Abstract
Female sexual dysfunction occurs frequently in midlife breast cancer survivors (BCS) and encompasses problems with sexual desire, interest, arousal, orgasm and genitopelvic pain. Although common, sexual problems are under-diagnosed and under-treated in BCS. The objective of this review was to assess primary studies that intervene on sexual dysfunction in BCS. In February 2015, PubMed, SCOPUS, CINAHL, COCHRANE and Web of Science databases were systematically searched for randomized controlled clinical trials (RCTs) of vaginal (lubricants, moisturizers, estrogens, dehydroepiandrosterone [DHEA], testosterone, vibrators, dilators), systemic (androgens, anti-depressants, flibanserin, ospemifene), physical therapy (physical activity, pelvic floor training), counseling and educational interventions on sexual function in BCS. Observational studies of vaginal interventions were also included due to the paucity of RCTs. The search yielded 1414 studies, 34 of which met inclusion criteria. Both interventions and outcomes, measured by 31 different sexual function scales, were heterogeneous, and therefore data were not pooled. The review found that regular and prolonged use of vaginal moisturizers was effective in improving vaginal dryness, dyspareunia, and sexual satisfaction. Educational and counseling interventions targeting sexual dysfunction showed consistent improvement in various aspects of sexual health. No consistent improvements in sexual health were observed with physical activity, transdermal testosterone or hot flash interventions. There was a lack of BCS-specific data on vaginal lubricants, vibrators, dilators, pelvic floor therapy, flibanserin or ospemifene. Overall, the quality of evidence for these studies was moderate to very low. Because each of the interventions with BCS data had limited efficacy, clinical trials to test novel interventions are needed to provide evidence-based clinical recommendations and improve sexual function in BCS.
Highlights
In the United States, there are more than 2.3 million female cancer survivors who are younger than age 60; 40 % of these women are survivors of breast cancer [1]
We present a systematic review of primary research on managing sexual dysfunction in breast cancer survivors to generate evidence-based content for improving knowledge on sexual health for BCS and their healthcare providers
The Vaginal Maturation Index, Vaginal Health Index, and Sexual Activity Questionnaire were each used in 2 separate studies
Summary
In the United States, there are more than 2.3 million female cancer survivors who are younger than age 60; 40 % of these women are survivors of breast cancer [1]. Most midlife breast cancer survivors (BCS) undergo surgery, chemotherapy, radiation and/or endocrine therapy for cancer treatment. Receiving a breast cancer diagnosis and undergoing associated treatments including long term endocrine therapy can impair sexual function via a number of mechanisms, including disrupting ovarian. A women is diagnosed with sexual dysfunction if she experiences persistent symptoms that last at least six months and cause marked distress, as detailed in the Diagnostic and Statistical Manual 5th Edition (DSM-5) [10] (Table 1). A population-based cohort study of recently diagnosed BCS showed 65 % reported that they were sexually active; 52 % of sexually active women described problems with two or more areas of sexual function [11]. At 5 and 10 years after cancer diagnosis, Seav et al Women's Midlife Health (2015) 1:9
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