For women living with metastatic breast cancer, managing side effects is essential for quality of life. One commonly overlooked area is vaginal health, which can impact comfort, sexual health, and overall well-being. This blog explores expert advice on dealing with symptoms like vaginal dryness, recurrent UTIs, and low libido, especially as they relate to the use of vaginal estrogen and other supportive treatments.
1. Addressing Vaginal Dryness and Related Discomfort
Vaginal dryness is a frequent concern among breast cancer patients, particularly those in lower estrogen states due to treatment or menopause. This can result in painful sex, discomfort, and an increased risk of urinary tract infections (UTIs). Non-hormonal moisturizers, especially those based on hyaluronic acid, can be a helpful first line of defense. However, some women may find these insufficient.
In these cases, vaginal estrogen therapy is a recommended option, offering relief from dryness and discomfort. Unlike hormone replacement therapy, which is absorbed into the bloodstream and not typically recommended for breast cancer survivors, vaginal estrogen is localized and has minimal absorption into circulation, making it safe per guidelines from ASCO, ACOG, and NAMS. Vaginal estrogen is available as creams, tablets, or rings, allowing women to choose the option that best fits their comfort and lifestyle needs.
2. Managing Low Libido in Survivorship
Low libido is another challenge for many cancer survivors, with causes ranging from physical to psychological. Physical contributors include the pain from vaginal dryness, while emotional factors can involve body image concerns, anxiety, and the effects of a cancer diagnosis. The social aspects, such as a partner’s fear of causing pain, can also add to the complexity of maintaining intimacy.
Addressing vaginal dryness can sometimes indirectly improve libido by reducing pain during sex, making intimacy less uncomfortable. However, for those with more persistent issues, medications like Addyi (flibanserin) may be considered for hypoactive sexual desire disorder. Working with a sexual therapist can also provide valuable support by helping to address emotional and psychological factors.
3. Clear Guidance on Vaginal Estrogen Use
One common point of confusion is differentiating vaginal estrogen from systemic hormone replacement therapy (HRT). Unlike HRT, vaginal estrogen is not significantly absorbed into the bloodstream, which makes it a safe option for breast cancer survivors. However, some patients report being advised against it, underscoring the importance of clear communication with healthcare providers. Patients are encouraged to reference current guidelines and seek a second opinion if vaginal estrogen is dismissed without thorough discussion.
In conclusion, taking a proactive approach to managing vaginal health can significantly improve the quality of life for women navigating breast cancer survivorship. With options ranging from non-hormonal moisturizers to localized estrogen treatments and sexual therapy, survivors have access to safe and effective tools to support both physical and emotional well-being.
