Sexual dysfunction after premenopausal Stage I and II breast cancer: Do androgens play a role?
Sexual dysfunction after premenopausal Stage I and II breast cancer: Do androgens play a role?
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DOI：
10.1111/j.1743-6109.2008.00893.x
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发表时间：
2008-08-01
影响因子：
3.5
通讯作者：
Bitzer, Johannes
中科院分区：
文献类型：
--
作者：
Alder, Judith;Zanetti, Rosanna;Bitzer, Johannes
导论.乳腺癌后的性功能障碍被归因于多种治疗相关和心理因素。关于治疗诱导的睾酮减少在乳腺癌幸存者性问题发展中的作用的数据仍然没有定论。然而，雄激素代谢物是总雄激素活性的更可靠的测量方法。检测乳腺癌患者的总雄激素活性水平，并探讨乳腺癌后性功能障碍的相关预测因素。29例绝经前诊断为I期或II期乳腺癌并终止辅助治疗的患者完成了关于性行为、关系质量、身体形象和抑郁的问卷调查。此外，采集血液样本进行性类固醇分析。主要结果指标。女性性功能指数（FSFI）、关系（PFB）、贝克抑郁量表和欧洲癌症研究和治疗组织生活质量问卷。二氢表雄酮、二氢表雄酮硫酸盐、雄烯二酮、17 β-二醇、睾酮、二氢睾酮、雄酮和ADT-G、3-α-二醇-3G、3-α-二醇-17 G的分析。低水平的性类固醇反映了药物诱导的绝经后状态，与化疗治疗类型无关。68%的研究组存在性功能障碍。有化疗史的女性在所有FSFI领域都受到更大的影响。唯一能预测性欲的因素是关系质量，而化疗则能预测性唤起、润滑、性高潮和性疼痛等问题。性满意度和较高的FSFI总分与较好的关系质量和无化疗史有关，分别解释了54.2%和49.7%的方差。乳腺癌后的性功能障碍是常见的，女性应该在治疗的早期阶段得到适当的告知。必须考虑与人相关的既存因素，提供具体干预措施，并应支持高危夫妇在乳腺癌后过渡到性生活。
Introduction. Sexual dysfunction after breast cancer has been attributed to a variety of treatment associated and psychological factors. Data on the role of a treatment-induced decrease of testosterone for the development of sexual problems in breast cancer survivors have remained inconclusive. However, androgen metabolites constitute a more reliable measure for total androgen activity.Aim. To measure levels of total androgen activity in breast cancer patients and to investigate relevant predictors of sexual dysfunction after breast cancer.Methods. Twenty-nine patients with a premenopausal diagnosis of Stage I or II breast cancer and terminated adjuvant treatment, completed questionnaires on sexuality, quality of relationship, body image, and depression. In addition, blood samples were taken for the analysis of sex steroids.Main outcome measures. Female Sexual Function Index (FSFI), Relationship (PFB), Beck Depression Inventory, and European Organization for Research and Treatment of Cancer quality of life questionnaire. Analysis of dihydroepiandrosterone, dihydroepiandrosterone-sulfate, androstenedione, 17 beta-diol, testosterone, dihydrotestosterone, androsterone, and ADT-G, 3-alpha-diol-3G, 3-alpha-diol-17G.Results. Low levels of sex steroids reflected the medication-induced postmenopausal status independent of the type of chemotherapy treatment. Sexual dysfunction was present in 68% of the study group. Women with a history of chemotherapy were more affected in all of the FSFI-domains. The only predictor for desire was quality of relationship, while chemotherapy was predictive for problems with arousal, lubrication, orgasm, and sexual pain. Sexual satisfaction and higher FSFI sum scores were predicted by better quality of relationship and no history of chemotherapy, together explaining 54.2% and 49.7% of the variance.Conclusions. Sexual dysfunction after breast cancer is common and women should be informed properly at an early stage of treatment. Specific interventions have to be offered considering person-related preexisting factors and couples at risk should be supported in the transition to sexual life after breast cancer.