Alder Judith, Zanetti Rosanna, Wight Edward, Urech Corinne, Fink Nadine, Bitzer Johannes
University Hospital Basel, Department Obstetrics and Gynecology, Basel, Switzerland.
J Sex Med. 2008 Aug;5(8):1898-906. doi: 10.1111/j.1743-6109.2008.00893.x. Epub 2008 Jun 28.
Sexual dysfunction after breast cancer has been attributed to a variety of treatment associated and psychological factors. Data on the role of a treatment-induced decrease of testosterone for the development of sexual problems in breast cancer survivors have remained inconclusive. However, androgen metabolites constitute a more reliable measure for total androgen activity.
To measure levels of total androgen activity in breast cancer patients and to investigate relevant predictors of sexual dysfunction after breast cancer.
Twenty-nine patients with a premenopausal diagnosis of Stage I or II breast cancer and terminated adjuvant treatment, completed questionnaires on sexuality, quality of relationship, body image, and depression. In addition, blood samples were taken for the analysis of sex steroids.
Female Sexual Function Index (FSFI), Relationship (PFB), Beck Depression Inventory, and European Organization for Research and Treatment of Cancer quality of life questionnaire. Analysis of dihydroepiandrosterone, dihydroepiandrosterone-sulfate, androstenedione, 17beta-diol, testosterone, dihydrotestosterone, androsterone, and ADT-G, 3-alpha-diol-3G, 3-alpha-diol-17G.
Low levels of sex steroids reflected the medication-induced postmenopausal status independent of the type of chemotherapy treatment. Sexual dysfunction was present in 68% of the study group. Women with a history of chemotherapy were more affected in all of the FSFI-domains. The only predictor for desire was quality of relationship, while chemotherapy was predictive for problems with arousal, lubrication, orgasm, and sexual pain. Sexual satisfaction and higher FSFI sum scores were predicted by better quality of relationship and no history of chemotherapy, together explaining 54.2% and 49.7% of the variance.
Sexual dysfunction after breast cancer is common and women should be informed properly at an early stage of treatment. Specific interventions have to be offered considering person-related preexisting factors and couples at risk should be supported in the transition to sexual life after breast cancer.
乳腺癌后的性功能障碍归因于多种与治疗相关的因素和心理因素。关于治疗引起的睾酮降低在乳腺癌幸存者性功能问题发展中所起作用的数据尚无定论。然而，雄激素代谢产物是衡量总雄激素活性更可靠的指标。
测量乳腺癌患者的总雄激素活性水平，并调查乳腺癌后性功能障碍的相关预测因素。
29例绝经前诊断为I期或II期乳腺癌且已完成辅助治疗的患者，完成了关于性、关系质量、身体形象和抑郁的问卷调查。此外，采集血样用于分析性类固醇。
女性性功能指数（FSFI）、关系问卷（PFB）、贝克抑郁量表以及欧洲癌症研究与治疗组织生活质量问卷。分析硫酸脱氢表雄酮、硫酸脱氢表雄酮、雄烯二酮、17β -二醇、睾酮、双氢睾酮、雄酮以及ADT - G、3-α -二醇-3G、3-α -二醇-17G。
性类固醇水平低反映了药物诱导的绝经后状态，与化疗类型无关。68%的研究组患者存在性功能障碍。有化疗史的女性在所有FSFI领域受影响更大。欲望的唯一预测因素是关系质量，而化疗是性唤起、润滑、性高潮和性交疼痛问题 的预测因素。关系质量较好且无化疗史可预测性满意度和更高的FSFI总分，二者共同解释了54.2%和49.7%的方差。
乳腺癌后的性功能障碍很常见，应在治疗早期对女性进行适当告知。必须根据个体相关的既往因素提供具体干预措施，并且应该支持有风险的夫妻在乳腺癌后过渡到性生活。
