Early Detection and Pelvic Floor Rehabilitation for Sexual Dysfunction with or Without Incontinence in the Breast Cancer

Abstract

Najwa Alfarra, Khulood Alrashid, Tola Akomolafe

Introduction: Sexual health is an important aspect of human life, and cancer should not change that. Data suggested that issues related to sexual function are quite common among women treated for cancer ranged from 30% to 100% [1]. However, clinicians often spend little to no time on the topic. However, the treatment options are available. The literature also supports the use of pelvic floor exercises and dilators to improve sexual function and urinary incontinence in women and specially those presenting with orgasm problems [2].

Objective: To explore the effectiveness of the pelvic floor rehabilitation on sexual dysfunction or sexual dysfunction combined with incontinence in the Saudi breast cancer survivors during, or post chemotherapy intervention.

Methods: Thirty breast cancer women who had either sexual dysfunction, or sexual dysfunction combined with incontinence, during or post chemotherapy were evaluated using the Oxford scale for muscle power assessment before and after the intervention. Additionally, FSFI & UDI-6 questionnaire responses were received and analyzed before and after the pelvic floor rehabilitation. The supervised pelvic floor rehabilitation (which included the pelvic floor muscle training (seven Yoga poses: Mountain pose, Tree pose, standing forward bend pose, worrier pose, bridge pose, bound angle pose, and seated twist pose), manual therapy, and dilator) were conducted for 45 minutes once a week for eight weeks (a total of 8 sessions).

Main Outcome Measures: The domain scores of the Female Sexual Function Index-Breast cancer (FSDI-BC) which included desire, arousal, lubrication, orgasm, satisfaction, and pain, were calculated. Furthermore, the domain of the Urinary Distress Inventory (UDI-6) which included frequent urination, urgency leakage, activity leakage, leakage with coughing or sneezing, difficulty emptying the bladder, and pain or discomfort in the lower abdominal or genital area were also analyzed. Muscle power (Oxford scale) was measured before and after the treatment.

Results: All subjects successfully completed the study with no adverse events. Significant improvement in sexual function as assessed by the FSFI-BC indicated that sex desire improved by 86%, sexual arousal improved by 83%, lubrication improved by 76.3%, orgasm improved by 70%, general satisfaction improved by 44-54%, 73.3% felt pain minor, and 23% free of pain during intercourse. Muscle power as measured by the Oxford scale improved from grade 1 or 2 out of 5 to3 or 3+ out of 5. Significant improvement in UDI-6 were also observed in all participants by 80%.

Conclusion: In this study, we observed the influence of chemotherapy side effects for breast cancer on women’s quality of life, sexual function and continence. The study confirmed that Pelvic floor muscle training, manual therapy and dilator use showed significant improvement in the symptoms of continence and sexual function in breast cancer patients.

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