Aromatase inhibitors (AIs) are associated with hypoactive sexual desire disorder (HSDD) and fecal incontinence in breast cancer survivors ten years after diagnosis, according to a recent Journal of Sexual Medicine study.
The drugs are considered an “oral adjuvant endocrine therapy” taken by postmenopausal women with hormone receptor positive breast cancer. Typically, they are taken for five years (or for two to three years after tamoxifen therapy). Some women choose to take AIs for up to ten years after their breast cancer diagnosis.
“AI therapy results in profound estrogen depletion,” the study authors wrote. This can lead to sexual issues such as vaginal dryness and painful intercourse.
The researchers questioned whether low estrogen levels associated with AIs might also contribute to low sexual desire, pelvic floor dysfunction, and related conditions of urinary incontinence, fecal incontinence, and pelvic organ prolapse. These angles have not been widely studied.
The current study investigated the prevalence of such problems in AI users and non-AI users approximately ten years after breast cancer diagnosis.
The study involved 625 Australian women who had been participants in a larger breast cancer project called the Bupa Study. Their median age was 65 years and 73% had a partner. About 85% had been diagnosed with hormone receptor positive breast cancer. Thirteen percent took either tamoxifen or an AI at the time of the study.
The women completed several questionnaires to evaluate sexual function, sexual distress, urinary incontinence, and pelvic floor function (including pelvic organ prolapse and fecal incontinence).
The researchers found that 55% of the women who currently used AIs met the criteria for the diagnosis of HSDD – low sexual interest accompanied by distress. For women who didn’t take AIs, this rate was 38%. About two-thirds of sexually active current AI users had HSDD, compared to 44% of sexually active non-users.
Age was considered in the analysis, and the relationship between AI therapy and HSDD remained.
Fecal incontinence was also associated with AI use, affecting about 30% of AI users and 16% of non-AI users. The study authors called this a “novel and potentially important finding,” as some scientists have considered the role of estrogen and estrogen receptors in inflammatory bowel disease and bowel cancer. Further research in this area is warranted, the authors said.
The researchers found no differences between AI users and non-AI users for urinary incontinence or symptomatic pelvic organ prolapse.
The acknowledged several limitations, including the small number of AI users. In addition, it was unknown whether symptoms of vulvar and vaginal atrophy prevented women from having sex.
“Our findings reinforce the importance of addressing sexual health in women even many years after their diagnosis of breast cancer,” the authors concluded.
“Future studies are needed to determine whether the treatment of [vulvar and vaginal atrophy] significantly alleviates the sexual dysfunction associated with [aromatase inhibitor] use and to elucidate the link between [aromatase inhibitor] use and [fecal incontinence],” they added.
Resources
The Journal of Sexual Medicine
Robinson, Penelope J., MBiostat, et al.
“Aromatase Inhibitors Are Associated With Low Sexual Desire Causing Distress and Fecal Incontinence in Women: An Observational Study”
(Full-text. Published online: October 21, 2017)
http://www.jsm.jsexmed.org/article/S1743-6095(17)31445-5/fulltext