Breast cancer and sexuality with focus in young women: From evidence-based data to women’s wording to treatment perspectives

Abstract

Seven percent of breast cancers are diagnosed in women younger than 40 years of age, who face a very demanding disease. Their sexuality is threatened in all its dimensions: sexual identity, sexual function and sexual relationship. Age (the younger the woman, the more serious the impact), lymphedema, side effects of surgery, radio- or chemotherapy and hormonotherapy, infertility, pregnancy-related problems during or after breast cancer and iatrogenic premature menopause with its cohort of symptoms secondary to the chronic loss of oestrogens on the brain, on the sensory organs, on the pathophysiology of sexual response and on the function of the pelvic floor may all affect the quality of sexuality after breast cancer. Body image issues may polarize the negative impact on women’s sexual identity. Female sexual disorders (FSD), namely, loss of sexual desire, arousal disorders, dyspareunia, anorgasmia and loss of sexual satisfaction, are progressively complained of, as sexual function goes worse over time. Sexual relationship is threatened most by sexual symptoms, loss of erotic intimacy and complicity and infertility-related issues. Women carriers of BRCA mutations, who might consider bilateral prophylactic mastectomy, may have a specific iatrogenic impact of surgery on their self-image and femininity. Attention to biological, systemic and genital factors that impair women sexuality after breast cancer is still limited. Treatment encompasses lifestyle interventions, breast self-massage, physiotherapy, pharmacologic hormonal and nonhormonal help and psychosexual short-term interventions. New drugs offer new effective treatment opportunities of FSD after BC: nonhormonal and topical drugs, including hyaluronic acid gel and colostrum gel, should be recommended soon after the diagnosis of breast cancer to prevent vaginal dryness and dyspareunia; nonhormonal and systemic drugs, such as ospemiphene, offer new opportunity to treat vaginal dryness and dyspareunia in women who have completed the adjuvant treatment for breast cancer. Testosterone, either systemic or topical, is receiving positive attention as antiproliferative on the breast and sexually boosting at the same time. Topical vaginal DHEA is under investigation. A multidisciplinary approach to sexual complaints of breast cancer survivors should be offered to women and couples who desire to get back a better sexual life. Now this is possible.