mac Bride MB, Rhodes DJ, Shuster LT. Vulvovaginal Atrophy. Mayo Clinic Proceedings. 2010;85(1):87-94. doi:10.4065/mcp.2009.0413.
  8. Arroyo C. Fractional CO2 laser treatment for vulvovaginal atrophy symptoms and vaginal rejuvenation in perimenopausal women. International Journal of Women’s Health. 2017;9:591-595. doi:10.2147/IJWH.S136857.