Sexual function of breast cancer survivors with GMS after laser treatment

Fractional CO2 laser therapy greatly improved both total and individual domain scores of the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale Revised (FSDS-R) in breast cancer survivors with genitourinary syndrome of menopause (GSM), according to a prospective study in the journal Menopause.

“Many women with a history of breast cancer are either postmenopausal at the time of diagnosis or experience menopause as a result of treatment with chemotherapy and/or endocrine therapy,” said co-author Stephanie Faubion, MD, MBA, director of the Mayo Clinic Center for Women’s Health in Jacksonville, Florida. “However, the majority of women on aromatase inhibitors experience sexual dysfunction and associated distress related to GSM as a result of this treatment.”

Stephanie Faubion, MD, MBA

Because the duration of these cancer therapies are now about 10 years, coupled with the fact that estrogen-based therapies for GSM are avoided in women with a history of breast cancer and specifically those on aromatase inhibitors, “a nonhormonal treatment to address GSM and related sexual dysfunction is desirable,”Faubion told Contemporary OB/GYN®.

The initial feasibility study was conducted at The Ohio State University Comprehensive Cancer Center. Among the 67 breast cancer survivors enrolled with symptoms of GSM, including dyspareunia and/or vaginal dryness, 59 women completed laser treatments and 4-week follow-up, while 39 participated in the 12-month follow-up.

The women received three sessions of fractional CO2 laser, spaced 30-45 days apart. Then, at 4 weeks and at 12 months after the final laser treatment, patients reported their outcomes and adverse events.

Overall, 83% of women were living with a spouse or significant other.

At baseline, 58% of participants said they were interested in sexual activity and 51% reported being sexually active. At 4-week follow-up, those percentages went up significantly: 86% and 78%, respectively.

The total FSFI scores rose from a median of 5.8 at baseline to a median of 21.3 at 4 weeks, with significant improvements in all six FSFI domains: desire, arousal, lubrication, orgasm, satisfaction and pain.

At 12 months, the median FSFI total and domain scores were lower than at 4 weeks, but remained significantly higher than baseline.

The median FSDS-R score was 29.0 at baseline, which improved to 16.0 at 4 weeks. At 12 months, scores also remained lower than baseline.

No grade 3 or higher adverse events were identified at 4-week or 12-month follow-up.

“The results are not surprising and underscore the significant issues with sexual dysfunction that breast cancer survivors experience, even after laser treatment,” said Faubion, who also is the medical director of the North American Menopause Society (NAMS).

The mechanism of action of the laser, which uses controlled tissue damage that results in remodeling of vaginal tissues with activation of fibroblasts, increased collagen production and improved vascularization, “should be assumed to be the same in the study population of breast cancer survivors as in the general population of postmenopausal women,” Faubion said.

Nonetheless, how long laser treatments are effective, how many repeat treatments are needed and at what interval(s) are still unknown, according to Faubion. “The treatment is also not covered by insurance and is expensive,” she said.

The study provides preliminary evidence of improvements in sexual function in breast cancer survivors who receive laser therapy. “However, additional studies are needed to assess longer term safety and efficacy before this treatment can be widely recommended or a change in clinical practice can be suggested,” Faubion said.

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Faubion reports no relevant financial disclosures.

Quick AM, Zvinovski F, Hudson C, et al. Patient-reported sexual function of breast cancer survivors with genitourinary syndrome of menopause after fractional CO2 laser therapy. Menopause. Published online February 1, 2021. doi:10.1097/GME.0000000000001738