Adjuvant Hormone Therapies, Sexual Dysfunction, and the Role of Physiotherapy
Chemotherapy and adjuvant hormone therapies administered to women as part of post-surgical treatment for breast cancer are significant contributors to the development of genitourinary syndrome (GSM).
The predominant symptoms of GSM include vaginal dryness (100%), dyspareunia (78%), burning sensations (57%), itching (57%), and dysuria (32%).
Among the non-hormonal treatment options for GSM associated with menopause (sudden cessation of menstruation) are pelvic floor exercises. These exercises are taught to affected women by specialized physiotherapists and are performed under guidance, with additional training for a home-based routine.
Pelvic floor muscle training is achieved through a series of exercises designed to improve strength, endurance, and relaxation. These exercises are always conducted under the supervision of a physiotherapist. Numerous studies have demonstrated the proven effectiveness of pelvic floor exercises in managing GSM and addressing its impact, particularly on sexual function and urinary continence.
Pelvic Floor Physiotherapy as First-Line Treatment for GSM
Pelvic floor physiotherapy (PFP) is recommended by the International Continence Society (ICS) as a first-line treatment for GSM and its symptoms, including sexual dysfunction side effects. It positively impacts the quality of life for postmenopausal women and women who have undergone breast cancer treatment.
Pelvic floor muscle training aims to enhance blood circulation and reduce tension in the muscle structures in the pelvis, alleviating pain and improving sexual function.
The low cost and minimal side effects of physiotherapy are additional reasons for its recommendation as a first-line treatment for pelvic floor dysfunction. A 2019 study showed that a 12-week pelvic floor muscle training program helped reduce GSM symptoms.
Although research on GSM remains limited, pelvic floor muscle training programs have proven effective in alleviating vaginal symptoms (dryness, dyspareunia) and improving sexual function across various populations.
For example, women who have survived gynecological cancer and experience symptoms similar to GSM post-menopause showed significant improvements in dyspareunia (pain during sexual intercourse) and sexual dysfunction following a four-week pelvic floor exercise program that included biofeedback sessions. Other studies have shown positive outcomes for sexual dysfunction in women after programs lasting from six weeks to 12 months.
Women Remain Unassisted Despite Effective Physiotherapy Solutions
Despite the safe and effective therapeutic options offered by physiotherapy for GSM symptoms post-menopause, most women experiencing these symptoms as a side effect of breast cancer treatment remain untreated. To date, physiotherapy has not been widely adopted as a treatment option and is not commonly recognized among patients or healthcare professionals caring for them.
Moreover, discussions about these symptoms are predominantly initiated by women themselves (85%). Potential reasons for women not seeking treatment include a lack of awareness about the natural progression of GSM, the availability of safe and effective treatments, and concerns about cost or the challenges of specific therapeutic approaches.
Healthcare providers may not address treatment options for GSM symptoms due to limited knowledge about the syndrome or its impact on women’s lives. Approximately 50% of women with breast cancer hesitate to discuss GSM symptoms with healthcare professionals and turn to alternative therapies lacking scientific validation. According to a European study conducted in 2014, only 10.3% of healthcare professionals are familiar with managing GSM symptoms. As a result, genitourinary and sexual concerns are often overlooked and left unaddressed.
The misconception that GSM symptoms should only be treated in sexually active women further contributes to the lack of treatment, negatively impacting women’s mental health. A study conducted in Cyprus examined the psychological and spiritual health effects on women diagnosed with breast cancer. It concluded that supportive mechanisms providing education and information are essential for better management of the condition and the associated negative emotions and psychological fluctuations.
Source: Clinical Obstetrics and Gynecology, Mimi Marcellou, PT PRAXIS®
