Dryness and Pain after Breast Cancer Treatment (GSM) – How to Make it Better

Dryness and Pain after Breast Cancer Treatment (GSM) – How to Make it Better

There’s a new medical term for an old and too familiar problem. It’s called Genitourinary Syndrome of Menopause or GSM and it is the medical term for a group of symptoms that include dryness of the vagina and skin area outside the vagina, burning, and irritation. It also includes painful sex, urinary symptoms, and recurring urinary tract infection (UTI).


For the 3.1 million breast cancer survivors in the United States, fighting breast cancer has been the priority. But once treatment is over, there may be quality of life issues due to genitourinary syndrome of menopause that need help.


Treatments for GSM for Women With Breast Cancer

Treatment Notes
Education Talk with your provider about your options
Counseling/Sex Therapy Can also provide relationship help
Lubricants/Moisturizers Avoid glycerin, parabens, propylene glycol; Can use with hormone/non-hormone treatment
Vaginal Dilators Gently stretches vaginal tissues to lower discomfort  
Vibrators May increase natural lubrication
Pelvic Floor Physical Therapy PT specialists can be found at www.womenshealthapta.org
Vaginal Estrogen Use when above treatments are not effective; Can be taken with tamoxifen; Discuss with your MD   
Vaginal DHEA Not tested in breast cancer patients
Ospemifene (SERM) Oral medication, approved in breast cancer patients in Europe, not in US
Lidocaine (aqueous 4%) Apply with cotton ball 3 minutes before sex
Vaginal laser Expensive, usually requires 3 treatments. Initial studies promising.


GSM is a challenging problem that affects more than half of all menopausal women, and it’s even more common in breast cancer survivors because treatment (chemotherapy, radiation and/or surgery), and the adjuvant post-treatments such as gonadotropin-releasing hormone (GnRh) agonists, aromatase inhibitors (AIs), or certain selective estrogen-receptor modulators (SERMs; eg, tamoxifen, raloxifene) all lead to lower estrogen levels in survivors, which cause the symptoms.


In addition, the time span for recommended use of these adjuvant post-treatments has been increasing from five to ten years. With concerns surrounding estrogen and breast cancer, most survivors are not considered a candidate for systemic hormone replacement therapy.


During my interview for Hot Years magazine, Dr. Stephanie Faubion, Director of the Office of Women’s Health at Mayo Clinic in Rochester, Minnesota, said that “satisfaction with sexual activity is a huge problem for most women after breast cancer treatment.” And they are not getting help with this issue. Only 39% of women with documented GSM symptoms receive any form of treatment or receive a referral for treatment.


For that reason, members of the North American Menopause Society (NAMS) and the International Society for the Study of Women’s Sexual Health (ISSWSH), formed a panel to create a consensus statement for what the best treatment should be for women breast cancer survivors with GSM.  


Talk with your healthcare provider if you have been treated for breast cancer and are having problems with dryness, pain, irritation and burning.  Healthcare providers who identify GSM in their patients are being encouraged to start a conversation with the women. As example, your healthcare provider might state, “Many women after menopause who have undergone breast cancer treatment have concerns about sexual function. What about you?” More detailed questions can follow. The goal is to begin the conversation. Especially since there are treatments available.


For more information on GSM and Breast Cancer and other midlife issues for women with or without breast cancer, download your free subscription to Hot Years Magazine by visiting www.HotYearsMag.com. Available for all digital devices. For more information on how to talk with your doctor about sexual health and start improving things right away, Click Here.

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