Breast Cancer Survivors with Genitourinary Syndrome of Menopause Receiving Aromatase Inhibitors Are Willing to Sexual Assessment: Is a Dyspareunia Approach Enough?

Abstract

Objective. To assess the sexual health and interest of breast cancer survivors (BCSs) in a tailored evaluation of their sexuality. Methods. A descriptive analysis on baseline sexual assessment of female BCS with genitourinary syndrome of menopause (GSM) receiving aromatase inhibitors (AIs), who have participated on an ongoing double-blinded randomized controlled trial on the efficacy and safety of laser therapy (NCT04619485), was conducted. Epidemiological and BC variables, as well as mental, vaginal, and basic sexual health assessment (self-reported sexual activity and frequency, sexual behavior, type of sexual activity and relationship status, Female Sexual Function Index (FSFI), and Body Image Scale questionnaires and 2 visual analogue scales (VASs) about sexual life disturbance and dyspareunia) were recorded. An optional specialized sexual assessment was offered. Results. Among 83 participants, 67 (80.7%) wanted sexual counseling. Half of them had a body image alteration, and 74% worsened their sexual life after receiving BC diagnosis and treatments. The sexual activity rate was 71.1%. Sexually inactive women had higher impairment of FSFI desire dimension ( $p=0.0013$ ), dyspareunia ( $p=0.0114$ ), and unsatisfaction with their sexuality ( $p=0.0530$ ) compared to sexually active women. In sexually active women, the mean FSFI and all of its dimensions showed a lower score. The most frequent sexual behavior was a combination of nonvaginal and vaginal sex, despite the high intensity of dyspareunia (mean VAS ± SD: 7.1 ± 2.1). Conclusion. Most of the BCSs with GSM receiving AI were interested in a specialized sexual consultation. Sexual activity and function were impaired, either secondary to dyspareunia or to other biopsychosocial sexual factors.