Inquiring about topics such as menopausal status, birth control, vaginal dryness, and dyspareunia shows the breast cancer patient that her healthcare team members consider topics influencing sexuality to be important. This may increase the likelihood that the patient will tell a member or members of her healthcare team about any sexual problems that arise during active treatment and subsequent follow-up.

There are a number of predisposing factors for sexual dysfunction after breast cancer diagnosis and treatment, including preexisting sexual problems and normal age-related changes in sexual function.

Basson (2006)  has recently reviewed sexual desire and arousal disorders in women and offered guidelines for assessment and diagnosis of sexual dysfunction. In addition to information obtained from interviewing the couple, information obtained from each partner during separate interviews should include the partner’s assessment of the problem and information about sexual response with self-stimulation;  past sexual experiences; developmental history; past or current sexual, emotional, or physical abuse; and physical health (especially conditions that can lead to debility and fatigue, impaired mobility, or difficulties with self-image).

In addition, each partner’s mood should be assessed. Basson also discusses the components of the physical examination that could be important in diagnosing and treating sexual dysfunction in a woman: examination of the external genitalia, examination of the introitus, full bimanual examination, and nongenital physical examination.

Such a detailed history and physical examination may be difficult for a medical, surgical, or radiation oncologist to accomplish during an office or clinic visit-physicians may not be comfortable with the topic of sexual dysfunction and may have limited knowledge of sexual desire and arousal disorders in women, and both time and expertise are required to accurately diagnose and effectively treat such disorders. 

Therefore, at M. D. Anderson, a multidisciplinary approach is used to adequately identify and treat sexual dysfunction in breast cancer survivors. We rely on the expertise of our colleagues in the Departments of Gynecologic Oncology and Psychiatry to help us, our patients, and their partners deal with this sensitive but important survivorship issue.

Karin M. E. Hahn
The University of Texas, Department of Breast Medical Oncology

References