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Effect of Tamoxifen on Sexual Functioning in Patients With Breast Cancer

From the Department of Medicine, Division of Medical Oncology, and Departments of Pathology, Statistics, and Health Psychology, Washington University, St. Louis, MO; and Department of Psychiatry and the Lombardi Cancer Center, Georgetown University Medical Center, Washington, DC.

Address reprint requests to Joanne Mortimer, MD, Washington University, Box 8056, 660 S Euclid Ave, St. Louis, MO 63110; email joanne{at}visar.wustl.edu

PURPOSE: To define the incidence of sexual dysfunction in a population of women with breast cancer treated with tamoxifen.

PATIENTS AND METHODS: Breast cancer patients with a performance status of 0 to 2 who had been treated with tamoxifen for 2 to 24 months completed the following measures: the Center for Epidemiologic Studies–Depression Scale, the Sexual History Form, and the Breast Cancer Prevention Trial Symptom Checklist. Forty-nine of the participants underwent gynecologic examinations with vaginal smears for determination of estrogen effect.

RESULTS: Fifty-seven women were entered onto the trial. Sexual desire, arousal, and ability to achieve orgasm were comparable to norms established in participants in the Tamoxifen Prevention Trial (National Surgical Adjuvant Breast and Bowel Project P-01). Pain, burning, or discomfort with intercourse was reported in 54% of patients and did not correlate with age, surgical treatment of the primary cancer, or chemotherapy. Estrogen effect was seen on the vaginal smears of 34 of 49 participants and was more common in older patients (P = .054). The presence of estrogen effect correlated with negative reactions during sex (P = .02) and vaginal dryness or tightness (P = .046).

CONCLUSION: Women treated with tamoxifen in the adjuvant setting experienced symptoms of sexual dysfunction. The individual contributions of chemotherapy and tamoxifen to sexual dysfunction warrant prospective study.

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