Risk-reducing procedures decrease libido, increase anxiety in BRCA–positive women

CHICAGO — The majority of BRCA–positive women who underwent risk-reducing surgery to prevent cancer reported having libido and sexuality issues, according to results of a survey presented at the ASCO Annual Meeting.

Further, these risk-reducing procedures are associated with higher rates of sexual inactivity, which, in turn, increased anxiety and decreased emotional and physical quality of life.

“The vast majority of women who have risk prevention surgery for cancer occurrence or recurrence have significant loss in libido,” Olga Ivanov, MD, FACS, medical director of the breast health center at Celebration Health in Celebration, Florida, said during a presentation. “The main contributing factors to this appear to be a drop in desire and negative body image.”

Women with BRCA mutation often undergo cancer risk-reducing procedures, such as mastectomy, bilateral salpingo-oophorectomy and hysterectomy, for the treatment of breast or ovarian cancers. Research has indicated these procedures are linked to an adverse effect on sexuality, self-image and libido, including premature menopause.

Ivanov and colleagues examined data from 763 BRCA1/2–positive women to further evaluate the prevalence of these adverse effects. Researchers sought to examine the impact these adverse effects had on psychological status using the Beck Anxiety Index and RAND–36 Quality-of-Life parameters.

Of that cohort, 53% were cancer “previvors” — or women who underwent risk-reducing surgery before receiving a diagnosis of BRCA–related cancer — and 48% were survivors, meaning they had been diagnosed with cancer.

Of the previvors, 60% underwent mastectomy, 59% had a bilateral salpingo-oophorectomy and 41% had a hysterectomy. Among the survivors, 87% underwent mastectomy, 77% underwent bilateral salpingo-oophorectomy and 62% underwent hysterectomy.

The analysis also included data from 122 BRCA–positive women and 26 controls who had participated in a lifestyle study that examined sexual activity, causes for reduced sexuality and psychosocial status.

Seventy-two percent of women who had a risk-reducing procedure reported sexuality and libido problems and 79% reported that having a low libido was a major concern. Eighty-nine percent of previvors and 77% of survivors experienced premature menopause.

Forty-four percent of survivors and 33% of previvors were sexually inactive compared with 12.5% of BRCA–negative women (P = .031).

The most commonly reported cause for sexual inactivity was loss of desire, which occurred more frequently among women who had a risk-reducing procedure than BRCA–negative women (63% vs. 39%).

Other commonly reported causes for sexual inactivity that occurred more frequently in women who underwent a risk-reducing procedure included poor body image (48% vs. 22%), vaginal dryness (46% vs. 16%) and relationship change (17% vs. 6%).

Among BRCA–positive women, a greater proportion of previvors experienced vaginal dryness (49% vs. 42%) and lost desire (68% vs. 58%), whereas more survivors reported poor body image (50% vs. 43%) and relationship changes (19% vs. 15%).

Women who were sexually inactive had significantly higher Beck Anxiety Index (approximately 12 vs. 8; P < .05).

Further, women who were sexually inactive had significantly lower emotional and physical quality-of-life scores compared with sexually active women (approximately 70 vs. approximately 90; P < .00001).

“The data showed that sexually inactive women had lower quality-of-life scores, as well as higher levels of anxiety,” Ivanov said. “The important thing for me to remember in the clinic will be to completely manage each individual woman’s expectations.” – by Nick Andrews

References:

Ivanov O, et al. Abstract 1505. Presented at: ASCO Annual Meeting; June 3-7, 2016; Chicago.

Disclosure: The researchers report no relevant financial disclosures.