In last month’s
blog posting, we saw that the U.S.
Food and Drug
Administration has considered
lowered sexual interest or lowered libido an unmet
medical need. Many women who have breast
cancer feel like their libido has vanished —
gone and doomed never to return.
With the recent newly published
Diagnostic and Statistical Manual V (DSMV),
Hypoactive Sexual Desire Disorder and
Sexual Arousal Disorder have been combined into one
specific diagnosis: Female Sexual Interest/Arousal Disorder.
Let’s look at some of the factors that help healthcare providers make the
diagnosis.
1. Lack of, or significantly reduced, sexual interest/arousal due to three
of the following:
- absent/reduced interest in sexual activity
- absent/reduced sexual/erotic thoughts or fantasies
- no/reduced initiation of sexual activity and lack of receptivity
- to partner’s attempts to initiate
- absent/reduced sexual excitement/pleasure during sexual activity in
- almost all or all (75%-100%) sexual encounters
- absent/reduced sexual interest/arousal in response to any internal
- or external sexual/erotic cues (written, verbal, visual)
- absent/reduced genital or non-genital sensations during sexual activity
- in almost all or all (75%-100%) sexual encounters
2. Symptoms should be persistent for a minimum of 6 months and should not
be the result of the following:
- a nonsexual mental disorder
- severe relationship distress
- other significant environmental or situational stressors
- effects of substance/medication or other medical conditions
Breast cancer and its treatments may bring some confusion when it comes
to lowered libido. For many women living with cancer, lowered libido may be
a direct result of their diagnosis, and/or treatments or regular medications;
this would exclude them from the “official on-paper diagnosis.” But this does
not mean that we can’t help or suggest some potential solutions to improve
libido! Most women will recover from their surgery, chemotherapy, and radiation
therapy and are tolerating their medications. They use lubricants, have no
sexual pain, and report that their relationships are excellent and supportive.
Yet some report a vanishing sexual mojo — no sexual thoughts or fantasies.
It’s as if they’ve lost an important aspect of their overall sexual function.
How do we manage this challenge? We’ll talk about different approaches in
part two of this column next month! In the meantime, use the comments
area below to let us know if you’ve had difficulty with libido.
Michael L. Krychman, M.D.C.M., is the executive director of the
Southern California Center for Sexual Health and Survivorship Medicine
in Newport Beach, California. He is the former co-director of the
Sexual Medicine and Rehabilitation Program at Memorial Sloan-Kettering
Cancer.
Dr. Krychman is also an American Association of Sexuality Educators,
Counselors and Therapists (AASECT) certified sexual counselor. He is an
associate clinical professor at the University of California, Irvine, Division of
Gynecological Oncology, and the medical director of
Ann’s Clinic, a high-risk program for breast and ovarian cancer survivors.
His special interests include menopausal health, hormone therapy, sexual pain
disorders, loss of libido, and chronic medical illness and its impact on female
sexual function as well as breast cancer sexuality. Dr. Krychman is also a
member of the Breastcancer.org
Professional Advisory Board.
