Breast Cancer and Sexual Function

As the most common malignancy affecting women within the United States, breast cancer can bring about multiple physical and psychological challenges. Among the greatest challenges are those associated with female sexual function. 

Chemotherapy, endocrine therapy, surgeries and radiation can all have a large effect in altering a woman's sexual health and function. Sexual concerns result in significant emotional distress, including sadness/depression, issues related to personal appearance, stigma, and negative impacts on personal relationships. 

In this article, we discuss some of the specific challenges that present with each type of treatment and the socio-physical impact they have on survivorship. Among the most detrimental to sexual function, are the use of chemotherapy and endocrine therapy. Additionally, anatomical changes that transpire in patients who have undergone surgery or radiation therapy (RT), disrupt perceptions of body image. Here we will discuss and also review the contemporary literature to determine effective management and treatment of sexual dysfunction.

Below:  Sexual health in women

Clinical trials of interventions in breast cancer survivors

Intervention	N	Trial	Results
Topical testosterone (25)	21	Phase I/II	Significant improvement in dyspareunia and dryness
Transdermal testosterone (26)	150	RCT	Compared to placebo, no difference in sexual function scores at 4 or 8 weeks of intervention
Vaginal dehydroepiandrosterone (33)	441*	RCT	Compared to placebo, improvement in sexual satisfaction scores
Aqueous 4% lidocaine (30,31)	49	RCT	Compared to normal saline, significant improvement in pain; resumption of sexual intercourse in 17 of 20 women who had previously abstained
Vaginal pH-balanced gel (28)	86	RCT	Compared to placebo, nonsignificant improvement in vaginal dryness and dyspareunia
Polycarbophil-based vaginal moisturizer (29)	45	RCT	Compared to placebo, trend towards improved dyspareunia scores. Both groups had improvement in average vaginal dryness

RCT, randomized controlled trial. *, breast and gynecologic cancer survivors included in this study.

Full article at:   http://goo.gl/MMyGHu

By:  Boswell EN1, Dizon DS1.

• 1 Dana-Farber Cancer Institute, 2 The Oncology Sexual Health Program, The Massachusetts General Hospital Cancer Center, Boston, MA 06114, USA.
• Transl Androl Urol. 2015 Apr;4(2):160-8. doi: 10.3978/j.issn.2223-4683.2014.12.04. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

A Manifesto on the Preservation of Sexual Function in Women & Girls with Cancer

Malignancies that affect females who survive cancer commonly originate in, invade, and/or metastasize to the sexual organs, including the ovaries, uterine corpus, uterine cervix, vagina, vulva, fallopian tubes, anus, rectum, breast(s), and brain. Females comprise most of the population (in number and proportion) with cancers that directly affect the sexual organs. Most females in the age groups most commonly affected by cancer are sexually active in the year before diagnosis, which includes most menopausal women who have a partner. 

Among female cancer survivors, the vast majority have cancers that are treated with local or systemic therapies that result in removal, compromise, or destruction of the sexual organs. Additionally, female cancer survivors often experience abrupt or premature onset of menopause, either directly with surgery, radiation, or other treatments or indirectly through disruption of female sex hormone or other neuroendocrine physiology. 

For many female patients, cancer treatment has short-term and long-lasting effects on other aspects of physical, psychological, and social functioning that can interfere with normal sexual function; these effects include pain, depression, and anxiety; fatigue and sleep disruption; changes in weight and body image; scars, loss of normal skin sensation, and other skin changes; changes in bodily odors; ostomies and loss of normal bowel and bladder function; lymphedema, and strained intimate partnerships and other changes in social roles. 

In spite of these facts, female patients who are treated for cancer receive insufficient counseling, support, or treatment to preserve or regain sexual function after cancer treatment.

Below:  Interactive biopsychosocial model of sexuality

Interactive Biopsychosocial Model of sexuality in the context of cancer, with examples in each domain that influence sexuality.

Full article at:   http://goo.gl/bL4EDW

By:    Stacy Tessler Lindau, MD, MAPP, Emily M. Abramsohn, MPH, and Amber C. Matthews, BA

Departments of Obstetrics and Gynecology (Dr Lindau, Ms Abramsohn, and Ms Matthews, https://obgyn.uchicago.edu/) and Medicine-Geriatrics (Dr Lindau), University of Chicago, Chicago, IL.

Corresponding author: Stacy Tessler Lindau, MD, MAPP. Email: ude.ogacihcu@uadnils

Am J Obstet Gynecol. 2015 Aug; 213(2): 166–174.

Published online 2015 Mar 25. doi:  10.1016/j.ajog.2015.03.039

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Malignancies in HIV/AIDS: From Epidemiology to Therapeutic Challenges

Via: ht.ly/PV5hP  HT @RushMedical

The incidence of AIDS-defining cancers (ADCs) -- Kaposi sarcoma, primary central nervous system lymphoma, non-Hodgkin lymphoma, and cervical cancer -- although on the decline since shortly after the introduction of highly active antiretroviral therapy (HAART), has continued to be greater even in treated HIV-infected persons than in the general population. While the survival of newly infected people living with HIV/AIDS now rivals that of the general population, morbidity and mortality associated with non-AIDS-defining cancers (NADCs) such as lung, liver, anal and melanoma are significant and also continue to rise. Increasing age (i.e., longevity) is the greatest risk factor for NADCs, but longevity alone is not sufficient to fully explain these trends in cancer epidemiology. In this review, we briefly review the epidemiology and etiology of cancers seen in HIV/AIDS, and in this context, discuss preclinical research and broad treatment considerations. Investigation of these considerations provides insight into why malignancies continue to be a major problem in the current era of HIV/AIDS care.

Below:  Summary of AIDS-defining cancers (ADC) and non-AIDS-defining cancer (NADC) etiology in the context of HIV and HAART