Breast cancer is the most common type of cancer among women of reproductive age. Chemotherapy poses a risk of diminished fertility to young patients and many of them seek ways to preserve their fertility. Cryopreservation of the embryo/oocyte following ovarian stimulation is the method of choice, however, not always possible due to contraindications and time constraints. However, women should consult an expert to determine if their situation makes cryopreservation possible, or to explore together alternative options.
Among the greatest challenges for young women undergoing breast cancer treatment are those associated with sexual function. Chemotherapy, radiation, surgery, and endocrine therapy can raise a multitude of sexual concerns both physical and emotional. Sexual dysfunction can occur during treatment but also it may extend into survivorship.
Young women who were not yet menopausal may experience chemotherapy-induced ovarian failure and onset of an early menopause, which may significantly affect sexual function. Furthermore, certain types of chemotherapy, such as the anthracyclines and taxanes can negatively affect overall physical function, reducing libido and arousal. In addition, common toxicities resulting from chemotherapy include fatigue, hair loss, and GI distress which may affect sexual health.
Radiation therapy may result in local side effects, including persistent breast pain, arm and shoulder discomfort and loss of flexibility, and lymphedema. Any of those symptoms can be linked to sexual function.
Surgery to the breast and axilla may result in long-term issues both physically and mentally. Women report significantly worse sexual function following breast cancer surgery predominantly due to issues related to arousal, and difficulty with orgasm. Women who have undergone mastectomy seem especially affected.
Finally, sexual health is often negatively affected in women undergoing endocrine therapy. Approximately 30% to 40% of women treated with tamoxifen report sexual complaints, while over 50% of those on an aromatase inhibitor report issues related to sexual health. In addition to primary impacts on sexual function, these agents are directly linked to the onset or worsening of menopausal-type symptoms.
While attention to reproductive/sexual health is an important part of treating young women diagnosed with breast cancer, it is often neglected by patients and physicians who are reluctant to bring up these topics. Please watch the video of Dr. Jennifer Griffin, MD, MPH, Medical Director of Gynecology at Nebraska Medicine talk about this important topic.