More than half of older women treated with so-called aromatase inhibitors said sex was almost always painful and they frequently had "insufficient lubrication," researchers reported in the journal Menopause.

In contrast, less than one-third of women on tamoxifen, another anti-estrogen drug, reported painful sex.

"We've suspected that the aromatase inhibitors would be more likely to cause sexual dysfunction for quite a while," said Dr. Don Dizon, a gynecologic oncologist from Massachusetts General Hospital in Boston who has studied sexual health in cancer survivors.

Those drugs, he said, block women's bodies from producing estrogen. Tamoxifen, on the other hand, just stops the hormone from acting on cells in the breast. Both can be prescribed to women with hormone receptor positive breast cancer, the most common type.

Dizon said it stands to reason that without any estrogen production, women could see their sex lives suffer. But most don't mention those problems to their doctors, and many oncologists feel uncomfortable discussing sexual health, he told Reuters Health.

For the new study, researchers surveyed 82 women who'd had breast cancer and were taking aromatase inhibitors or tamoxifen to prevent the cancer from coming back. The women were all between 55 and 70 years old, and had been diagnosed two to six years earlier.

Dr. Juliane Baumgart of Orebro University Hospital and colleagues compared those women's responses to sexual health surveys from 102 women of the same age who hadn't had breast cancer.

Most women in both the cancer and non-cancer groups said they were sexually active.

Among those having sex, 74 percent of women taking aromatase inhibitors said they always or almost always had trouble with lubrication, compared to 40 to 42 percent of women who hadn't had breast cancer or those who were treated with tamoxifen.

Painful sex was reported by 57 percent of sexually active women on aromatase inhibitors, compared to 31 percent on tamoxifen and 21 percent or less in the comparison group.

There was not a substantial difference across groups in how many women reported trouble reaching orgasm, but more women taking aromatase inhibitors said they were generally dissatisfied with their sex lives.

Dizon, who wasn't involved in the new study, said it helps illustrate the different ways sexual health may be affected for women on aromatase inhibitors. Most women in the U.S. who get breast cancer after menopause are treated with a five-year course of those drugs, he said.

Oncologists at the very least should be ready to point women to resources where they can get help for sexual problems, according to Dizon.

He tells patients that using vaginal moisturizers and water- or silicone-based lubricants may help alleviate pain during sex. In addition, Dizon said he emphasizes the importance of intimacy in relationships.

"As women get treated for cancer we need to think about the toxicities and the long-term side effects, and sexual health is one of those areas that is really important," he said.

"The notion from an oncologist that you're just lucky to be alive is not acceptable."

SOURCE: bit.ly/Uyc8mn Menopause, online September 17, 2012.

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