Tag Archives: Sexual Dysfunction

Sexual Dysfunction, Breast Cancer and the Role of Physical Therapy

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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.

Overcoming Painful Intercourse: Women’s Health Physical Therapists Should be Part of Your Medical Team

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If you have pain with intercourse you likely do not talk about it or you may think it is normal. If occurring, you may endure it or avoid the activity all together. These responses can lead to significant emotional and psychological repercussions. You may not even know where to start or may be too embarrassed to bring it up to your physician. You also probably have no idea a physical therapist specialized in women’s health can play a significant role in reducing your pain.

The medical term for painful intercourse is dyspareunia. Dyspareunia is recurring or persisting pain with sexual activity that can cause significant distress or conflict. It occurs in approximately 10-20% of women in the US. There can be two types of dyspareunia, one occurring with initial penetration and the other occurring with deep penetration.¹

 Common causes of dyspareunia include:¹

  • Pregnancy (especially during the second half) ²
  • Postpartum trauma
  • Vaginal atrophy post menopause (affects 50% of postmenopausal women due to decrease in estrogen)
  • Vaginismus (involuntary contraction of the pelvic floor muscles that limits vaginal entry)
  • Vulvodynia (pain localized to the vagina and supporting structures)
  • Orthopedic issues
  • Dermatologic disease (examples include lichen sclerosis and psoriasis)
  • Endometriosis
  • Interstitial Cystitis
  • Perivaginal infections¹

All of the above listed conditions are unique issues that come with varied treatments. However, a common problem that can occur in all of the above issues are pelvic floor muscles functioning inappropriately.¹ Treating and retraining the pelvic floor muscles are where women’s health physical therapists play a role as part of the medical team.  In a sample of 132 women that examined the effects of a multidisciplinary program consisting of pelvic floor physical therapy, medical management, and psychological intervention for vulvodynia, strong significant effects were reported in reduction of dyspareunia, sex related distress, sexual arousal, and overall sexual functioning. Thus, a multidisciplinary approach to painful intercourse including pelvic floor physical therapy can have positive outcomes. ³

If you are considering surgery for painful intercourse issues you also may want to discuss trying pelvic floor physical therapy with your physician before surgery to see if it is a viable option. In a sample of 90 patients with a history of sexual dysfunction researchers compared patients who underwent a surgical procedure versus pelvic floor physical therapy alone. Orgasm and dyspareunia improved significantly in the physical therapy group and dyspareunia was more painful in the surgical group. Therefore, pelvic floor physical therapy may be a good option to try before considering surgical procedures if your doctor thinks you are an appropriate candidate. ⁴

Physical therapy treatment for dyspareunia can include soft tissue mobilization to internal and external muscles, pelvic floor muscle retraining exercises, dilator programs, biofeedback, and orthopedic exercises. ⁵ Women’s health physical therapists also can provide options for positions during intercourse based off orthopedic considerations or pain locations. Partner and patient education about dyspareunia is also important secondary to partner responses to pain and women’s maladaptive beliefs regarding vaginal penetration being found as strong predictors to sexual pain behaviors. ⁶ It is important to address all the factors contributing to dyspareunia with your medical team for success. If you feel you are suffering from dyspareunia, you don’t have to. The team at New Dimension’s Physical Therapy can help improve your symptoms and direct you on the right track for treatment. Painful intercourse is not normal and there are many viable conservative treatment options to help.

Lila Abbate PT, DPT, OCS, WCS

Andrea Wood, PT, DPT

References:

  1. Seehusen D, Baird D, Bode, D. Dyspareunia in women.Am Fam Physician. 2014; 90(7): 465-470.
  2. Galazka I, Drosdzol-Cop A, Naworska B, et al. Changes in the sexual function during pregnancy. J Sex Med. 2015; 12(2): 445-454.
  3. Brotto LA, Yong P, Smith KB, et al. Impact of a multidisciplinary vulvodynia program on sexual functioning and dyspareunia. J Sex Med. 2015; 12(1) 238-247.
  4. Eftekhar T, Sohrabi M, Haghollahi F et al. Comparison effect of physiotherapy with surgery on sexual function in patients with pelvic floor disorder: a randomized clinical trial. Iran J Reprod Med. 2014; 12(1): 7-14
  5. Ensor W, Newton Roberta. The role of biofeedback and soft tissue mobilization in the treatment of dyspareunia: a systematic review. J Womens Health Phys Therap. 2014; 38(2): 74-80
  6. Brauer M, Lakeman M, Van Lunsen R, et al. Predictors of task-persistent and fear-avoiding behaviors in women with sexual pain disorders. J Sex Med. 2014; 11(12): 3051-3063.