Breast Cancer Hormonal Therapies and Sex

Women who are taking endocrine or hormonal therapy for ER-positive breast cancers have long reported concerns about their sexual functioning and intimate relationship. There are many possible contributing reasons in addition to the medicine itself: many women are post-menopausal and contending with the normal changes to sexuality; being diagnosed with and treated for breast cancer is never a sexual plus, and women are dealing with other body-related and psychological issues; generally women don't feel their best for some time after completing active breast cancer treatment, and sex may be low on their list of preferred activities.

We often talk about this in support groups, and it is evident that there is shared trouble when the question is asked: What would you rather do than have sex on Sunday afternoon? The answers usually include things like scrub the kitchen floor, clean closets, and or even have emergency dental work. Not exactly the stuff of sexual fantasies!

A recent study, reported at the Supportive Care in Oncology Symposium, emphasized how pervasive these issues are and suggested that oncologists are not talking enough with their patients about their sexual concerns. Four hundred and forty-six women participated in the study, and 99% of them reported a high degree of sexual dysfunction, including vaginal dryness and pain with intercourse. Women who had begun their endocrine treatments with tamoxifen and then, after a few years, transitioned to one of the aromatase inhibitors, had the lowest scores indicating the most trouble on the Female Sexual Function Index. Of note is that women who had been taking these therapies longer scored lower than those who were newer to treatment, suggesting that the impact is cumulative. Since increasing numbers of women are being urged to continue these treatments for longer than the original five years, this is important. Many women stay on them for ten years, and some for even longer.

Most of us would agree that staying healthy is our primary goal, and we understand that we may need to sacrifice some physical attributes or experience some side effects as part of this quest. However, it is asking a lot to expect women (and couples!) to take such a negative hit to their intimate lives for years.

When I talk with women about their sex lives, most say that it is not a subject that has been discussed with their oncologists or other cancer doctors. We understand that time during follow-up appointments is precious, and there are many issues that need to be addressed, I suspect, however, that part of the reason is also that many doctors just don't register this as an important problem and/or don't feel so comfortable with the conversation. However, when the women were asked how distressed they were about their sexual function or vulvovaginal health, the majority said they were very concerned. Younger women expressed the most distress.

We all acknowledge that even normal aging usually takes a toll on even the most robust sexual appetite. Adding cancer and cancer treatment to the mix almost always makes it worse. Couples need to find ways to talk honestly with one another about their feelings and concerns and to work towards maintaining mutually satisfying intimacy.

The recommendations at the conclusion of the study upheld the importance of early intervention with sexual issues and the absolute necessity of cancer doctors including sex in their conversations with their patients. As patients, we can take part of the responsibility and bring it up. It is completely appropriate to tell your doctor about any problems you are experiencing with sexuality and intimacy and ask for help.