The Acceptability, Feasibility, and Efficacy (Phase I/II Study) of the OVERcome (Olive Oil, Vaginal Exercise, and MoisturizeR) Intervention to Improve Dyspareunia and Alleviate Sexual Problems in Women with Breast Cancer

Abstract

Introduction Almost half of breast cancer survivors experience chronic sexual problems. Despite the negative effects of dyspareunia on physical and overall quality of life, sexual dysfunction remains underreported and undertreated in clinical practice. This is likely due to the paucity of evidence-based interventions to improve sexual functioning. Aim The study aims to prospectively evaluate the acceptability, feasibility, and efficacy of a novel intervention (Olive Oil, Vaginal Exercise, and MoisturizeR [OVERcome]) to improve sexual problems following breast cancer treatment. Main Outcome Measures Dyspareunia, sexual functioning, quality of life, distress, and pelvic floor muscles (PFMs) functioning were evaluated. Methods Twenty-five women with dyspareunia were instructed to perform pelvic floor muscle (PFM) relaxation exercises twice/day to prevent/manage PFM overactivity, apply a polycarbophil-based vaginal moisturizer three times/week to alleviate vaginal dryness, use olive oil as a lubricant during intercourse, and complete a weekly compliance diary. PFM relaxation training was administered by a physiotherapist at weeks 0 and 4, with follow-up at weeks 12 and 26. At each visit, women completed validated self-report questionnaires and the physiotherapist recorded objective measures of PFM functioning. Results OVERcome resulted in significant improvements in dyspareunia, sexual function, and quality of life over time (all P < 0.001). PFM relaxation training was reported to be effective (P ≤ 0.001). Maximum benefits were observed at week 12. Most women rated PFM relaxation exercises (92%), vaginal moisturizer (88%), and olive oil (73%) as helpful, indicating that the intervention was acceptable. Unexpectedly, six cases (11%) of vaginal stenosis were noted during initial screening. Conclusions This novel intervention is acceptable to patients with demonstrated efficacy in improving dyspareunia and sexual function following breast cancer. Delivery of the OVERcome intervention appears feasible in a clinical setting, providing a potential treatment for this important clinical issue. The unexpected number of observed cases of stenosis further highlights the underreporting of sexual problems in this population, deserving further exploration.

A clinical guide to the management of genitourinary symptoms in breast cancer survivors on endocrine therapy

“…Lubricants and moisturizers may also be used effectively in combination. An intervention to improve genitourinary symptoms and related sexual issues used a combination of olive oil as a lubricant, pelvic floor muscle relaxation exercises and a vaginal moisturizer, reported improvements in dyspareunia and sexual function in women with breast cancer [Juraskova et al 2013]. Additionally, use of vaginal moisturizers on a regular basis may promote hydration of the epithelium and consequently lubrication of the vaginal wall thus, providing more long-term (2-3 days) relief of symptoms such as itching, irritation and dyspareunia [van der Laak et al 2002].…”

Interventions to Address Sexual Problems in People with Cancer

“…In addition, eight other publications provide evidence of moderately high quality [38][39][40]44,45,[47][48][49] .…”

“…The current evidence does not support a specific psychosocial counselling intervention to improve sexual functioning and satisfaction. The evidence base for this recommendation consists of sixteen publications of moderate quality [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] and four systematic reviews [14][15][16][17] . …”

The Impact of Breast Cancer on Female Sexuality: An Integrative Literature Review

“…< 5 years 12 Andersen, 2009;Barni & Mondin, 1997;Cavalheiro et al, 2012;Herbenick et al, 2008;Takahashi et al, 2008;Jun et al, 2011;Juraskova et al, 2013;Kedde et al, 2013;Panjari, Bell, & Davis, 2011;Safarinejad M, Shafiei, & Safarinejad S, 2013;Sbitt et al, 2011;Yang et al, 2011. Takahashi et al, 2008 (24,7%).…”

“…≥ 6 months after surgery 09 Andersen, 2009;Cavalheiro et al, 2012;Jun et al, 2011;Herbenick et al, 2008;Juraskova et al, 2013;Kedde et al, 2013;Panjari, Bell, & Davis, 2011;Safarinejad M, Shafiei, & Safarinejad S, 2013;Yang et al, 2011. Legend: (FSFI) Female Sexual Function Index, (SFQ) Sexual Function Questionnaire, (CRESQ) Cancer Rehabilitation Evaluation System Questionnaire.…”