by Lauren Streicher, MD
For the woman who is newly contending with a diagnosis of breast cancer and dealing with the overwhelming stress of surgery, chemotherapy and radiation, sex is usually the last thing on her mind. The emphasis is, and should be, on treating the cancer. But after the physical scars have healed and hair has grown back, the consequences on a woman’s sexuality are often minimized. Sadly, many cancer survivors feel reluctant to complain about something as “trivial” as the loss of their sex life. It’s not unusual for a breast cancer survivor to attempt intercourse, only to find what was once satisfying and enjoyable is intolerable and upsetting, If she is brave enough to bring it up to her doctor, it’s typical to not get a lot of advice beyond “buy a lubricant” When that doesn’t work most women give up, assuming that vaginal estrogen, the most successful way to reverse vaginal dryness and intercourse, are just not an option.
Even if a doctor does give the go ahead, many women take one look at the package insert that practically has a skull and cross bones on it and decide it just isn’t worth the risk.
I published a study in 2013 in The Journal of Sexual Medicine showing a majority of gynecologists would themselves use vaginal estrogen even if they had breast cancer. It’s not that gynecologists are more willing than the general population to risk their lives in the name of having good sex, it’s that gynecologists know that the Black Box Warning that lists the dangers of using estrogen is not based on data that has anything to do with vaginal estrogen, much less women with breast cancer who use vaginal estrogen.
Today, the American College of Obstetricians and Gynecologists (ACOG) released a position statement very clearly stating that the use of estrogen in women with a history of an estrogen dependent breast cancer is safe and appropriate . ACOG states, " Data do not show an increased risk of cancer recurrence among women currently undergoing treatment for breast cancer or those with a personal history of breast cancer who use vaginal estrogen to relieve urogenital symptoms. "
Since there is essentially no evidence that using a tiny amount of estrogen directly on vaginal tissues to increase lubrication and elasticity of tissue that has become thin and dry causes an increased risk of breast cancer recurrence, it is time for the FDA to remove the scary, inappropriate black box warnings. Clearly the miniscule amount of estrogen absorbed from the vaginal use of estrogen doesn’t even increase blood estrogen levels above the normal menopausal range andis not risky. And in fact, what little data there is regarding the use of vaginal estrogen in women with breast cancer is very reassuring. One study which was published in a medical journal (Climacteric 2003; 6:45-52) followed 1,472 breast cancer patients who routinely used vaginal estrogen and were found to have a LOWER recurrence rate than women who did not use vaginal estrogen.
Most breast surgeons and oncologists are now comfortable allowing women with breast cancer to use vaginal estrogen. Ultimately, you need to do what you are comfortable with, but if you do decide to use vaginal estrogen, it should ease your anxiety a lot knowing not only most gynecologists, but alsoACOG is now firmly on board.