A paper diary. It may seem anachronistic or too “old fashioned” in the age of apps, Instagram and Tik Tok, but it isn’t. On the contrary. It is in some ways a very innovative tool, because innovative is what it was designed for. In fact, we are talking about a diary intended to collect the experiences in the field of sexuality of women and men who face breast cancer and its treatments. It is called “My diary of the sexual sphere” and was created by specialists from the Regina Elena IRE-IFO Cancer Institute in Rome to help patients – and male patients, albeit few – to more easily express the impact of the disease and intimacy therapies: both through structured questionnaires and as free text, to collect spontaneous reflections and perceptions.
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Pen in hand
“The project was born from the request of the patients themselves”, says a Breast Health Patrizia Vici, oncologist responsible for the Phase IV Trials Operational Unit at Regina Elena, and among the 4 oncologists who organized the conference ‘Breast Carcinoma in Young People, Fertility, Sexuality, Aesthetics and Surroundings’ in Rome, where the diary was presented. “There are many questions that have been asked to us about sexuality in recent times, especially to us female oncologists – continues Vici – we have therefore thought of a diary to help people express their problems and to collect them in a systematic way. The patients are very precise and correct in writing the diary, we can therefore consider the data reliable. They attest that the size of the problem is much larger than what was thought. It is not surprising: until recently sexual dysfunction caused by the diagnosis of breast cancer and therapies were not a topic of discussion among clinicians.”
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A submerged need
To date, around seventy diaries have been distributed (in two different versions, for women and men) and the project will continue throughout the year. The diaries are given for the first time at the beginning of hormone therapy: patients keep them with them for a week and then return them. The same happens six months later. They contain information on the main consequences of the treatments on sexuality and the questionnaire includes about fifteen questions on sexual desire, symptoms, the number of intercourse had in the last month, and so on. “There has been a lot of word of mouth about the existence of the diary in the ward, which is requested by patients of all ages – continues Vici – Which shows us how much the topic is felt, even though it has remained submerged until now: things have changed positively compared to just 2-3 years ago. Based on the problems reported, many patients are then referred to gynecologists or sexological psycho-oncologists”.
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The rapid induction of menopause through drugs – recall the experts who spoke at the conference today – has a very strong psychological impact especially among younger women – between 20 and 40 years old – who have to face the disappearance of menstruation. The lack of estrogen and testosterone, in addition to a decline in sexual desire, can cause physical discomfort such as the reduction of vaginal lubrication, with dryness and difficulty in intercourse. This is associated with the defensive contraction of the levator ani muscle, which closes the pelvis downwards, narrows the vaginal entrance and causes even more discomfort during intercourse, also increasing the risk of cystitis. Again: the vaginal microbiota, that set of microorganisms that protects the vagina from invading germs during fertile age, could change: without estrogen, lactobacilli disappear and the risk of atrophic vaginitis increases.
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Possible solutions
The importance of preventing sexual disorders emerges strongly from the conference: the earlier the therapeutic intervention, the greater the possibility of preventing the problem or preventing it from worsening. There is no single solution, but a multifactorial approach is needed, underline the experts at Regina Elena: “Non-hormonal anti-inflammatories for local use, such as palmitoylethanolamide in cannulas, facilitate vaginal lubrication. Vaginal probiotics, such as Lactobacillus plantarum P 17630, improve defense capabilities against pathogenic germs, and reduce the risk of vaginitis and cystitis. Some natural supplements, such as dextro-mannose, reduce the aggressiveness of theEscherichia coli and cystitis. Exercises to relax the contracted levator ani muscle, through self-massage with St. John’s Wort oil or palmitoylethanolamide gel, improve the elasticity and well-being of the mucous membranes. And if the return to sexual life becomes difficult, psycho-oncological and sexological consultancy can be useful, understood as an integral part of the treatment process, because it also has a positive impact on adherence to therapies”.
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A topic that is still open and debated is the use of local hormonal therapies – for selected cases and after the end of treatment – on which there are conflicting data and there is no agreement in the scientific community: “The hormonal preparations conflict with the therapies – specifies Vici – And this is also valid, at the moment, topically, endovaginally and cutaneously, because in any case it would involve absorption which is important to avoid, although there are some reassuring studies for some specific cases. The important thing, in any case, is avoid DIY”.
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From beauty treatments to supplements: there is a need for information
Not only sexuality is among the topics discussed at the conference, but quality of life in general. “Every day we receive emails and questions about the possibility of carrying out aesthetic treatments such as Botox and filler injections, of taking supplements and natural remedies or about rehabilitation therapies – underlines the oncologist – There is certainly a lack of information and many false myths dispel. Among the studies presented today, for example, one shows that in Europe a patient with breast cancer spends 300 euros a month, on average, on supplements and useless products. Another very important topic is that of fertility preservation to attempt a pregnancy after cancer. Once upon a time – concludes Vici – we only dealt with therapies and survival rates. Today quality of life is a topic that can no longer be ignored by us oncologists. And it is an injection of optimism for everyone”.
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– 2024-04-12 21:01:21
