Use it or Lose it
Posted 9/15/2011
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Sexuality and intimacy are important issues that are frequently less discussed with our doctors. At the beginning, worries about survival and treatment are most important. Going through treatment, most women are quite focused on just getting through, one day, one treatment at a time. No one, or hardly anyone, expects to have a rollicking sex life during chemotherapy, but, blessedly, that ends, and we start to feel better, and this again becomes important.
For many women, there are concerns/issues about libido, responsiveness, and physical function (meaning lubrication and sometimes pain). If you are interested in my whole fact sheet about helpful products, email me, and I am happy to send it to you (hhill@bidmc.harvard.edu). This is a report of a presentation at the recent Breast Cancer Sympoisum about vulvovaginal atrophy--big words meaning discomfort and dryness.
Presentation Highlights Care of Patients with Vulvovaginal Atrophy, Including Use of Local Estrogen Therapy
Minimally absorbed vaginal estrogen agents can be considered for the treatment of symptomatic vulvovaginal atrophy in women with a history of breast cancer, even those on estrogen-deprivation therapy, although the risk of recurrence and safety in all breast cancer populations remains to be fully defined.
This recommendation was made by James A. Simon, MD, a clinical professor of obstetrics and gynecology at the George Washington School of Medicine, who, during General Session V: Survivorship, candidly discussed the care and management of patients with vulvovaginal atrophy—a problem afflicting many with breast cancer, but one that frequently goes undiagnosed and untreated.
The goals of vulvovaginal treatment are to relieve symptoms, reverse anatomic changes, and improve the patient's sexual function and quality of life. Toward these ends, the first line of management involves nonhormonal modalities, such as vaginal moisturizers or lubricants and lifestyle modification.
Dr. Simon urges his patients with vulvovaginal atrophy to "use it or lose it." According to Dr. Simon, continued sexual activity via coitus or masturbation increases blood flow to the pelvic organs, thereby preventing or reversing the atrophic process.
In patients who require more aggressive therapy, atrophy symptoms can usually be relieved with prescription vaginal estradiol preparations, although questions exist regarding whether these agents may increase the risk of breast cancer recurrence. As such, low-dose estrogen agents that have little, if any, systemic absorption should be selected.
In extreme cases of atrophy, physical therapy with vaginal dilation may be needed to restore function.
http://www.breastcasym.org/BreastCancerSymposiumDailyNews/BCSOnsiteCoverageFriday.aspx
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