HJBR Jul/Aug 2022

54 JUL / AUG 2022 I  HEALTHCARE JOURNAL OF BATON ROUGE ONCOLOGY all couples are able to advance to Phase 3 of penetrative intercourse. If a woman has a partner, studies show that couples therapy offers more benefits than usual care. It is important to note that the partners of patients with breast cancer are impacted as well. Studies show reports of lower sexual satisfaction and more erectile dysfunction in partners, too. Regular physi- cal exercise improves sexual function in both patients with breast cancer and their partners. Genitourinary syndrome of menopause is a common condition associated with genital dryness, decreased lubrication; dis- comfort or pain with sexual activity; post- coital bleeding; decreased arousal, orgasm, desire; irritation/burning/itching of vulva or vagina; dysuria; and urinary frequency/ urgency. Vulvovaginal atrophy affects one in three breast cancer survivors and leads to thinning, drying, and inflammation of the vaginal walls. These symptoms can make daily activities uncomfortable and are not just limited to discomfort with sexual activity. Treatment options include vaginal moistur- izers, Osphena (if not an estrogen-dependent cancer), or consideration for vaginal laser. Dyspareunia can lead to dread of intercourse due to pain. Studies have shown that dyspa- reunia led up to 50% of women to give up penetrative intimacy. Vaginal moisturizers can improve tissue quality when used 3 to 5 times per week and are not just for use during intercourse. However, up to 42% of women report inadequate relief with vaginal mois- turizers alone. American Society of Clinical Oncology guidelines do recommend low- dose vaginal estrogens (even in women with estrogen-dependent cancer) when they are not responding to lubricants or moisturizers. No prospective randomized controlled trials have been performed to evaluate its use, but retrospective studies have shown that there are no increased risk of developing primary breast cancer or increased risk of recurrence in patients with breast cancer when using vaginal estrogens. Painful penetration can be mitigated with topical 4% aqueous lidocaine. A randomized, controlled, double-blind trial of 4% lidocaine versus placebo shows that dyspareunia reduced from88% down to 33%. Pelvic floor dysfunction is a frequent source of sexual pain for patients with cancer. An overactive pelvic floor can cause genito- pelvic penetration disorder — dyspareunia and vaginismus, as well as urinary symptoms. Apelvic floor physical therapist can address this pain and educate patients to restore healthy sexual function. Graduated vaginal dilators can be used for patients who may be at risk for or develop vaginal stenosis after pelvic radiation. The benefit of vaginal dila- tors is the greatest when initiated early and should be considered irrespective of sexual activity to prevent vaginismus. How can physicians adequately address the sexual health of female patients with can- cer? Start by educating yourself on options for treatment. Commit to asking patients about their sexual health, and integrate the questions intro routine clinic visits. Recog- nize that sexual dysfunction is often multi- factorial, and ask for assistance from pelvic floor physical therapists, mental health coun- selors, and gynecologists as needed. Youmay be surprised by how asking a simple question can have a big impact on the quality of life of our patients. n Lauren A. Zatarain, MD received a medical degree fromLouisiana State University School of Medicine in New Orleans. She completed an internship and resi- dency at LSUHealth Sciences Center in Baton Rouge and completed a fellowship in hematology/oncology at Vanderbilt University Medical Center in Nashville, Tennessee. She served as chief resident and chief fel- low in her respective training programs. Zatarain is board certified in hematology, oncology, and internal medicine.She is amember of theAlpha OmegaAlpha Honor Medical Society, theAmerican Society of Clini- cal Oncology,and theAmerican Society of Hematology. Zatarain specializes in the treatment of all cancer types, including solid tumors and hematologic tumors, non- cancerous blood disorders,and coagulation disorders. Her passion lies in women’s health with a special em- phasis in caring for patients with breast cancer. “If a woman has a partner, studies show that couples therapy offers more benefits than usual care. It is important to note that the partners of patients with breast cancer are impacted as well. … Regular physical exercise improves sexual function in both patients with breast cancer and their partners.”