Under the covers: Sex, intimacy and breast cancer

Anne Katz PhD RN FAAN

LBBC April 25, 2018

Interventions

• Vulvo-vaginal dryness

– Non-pharmaceutical (Krychman 2012)

– Moisturizers

– Lubricants

– Pharmaceutical

• Local estrogen (estriol) (Bucholz 2015)

• Local testosterone (Dahir 2014)

• Lidocaine (Goetsch 2015)

Moisturizers

• Vulvar dryness, itching, irritation

Lubricants

• Sex play and penetration

What about?

Help with arousal or loss of sensation

Flibanserin (Addyi)

Vulvo-vaginal rejuvenation (lasers)

• Not FDA approved

• Small studies

• No long term data

• Optimal regimen not established

• No good evidence for use in women with cancer

• EXPENSIVE

Psychosocial interventions

• Limited evidence of psychosocial interventions

• Couple based sex therapy (Carroll 2016)

– Sensate focus

– Coping and attachment

– Emotion focused therapy

• Education about reactive libido

Mindfulness-based meditation

COMMUNICATION

Partner

Health care providers

Pharmacist

Psychosocial clinicians