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Expert Point of View: Charles L. Loprinzi, MD


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Charles L. Loprinzi, MD, Regis Professor of Breast Cancer Oncology at the Mayo Clinic, Rochester, Minnesota, discussed this abstract on sexual health in women treated for breast cancer. Addressing patients’ questions, offering advice, and providing appropriate referrals should improve patient care, he noted.

Charles L. Loprinzi, MD

Charles L. Loprinzi, MD

“Believe patients when they say have symptoms. And even if they don’t bring it up, ask patients about their sexual health,” said Dr. Loprinzi. “If you don’t feel comfortable providing advice, refer your patient to someone in a sexual health clinic who may be more knowledgeable.”

Managing Genitourinary Symptoms

For patients experiencing genitourinary symptoms of menopausal treatment, said Dr. Loprinzi, nonestrogen vaginal moisturizers can be applied several times a week, and vaginal lubricants can be used at the time of intercourse. He also noted that because they decrease estrogen, aromatase inhibitors are associated with more prominent sexual health problems than tamoxifen.

“Vaginal estrogen can be used, but you have to be somewhat careful with patients on aromatase inhibitors,” cautioned Dr. Loprinzi. “Most vaginal estrogen preparations lead to systemic estrogen absorption. While lower doses may not be absorbed as much, it’s also possible to switch patients from an aromatase inhibitor to tamoxifen. Systemic estrogen absorption is not as big an issue for patients on tamoxifen, as this drug does work in premenopausal women, despite it increasing estrogen concentrations in this group. For patients on an aromatase inhibitor, the testosterone precursor DHEA [dehydroepiandrosterone] can also be utilized, as the aromatase inhibitor is designed to prevent the conversion of DHEA to estrogen.”

Finally, said Dr. Loprinzi, there is a study published in the Journal of Clinical Oncology that illustrated that topical lidocaine can be helpful before sexual intercourse. 

DISCLOSURE: Dr. Loprinzi reported no conflicts of interest.

 


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