Assessment of sexual function in postmenopausal breast cancer survivors.

Background: Breast cancer (BC) is considered a risk factor for sexual dysfunction, which may be associated with the diagnosis itself or with oncological treatments. However, sexual dysfunction often remains underdiagnosed and unaddressed among BC survivors. Aim: The study sought to evaluate the sexual function of postmenopausal BC survivors compared with postmenopausal women without BC. Methods: This case-control study included 178 postmenopausal BC survivors (stages I-III), 45 to 70 years of age, with amenorrhea for ≥12 months and sexually active. They were compared with 178 women without BC, matched (±2 years) for age and time since menopause in a 1:1 ratio. Sexual function was evaluated using the Female Sexual Function Index (FSFI), which consists of 6 domains (desire, arousal, lubrication, orgasm, satisfaction, and pain), with a total score ≤26.5 indicating risk of sexual dysfunction. Statistical analysis included Student's t test, chi-square test, and logistic regression (odds ratio [OR]). Outcomes: Evaluation of sexual function in postmenopausal women treated for BC. Results: Postmenopausal BC survivors showed poorer sexual function in the desire domain (P = .002). No significant differences were observed between groups in the other FSFI domains and total score (P > .05). Postmenopausal BC survivors had a higher prevalence of risk of sexual dysfunction (64.6% with a total score ≤26.5) compared with the control group (51.6%) (P = .010). Adjusted risk analysis for age and time since menopause revealed a higher risk of sexual dysfunction in BC survivors compared with women without cancer (OR, 1.98; 95% confidence interval, 1.29-2.96; P = .007). Among BC survivors, the use of hormone therapy was associated with a higher risk of sexual dysfunction (OR, 3.46; 95% confidence interval, 1.59-7.51; P = .002). Clinical Implications: Postmenopausal BC survivors should be regularly assessed before and throughout treatment to enable the early detection and diagnosis of sexual dysfunction. Strength and Limitations: The main strength is that this study might contribute to a better understanding of sexual function in postmenopausal BC survivors compared with women without BC. The main limitation is that while the FSFI is a valid and reliable tool for the evaluation of female sexual function, it does not allow a comprehensive diagnosis of sexual dysfunction, as it is not applicable to partners. Conclusion: Compared with postmenopausal women without BC, postmenopausal BC survivors face a higher risk of sexual dysfunction, especially when treated with adjuvant hormone therapy.

Relationship between breast arterial calcification and coronary artery disease by invasive coronary angiography in postmenopausal women.

PURPOSE: To evaluate the relationship between the presence of BAC and coronary artery disease (CAD) by invasive coronary angiography (ICA) in postmenopausal women. METHODS: In this cross-sectional study, postmenopausal women (age ≥ 45 years) with history of CAD, who underwent both ICA and digitized mammography, within six months of each other, were enrolled. Women who underwent prior percutaneous coronary intervention, or exhibited grade D breast density (BI-RADS®) or breast cancer upon mammography were excluded. Digital mammograms were identified in the electronic medical record system and reviewed for the presence of BAC, without knowledge of the ICA results by two experienced physicians. The ICA results were obtained from the electronic medical record, and categorized as follows: 1-single-vessel disease; 2-two-vessel disease; and 3-multivessel disease (≥3vessels). For statistical analysis Student t test, Gamma distribution, Chi-square test and logistic regression (odds ratio,OR) were used. RESULTS: Of the 183 postmenopausal women evaluated, 39 (21.3 %) had BAC. Women with BAC were older and had a longer time since menopause when compared to women without BAC (68.2 ± 9.6 × 59.6 ± 10.0 years of age and 19 ± 10.1 × 13.5 ± 8.2 years, respectively) (p < 0.0.0001). Among the clinical and cardiovascular characteristics evaluated, only the incidence of smoking was higher in women with BAC (p = 0.007). There was no difference in the number of affected vessels upon ICA in women with or without BAC (p = 0.683). In multivariate analysis, after adjustment for age, time since menopause and smoking, the presence of BAC was not associated with a significant risk of observing a greater number of affected vessels upon ICA (OR1.07; 95 %CI 0.41-2.76, p = 0.609). CONCLUSIONS: The presence of BAC was not associated with the severity of CAD in postmenopausal women.

Association Between Pelvic Floor Muscle Strength and Sexual Function in Postmenopausal Women.

INTRODUCTION: Although pelvic floor muscle (PFM) weakness can be associated with pelvic floor dysfunctions, knowledge about the relationship with sexual dysfunction is limited. AIM: The aim of this study was to evaluate the association between PFM strength and sexual function in postmenopausal women. METHODS: An analytical cross-sectional study was conducted on 226 sexually active heterosexual women aged 45-65 years with amenorrhea >12 months and without pelvic floor disorders. The Female Sexual Function Index (FSFI) was used for the evaluation of sexual function (total score ≤26.5 indicating sexual dysfunction). PFM strength was assessed by bidigital vaginal palpation using the modified Oxford scale (score 0-5) and was categorized into nonfunctional (scores 0-1, without contraction) and functional (scores 2-5, with contraction). Three-dimensional transperineal ultrasound was used to evaluate total urogenital hiatus area, transverse and anteroposterior diameters, and levator ani muscle thickness. MAIN OUTCOME MEASURE: The main outcome measure was to determine the relationship between sexual dysfunction and PFM strength. RESULTS: The participants were classified as functional PFM (n = 143) and nonfunctional PFM (n = 83). There were no differences between groups in clinical and anthropometric parameters. A higher percentage of menopausal hormone therapy users was observed in the group with functional PFM (39.2%) compared to the nonfunctional group (24.1%; P = .043). Women classified as functional PFM exhibited greater levator ani muscle thickness than those classified as nonfunctional (P = .049). Women with nonfunctional PFM had poorer sexual function in the desire (P = .005), arousal (P = .001), and orgasm (P = 0.006) domains and in total FSFI score (P = .006) compared to the functional group. There was a weak positive correlation of PFM strength with the desire (r = 0.35; P = .0003), arousal (r = 0.21; P = .013), and orgasm (r = 0.23; P = .033) domains and with total FSFI score (r = 0.28; P = .004). Ultrasonographic levator ani muscle thickness showed a weak positive correlation with PFM strength (r = 0.21; P = .046) and with the arousal domain (r = 0.23; P = .044). Risk analysis adjusted for age, time since menopause, parity, and body mass index showed a lower risk of sexual dysfunction in menopausal hormone therapy users (odds ratio = 0.26; 95% CI 0.11-0.60; P = .002) and in women with greater levator ani muscle thickness (odds ratio = 0.85; 95% CI 0.73-0.98; P = .025). CLINICAL IMPLICATIONS: The maintenance of PFM strength in the climacteric period is an important factor in postmenopausal women's sexual function. STRENGTH & LIMITATIONS: The main strength of the study is that, to our knowledge, this is the first study that evaluated the correlation of PFM strength and 3D transperineal ultrasound with different domains of sexual function in postmenopausal women. The main limitation is the cross-sectional design does not permit to establish a cause-effect relationship. CONCLUSION: Postmenopausal women with PFM dysfunction have poorer sexual function than women with functional PFM. Omodei MS, Marques Gomes Delmanto LR, Carvalho-Pessoa E, et al. Association Between Pelvic Floor Muscle Strength and Sexual Function in Postmenopausal Women. J Sex Med 2019;16:1938-1946.