Mary Lou Willard French Professor of Nursing
University of Michigan School of Nursing
Ann Arbor, Michigan
Changes in sexual health and functioning have been reported in over 50% of women who have been diagnosed with breast or gynecologic cancer. Declines in sexual health can last well beyond the course of cancer treatment. These issues are unfortunately not a part of standard cancer care in most cases. There are several potential reasons for this, including a lack of effective interventions, a discomfort with speaking about sexual function from both the provider and patient perspective, and lack of a comprehensive, individualized approach. Studies have shown that vaginal symptoms (dryness and pain with intercourse), partner communication, and energy are all important predictors of a decline in sexual health. Dr. Barton’s BCRF research has focused on this issue and in the last year, her group has shown that vaginal moisturizers containing a low dose of the hormone, dehydroepiandosterone (DHEA), can improve vaginal symptoms. In the coming year, she will design a three-part intervention to address the impact of cancer diagnosis and treatment on 1) vaginal dryness and pain, 2) body image and sexual self-image, and 3) loss of libido resulting from decreases in sexual energy and motivation. The interventions will include vaginal DHEA cream to improve arousal and decrease pain and dryness, a cognitive-behavioral intervention for enhancing body and sexual self-image, and exploration of the use of an antidepressant as a means to improve sexual desire, motivation and energy. If successful, these combined interventions could become part of a comprehensive individualized approach to preserve sexual health in women with breast cancer.
Debra Barton been a funded investigator in oncology symptom management since 2002, having developed, implemented and completed 11 large multi-site intervention trials. She has developed phase II and III clinical trials in a variety of symptoms including fatigue, hot flashes, peripheral neuropathy, sleep problems, cognitive changes related to chemotherapy, nausea and vomiting, and sexual health, using behavioral interventions such as hypnosis and imagery as well as dietary supplements. Three previously completed trials have demonstrated promising positive effects; a topical gel for peripheral neuropathy, American ginseng for cancer related fatigue and vaginal dehydroepiandosterone (DHEA) for vaginal symptoms. She also completed a pilot study showing positive effects on hot flashes from hypnosis alone that were equal to the improvement seen with an antidepressant known to help hot flashes. Dr. Barton is currently developing a comprehensive multi-faceted intervention for improving sexual health for women with a history of cancer that involves both pharmacologic and non-pharmacologic components that address physiologic, psychosocial and cognitive variables that impact sexual health. Therefore, her approach to symptom management is to address symptoms from multiple perspectives, using more than one intervention, to reduce symptoms with minimal to no side effects.