We Hear Your Frustration With Low Libido and Vaginal Dryness!

By on June 3rd, 2015 Categories: Sex Matters

We know that reclaiming your sexual self after a breast cancer diagnosis can be incredibly challenging. It doesn’t help that there are no approved drugs for lowered libido (sexual desire) in women, and while there are many treatments approved for vaginal dryness, none have been approved specifically for women who’ve had breast cancer. And many vaginal dryness treatments carry warnings and precautions for women who’ve had breast cancer.

So, there is no magic pill – and this can be frustrating not only for you, but also for healthcare professionals who want to help their patients.

As this column is being published, I am in Washington D.C., meeting with your elected politicians on Capitol Hill – senators, representatives, and other key officials – attending meetings to discuss our frustration with the lack of medical solutions for women when it comes to lowered sexual desire.

As it stands today, there are 26 solutions for lowered sexual interest for men and zero for women. The inequality is pathetic and staggering! Both the government and the Food and Drug Administration need to finally listen and understand that women, including those who read this column, are suffering without solutions. Safe and effective non-hormonal medications need to be available for women! Hormones are not the answer for everyone and certainly not for those who’ve had a breast cancer diagnosis.

Cancer can create an emotional vulnerability and a sense of loss: physical devastation from bodily changes that result from treatment, as well as a deep and profound loss of a sense of femininity. The medical and scientific communities agree on and acknowledge the medical, physical, and emotionally challenging aspects of reclaiming your sexuality and vitality after cancer.

As you’ve said, sexual function and sexuality is certainly not only about being mindful or having time to engage and communicate with your partner. It’s about much more than buying new lingerie or incorporating moisturizers, lubricants, or sexual accessories into your routine. It’s about reclaiming a part of your inner soul, your inner being that sometimes, during and after breast cancer treatment, feels as though it’s been assaulted by external forces.

I certainly acknowledge that the lack of approved medical solutions for low libido is both concerning and frustrating – but it’s NOT a time to give up hope.

Thankfully, there are medical solutions for lowered libido that are very close to approval. They may not be magic bullets, and may not help everyone, but they might help some women. This road has not been easy, we know, but we must continue to be optimistic.

Here’s the state of affairs with some medications addressing lack of sexual desire:

  • Flibanserin, if approved, remains a possible solution for addressing libido problems in premenopausal women who’ve had a breast cancer diagnosis. Flibanserin is a non-hormonal pill that’s believed to balance the brain chemicals (dopamine, norepinephrine, and serotonin) that affect sexual desire. Flibanserin has been shown to be safe and effective in over 11,000 women (though not studied specifically in women who’ve had breast cancer). Studies have demonstrated that flibanserin can increase sexually satisfying events and decrease the distress associated with low desire. This Thursday, June 4, 2015, the FDA will decide whether Flibanserin should be approved. Stay tuned and remain hopeful that the FDA will hear our voices!
  • Bremelanotide, a non-hormonal injectable medication, will be up next. Bremelanotide enhances dopamine, a chemical associated with many kinds of pleasure, including sexual pleasure. Bremelanotide is in phase III clinical trials (the final phase before possible approval) for the treatment of arousal and desire issues in premenopausal women. It’s taken on an as-needed basis, just before sex. Though it has not been studied in women who’ve had breast cancer, it does show promise for the treatment of sexual desire and arousal problems.

Besides potential medications for lowered desire, addressing vaginal dryness and pain is critical, as we’ve discussed in previous columns. There are many over-the-counter products available for moisturizing, lubricating, and enhancing sex. Yes, many of these do come with warnings and precautions if you’ve been diagnosed with breast cancer – so it’s important to talk about your options with your healthcare professional. And if you feel you’ve tried everything and nothing is working, never hesitate to seek a second opinion from another specialist.

It’s also critical to make sure you’re receiving the emotional support you need around these issues. We know that emotions such as frustration and a sense of pain and loss can emerge and make you feel alienated and alone, so it’s important to take care of yourself emotionally and get the support you need. You can find qualified therapists at the American Association of Sexuality Educators, Counselors, and Therapists, or you can ask your healthcare professional about therapists or counselors.

Are there sexual issues we have not mentioned here that are frustrating you no matter what you’ve tried? Please let us know in the comments below. We will be answering your questions in future columns!

Michael L. Krychman, M.D.C.M., is the executive director of the Southern California Center for Sexual Health and Survivorship Medicine in Newport Beach, California. He is the former co-director of the Sexual Medicine and Rehabilitation Program at Memorial Sloan-Kettering Cancer. Dr. Krychman is also an American Association of Sexuality Educators, Counselors and Therapists (AASECT) certified sexual counselor. He is an associate clinical professor at the University of California, Irvine, Division of Gynecological Oncology, and the medical director of Ann’s Clinic, a high-risk program for breast and ovarian cancer survivors. His special interests include menopausal health, hormone therapy, sexual pain disorders, loss of libido, and chronic medical illness and its impact on female sexual function as well as breast cancer sexuality. Dr. Krychman is also a member of the Breastcancer.org Professional Advisory Board.


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