Sexual Health Q&A

Female Sexual Health Sexual Dysfunction
What is BRCA prophylactic surgery and what sexual side effects can occur?

Prophylactic surgery involves the removal of tissue that may or may not develop cancer.  People who are genetically predisposed to a particular type of cancer may opt for surgery as a way to reduce their risk.

For some people, cancer risk increases with the presence of certain gene mutations. Two genes that may be affected are BRCA1 and BRCA2.

In normal circumstances, BRCA1 and BRCA2 release tumor suppressor proteins. If a cell’s DNA becomes damaged, these proteins help to repair it. However, if there is a mutation, complete repair may not be possible, raising the risk for cancerous tumors.

Having a BRCA1 or BRCA2 mutation can raise a woman’s risk for both breast and ovarian cancers. Prophylactic surgery to remove the breasts or ovaries reduces (but does not eliminate) cancer risk.

A prophylactic mastectomy is the removal or one or both breasts.

Such surgery can affect women’s sexuality in a few ways:

  • There is a loss of breast and nipple sensation, which some women find sexually arousing.
  • Some women become insecure about their body image after surgery. They may feel less feminine or less attractive to a partner.
  • Stress and anxiety might make women withdraw from their partner or other relationships. Sex drive might diminish.

Risk-reducing removal of the ovaries and Fallopian tubes is called a salpingo-oophorectomy.

The ovaries are glands that produce estrogen, an important sex hormone for women. When they are removed, a woman goes through surgical menopause, which often has sexual side effects.

Estrogen helps keep the vagina moist and flexible. When estrogen levels drop, the vagina can become dry and brittle, leading to uncomfortable intercourse. Women may feel less interested in sex, and stress and anxiety can take a toll on desire and satisfaction.

Fortunately, many of the sexual repercussions of BRCA prophylactic surgery can be addressed and treated. Couples may need to make some adjustments in the bedroom. Women who experience vaginal dryness or painful intercourse might consider using a vaginal lubricant or moisturizer. Some women benefit from hormone therapy. Those who feel uncomfortable about their bodies after mastectomy might think about trying new styles of clothes or using breast forms. Breast reconstruction surgery is another option.

Counseling can also help. Some couples are uncomfortable discussing sex together. A therapist can offer communication strategies so that couples may better articulate their concerns and needs.

Prophylactic surgery is a big decision, as having the BRCA1 or BRCA2 mutation does not automatically mean one will get cancer. Some people with the mutation remain healthy. People considering surgery should talk in depth with their healthcare provider. They may also wish to discuss it with their partner, family, or a counselor.

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