Sexual Dysfunction, Breast Cancer and the Role of Physical Therapy

There are more than 2.8 million women living in the United States today who are either being treated or have completed treatment for breast cancer. While the side effects associated with these treatments are taxing enough – possibly including axillary web syndrome, lymphedema, cancer-related fatigue, and emotional distress – in addition, up to 77% of breast cancer survivors also qualify for a diagnosis of sexual dysfunction even three years or longer after their initial diagnosis. This includes anything from difficulties with arousal and desire to pain with intercourse (dyspareunia), medication-induced atrophy or dryness, vaginal stenosis and hypo-orgasmia, among other symptoms. Whether you are pre- or post-menopausal, these side effects deserve the attention of your healthcare support staff.

Currently there is conflicting evidence regarding the efficacy of medications to treat sexual dysfunction in breast cancer survivors. Hormone Replacement Therapy (HRT) has been studied as a treatment for relief of symptoms of sexual dysfunction, and while there was an increased risk of reoccurrence of breast cancer in the initial study, a ten-year follow-up study did not show a significantly higher recurrence rate in the group treated with HRT. Other pharmacological interventions tested in breast cancer survivors include topical testosterone, DHEA and Tibolone, among others. Every patient is distinct, and pharmacological intervention is a potential treatment that should be discussed with your physician. However, if medications are ineffective, not recommended, insufficient for all of your symptoms or simply not your treatment of choice, there are alternatives available, including pelvic floor physical therapy.

If you are currently experiencing symptoms of sexual dysfunction, especially vaginal dryness, pain with intercourse, and /or anorgasmia, a pelvic floor physical therapist can perform an evaluation to determine the source of your dysfunction, provide scientifically supported education regarding proper moisturizers and lubricants and optimal positioning for decreased pain, and assist you in alleviating your symptoms to achieve optimal sexual function. A study performed in 2013 found that performing pelvic floor muscle (PFM) relaxation exercises, in combination with an appropriate moisturizer and lubricant, significantly improved pain with intercourse, sexual function and general quality of life in women with a history of breast cancer. Training in PFM relaxation, along with recommendations for lubrication and moisturizers, took place with a physical therapist during the first and fourth weeks, but otherwise the participants carried out the treatments from the comfort of their own homes.

If you are experiencing these symptoms, set up an evaluation with a specialized pelvic floor physical therapist today to begin your path back to optimal physical and sexual function.

Lila Abbate PT, DPT, OCS, WCS

Justine Payne, PT, DPT

References:

“U.S. Breast Cancer Statistics.” Breastcancer.org. N.p., 11 May 2015. Web. 24 June 2015.

Bober SL, Varela VS. Sexuality in adult cancer survivors: challenges and intervention. J Clin Oncol 2012;30:3712-9.

Fahlén M, Fornander T, Johansson H, Johansson U, Rutgvist LE, Wilking N, et al. Hormone replacement therapy after breast cancer: 10 year follow up of the Stockholm randomized trial. Eur J Cancer, 2013;49(1):52-9.

Heath A, Massa L, Sebba N, Westbrook K. Sexual Health for Breast Cancer Survivors. Combined Sections Meeting, 2015. Indianapolis, IN.

Holmberg L, Iversen OE, Rudenstam CM, Hammar M, Kumpulainen E, Jaskiewicz J, et al. Increased risk of recurrence after hormone replacement therapy in breast cancer survivors. J Natl Cancer Inst, 2008; 100(7): 475-82.

Juraskova I, et al. The acceptability, feasibility, and efficacy (Phase I/II Study) of the OVERcome (olive oil, vaginal exercise, and moisturizer) intervention to improve dyspareunia and alleviate sexual problems in women with breast cancer. J Sex Med. 2013; 10: 2549-2558

Pinto AC. Sexuality and breast cancer: prime time for young patients. J Thorac Dis, 2013; 5(S1): S81-6.

Raggio GA, Butryn ML, Arigo D, Mikorski R, Palmer SC. Prevalence and correlates of sexual mobidity in long-term breast cancer survivors. Psychology & Health, 2014; 29(6): 632-50.

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