Low Sexual Desire in Breast Cancer Survivors and Patients: A Review.

INTRODUCTION: As survival rates for women with breast cancer (BC) continue to improve, sexual dysfunction including low sexual desire is becoming more prevalent. BC diagnosis, treatment, and treatment-induced changes have been shown to affect sexual desire in BC survivors. Understanding low sexual desire and current treatment options will allow practitioners to address it efficaciously to allow for an improved quality of life in women with BC. OBJECTIVES: To review the literature regarding the prevalence, predictors, and current treatments for low sexual desires in BC survivors. METHODS: We performed a PubMed search for English-language articles in peer-reviewed journals between 2005-2021. We used the following keywords: "breast cancer" and "sexual function," "sexual dysfunction," "hypoactive sexual desire disorder", "sex drive" or "sexual desire." Articles featuring a study or survey that evaluated sex drive in women BC survivors or patients, its identification, management or treatment, were reviewed. RESULTS: A total of 37 studies that evaluated the relationship between BC, its treatments and treatment-induced effects on BC survivors and sexual desire were included. Studies indicate that low sexual desire persists throughout the timeline of BC survivors, from BC diagnosis to after treatment. Surgical treatment, body image, and adjuvant hormone therapy are a few factors that influence low sexual desire in BC survivors. Treatment options are efficacious at varying levels and include non-pharmacologic, pharmacologic, and hormonal therapies. CONCLUSIONS: Low sexual desire is prevalent in BC patients and survivors. More research is needed to better evaluate the safety and efficacy of treatment options, particularly pharmacologic and hormonal therapy. Luo F, Link M, Grabenhorst C, et al. Low Sexual Desire in Breast Cancer Survivors and Patients: A Review. Sex Med Rev 2022;10:367-375.

The Use of Pramipexole to Treat Persistent Genital Arousal Disorder: A Case Report.

INTRODUCTION: Persistent Genital Arousal Disorder (PGAD) is defined as "spontaneous, intrusive, and unwanted genital arousal (tingling, throbbing, pulsating) in the absence of sexual interest and desire" and traditionally causes marked distress, embarrassment and shame. PGAD may be caused by starting, discontinuing, or making adjustments in certain antidepressants or other medications. AIM: To report the case of a 36- year- old woman with PGAD, likely due to changes in her psychiatric medications, who was treated with pramipexole and experienced improvement in her PGAD symptoms. METHODS: Patient self-report and literature review. Written informed consent was obtained from the patient. MAIN OUTCOME MEASURE: Improvement in PGAD symptoms. RESULTS: Patient reported improvement in her symptoms by "90%" on a low dose of pramipexole, although higher doses exacerbated her symptoms. CONCLUSIONS: It is likely that an effective treatment window exists for the treatment of PGAD with drugs that possess the ability to exert their control of dopaminergic transmission. This includes direct acting receptor agonists like pramipexole, which produce feedback inhibition. Limitations to their efficacy then involve co-treatments that counteract their ability to exert a dampening effect on hyperstimulated dopamine transmission. It is recommended that clinicians be aware of drugs taken by patients to treat psychiatric disorders that could induce PGAD symptoms, drugs recently discontinued where a rebound effect could lead to PGAD symptoms, and drug mechanisms that could counteract the effect of treatments for PGAD. Lynn BK, Grabenhorst C, Komisaruk BR, et al. The Use of Pramipexole to Treat Persistent Genital Arousal Disorder: A Case Report. Sex Med 2021;9:100372.