How Do Hormone Therapies for Breast Cancer Affect Libido and Sexual Function?

Breast cancer treatment often includes hormone therapies, which can be highly effective in reducing cancer recurrence and improving survival rates. However, these therapies can also impact a woman’s sexual health and overall quality of life. Many women experience changes in libido, vaginal health, and sexual function during and after treatment, which can be difficult to navigate emotionally and physically.

What Are Hormone Therapies?

Hormone therapies for breast cancer are typically used when the cancer is hormone receptor-positive, meaning its growth is fueled by hormones like estrogen or progesterone. Common hormone therapies include:

1. Selective Estrogen Receptor Modulators (SERMs) – These medications, such as tamoxifen, block estrogen receptors in breast tissue.
2. Aromatase Inhibitors (AIs) – Such as letrozole, anastrozole, and exemestane, reduce estrogen levels in postmenopausal women by preventing the conversion of androgens into estrogen.
3. Gonadotropin-Releasing Hormone (GnRH) Agonists – These suppress the ovaries from producing estrogen, essentially inducing menopause in premenopausal women.

While effective in managing cancer, hormone therapies often come with side effects, including sexual changes that are rarely discussed in depth.

Impact on Libido and Sexual Function

One of the most common side effects of hormone therapies is a decrease in sexual desire or libido. This can happen for a few reasons:

1. Lower Estrogen Levels: Estrogen is a key hormone in maintaining vaginal health, lubrication, and sexual responsiveness. When levels drop significantly due to hormone therapy, women may notice reduced vaginal lubrication, making intercourse uncomfortable or painful.
2. Testosterone Suppression: Although known primarily as a male hormone, testosterone is also present in women and plays a crucial role in libido. Many breast cancer hormone therapies can suppress testosterone levels, leading to a decrease in sexual desire and satisfaction.
3. Emotional and Physical Changes: Cancer treatment can take a significant toll on emotional well-being. Body image changes, fatigue, anxiety, or depression are common and can compound the physical side effects of hormone therapy, further diminishing sexual interest.

Addressing Vaginal Dryness and Discomfort

Vaginal dryness, burning, or pain during intercourse is a frequent concern for women undergoing hormone therapies. These symptoms often result from a thinning of the vaginal tissues (vaginal atrophy) due to low estrogen levels. Some ways to manage these symptoms include:

• Non-Hormonal Lubricants and Moisturizers: Water-based or silicone-based lubricants can reduce friction and discomfort during intercourse. Vaginal moisturizers used a few times per week can also help maintain hydration and tissue elasticity.
• Vaginal Estrogen Treatments: Although systemic estrogen is often contraindicated for women with hormone-sensitive breast cancer, localized vaginal estrogen therapies like creams or rings may be considered under the guidance of a healthcare provider. These treatments deliver low doses of estrogen directly to vaginal tissues, helping to alleviate dryness without significantly raising systemic estrogen levels.

Supporting Sexual Health and Intimacy

Maintaining intimacy and sexual health during and after breast cancer treatment requires a holistic approach. Open communication with healthcare providers and partners is key. Some strategies to improve sexual health include:

1. Counseling or Sex Therapy: Professional support from a counselor or sex therapist can help women and their partners navigate changes in sexual desire and intimacy, addressing both emotional and relationship concerns.
2. Pelvic Floor Physical Therapy: For women experiencing pain during intercourse, pelvic floor exercises and therapy can strengthen vaginal muscles and reduce discomfort, enhancing sexual function.
3. Exploring Different Types of Intimacy: Women may need to redefine what intimacy means during this time. Focusing on non-sexual forms of affection, such as cuddling, massage, or spending quality time together, can help maintain connection without the pressure to engage in sexual activities.

Talking to Your Healthcare Provider

Women experiencing changes in sexual function during breast cancer treatment should feel empowered to discuss these concerns with their healthcare team. Options are available to manage side effects and support a healthy, satisfying sex life, even in the face of challenging treatments. Taking a proactive approach to sexual health can improve overall quality of life and help women feel more in control during their breast cancer journey.

By understanding how hormone therapies impact sexual health, women can make informed decisions and access resources to maintain their well-being during and after treatment.

For more information on this topic, please read these publications from the ISSM Journals: The Journal of Sexual Medicine, Sexual Medicine Reviews, and Sexual Medicine Open Access:

Testosterone therapy in females is not associated with increased cardiovascular or breast cancer risk: a claims database analysis

Prophylactic mastectomy and bilateral salpingo-oophorectomy in patients with breast cancer: a systematic review of postsurgical sexual function and menopausal hormone therapy symptom mitigation

References:

Bober, S. L., & Varela, V. S. (2012). Sexuality in adult cancer survivors: challenges and intervention. Journal of clinical oncology: official journal of the American Society of Clinical Oncology, 30(30), 3712–3719. https://doi.org/10.1200/JCO.2012.41.7915

Burstein, H. J., Lacchetti, C., Anderson, H., Buchholz, T. A., Davidson, N. E., Gelmon, K. A., Giordano, S. H., Hudis, C. A., Solky, A. J., Stearns, V., Winer, E. P., & Griggs, J. J. (2019). Adjuvant Endocrine Therapy for Women With Hormone Receptor-Positive Breast Cancer: ASCO Clinical Practice Guideline Focused Update. Journal of clinical oncology: official journal of the American Society of Clinical Oncology, 37(5), 423–438. https://doi.org/10.1200/JCO.18.01160

Faubion, S. S., Larkin, L. C., Stuenkel, C. A., Bachmann, G. A., Chism, L. A., Kagan, R., Kaunitz, A. M., Krychman, M. L., Parish, S. J., Partridge, A. H., Pinkerton, J. V., Rowen, T. S., Shapiro, M., Simon, J. A., Goldfarb, S. B., & Kingsberg, S. A. (2018). Management of genitourinary syndrome of menopause in women with or at high risk for breast cancer: consensus recommendations from The North American Menopause Society and The International Society for the Study of Women’s Sexual Health. Menopause (New York, N.Y.), 25(6), 596–608. https://doi.org/10.1097/GME.0000000000001121

Kingsberg, S. A., Clayton, A. H., & Pfaus, J. G. (2015). The Female Sexual Response: Current Models, Neurobiological Underpinnings and Agents Currently Approved or Under Investigation for the Treatment of Hypoactive Sexual Desire Disorder. CNS drugs, 29(11), 915–933. https://doi.org/10.1007/s40263-015-0288-1

Nappi, R. E., Martini, E., Cucinella, L., Martella, S., Tiranini, L., Inzoli, A., Brambilla, E., Bosoni, D., Cassani, C., & Gardella, B. (2019). Addressing Vulvovaginal Atrophy (VVA)/Genitourinary Syndrome of Menopause (GSM) for Healthy Aging in Women. Frontiers in endocrinology, 10, 561. https://doi.org/10.3389/fendo.2019.00561