Breast cancer patients in a female sexual medicine and women’s health program: A cross-sectional retrospective study.

Abstract

8 Background: Cancer treatment impacts sexual health and QOL with symptoms of vulvovaginal dryness, dyspareunia, and sexual dysfunction. There are limited data on specific sexual changes in patients with varying treatments. We examined patient-reported and exam outcomes of breast cancer patients’ initial consults at Female Sexual Medicine & Women’s Health Program (FSMWHP) at Memorial Sloan Kettering Cancer Center. Methods: We obtained a limited waiver to evaluate medical records and Female Sexual Medicine Clinic Assessment Forms (FSMCAFs) of initial consults at FSMWHP from 6/29/12–12/23/16. The FSMCAF is composed of a pelvic exam checklist, sexual function measures (Female Sexual Function Index-FSFI; Sexual Activity Questionnaire-SAQ), vulvovaginal health measures (Vaginal Assessment Scale—VAS; Vulvar Assessment Scale—VuAS), and questions about concerns. Descriptive statistics were calculated using SPSS. Results: 446 women were categorized by menopausal status and endocrine therapy. Subcohorts were: postmenopausal with aromatase inhibitors (AIs) alone (30%), tamoxifen followed by AI (22%), tamoxifen alone (16%) or no therapy (16%), and pre/peri-menopausal with tamoxifen alone (9%) or no therapy (5%). In postmenopausal women, initial consults avg. 3.3 yrs post-treatment (pre/peri avg. 1.8 yrs). Endocrine use avg. 3 yrs. across groups. 99% of postmenopausal women scored < 26.6 on FSFI, indicating sexual dysfunction (tamoxifen alone avg: 13.7; tamoxifen followed by AI avg: 10.4). Vulvovaginal dryness and severe dyspareunia were highest in postmenopausal women with endocrine exposure (AI alone: 83% and 36%; tamoxifen alone: 66% and 32%). Related exam outcomes (pH > 6.5, petechiae, vulvovaginal atrophy, minimal/no moisture) were also highest in postmenopausal women (AI alone: 30%, 13%, 78%, 89%; tamoxifen alone: 19%, 5%, 65%, 70% respectively). Conclusions: Sexual health concerns are common in breast cancer patients. Endocrine exposure and menopause can negatively impact tissue quality. Women exposed to AIs appear to have the poorest self-reported and clinical outcomes. Proactive sexual health interventions, including early counseling, are warranted in these patients.