Advertisement

The management of sexuality, intimacy, and menopause symptoms (SIMS) after prophylactic bilateral salpingo-oophorectomy: How to maintain sexual health in “previvors”

  • Author Footnotes
    1 These authors contributed equally to this work.
    Mehida Alexandre
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, CT, USA
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.
    Jonathan Black
    Correspondence
    Corresponding author at: 333 Cedar St New Haven, CT, 06510, USA.
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, CT, USA
    Search for articles by this author
  • Margaret Whicker
    Affiliations
    Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, CT, USA
    Search for articles by this author
  • Mary Jane Minkin
    Affiliations
    Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, CT, USA
    Search for articles by this author
  • Author Footnotes
    2 Dr. Elena Ratner is the Section Chief of Gynecologic Oncology and Director of the Sexuality, Intimacy, and Menopausal Symptoms (SIMS) Clinic at Yale School of Medicine.
    Elena Ratner
    Footnotes
    2 Dr. Elena Ratner is the Section Chief of Gynecologic Oncology and Director of the Sexuality, Intimacy, and Menopausal Symptoms (SIMS) Clinic at Yale School of Medicine.
    Affiliations
    Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, CT, USA
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.
    2 Dr. Elena Ratner is the Section Chief of Gynecologic Oncology and Director of the Sexuality, Intimacy, and Menopausal Symptoms (SIMS) Clinic at Yale School of Medicine.

      Highlights

      • “Previvors” are individuals who have a genetic predisposition to cancer.
      • For premenopausal women, the removal of ovaries results in immediate menopause.
      • Sexuality, Intimacy, and Menopausal Symptoms (SIMS) are a significant.
      • Sexuality, Intimacy, and Menopausal Symptoms are underreported by patients and underdiagnosed by practitioners.
      • Treatment requires identification of the problem and a willingness to treat it.

      Abstract

      “Previvors”, or “pre-survivors”, are individuals who do not have cancer but have a genetic predisposition to cancer. One such example is women with BRCA mutations. As a result of their predisposition to cancer, many will undergo a bilateral salpingo-oophorectomy when they are premenopausal. For premenopausal women, the removal of ovaries results in the depletion of estrogen, immediate menopause, and, in many cases, resultant Sexuality, Intimacy, and Menopausal Symptoms (SIMS). Furthermore, they may undergo changes in body image. SIMS are underreported by patients and underdiagnosed by practitioners. At the time of diagnosis or at preoperative visits, women should be informed of the potential physiologic, hormonal, and psychosocial effects of their risk-reducing surgery. There are many modalities for management of these symptoms. Successful treatment requires the provider’s awareness of the problem, ability to identify it, and willingness to treat it.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Maturitas
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cruz G.
        Top ten buzzwords: previvor.
        Time. 2007; : 2013
        • Wilmoth M.C.
        • Hatmaker-Flanigan E.
        • LaLoggia V.
        • Nixon T.
        Ovarian cancer survivors: qualitative analysis of the symptom of sexuality.
        Oncol. Nurs. Forum. 2011; 38: 699-708
        • Kuusisto K.M.
        • Bebel A.
        • Vihinen M.
        • Schleutker J.
        • Sallinen S.-L.
        Screening for BRCA1, BRCA2, CHEK2, PALB2, BRIP1, RAD50, and CDH1 mutations in high-risk Finnish BRCA1/2-founder mutation-negative breast and/or ovarian cancer individuals.
        Breast Cancer Res. 2011; 13: R20
        • Minion L.E.
        • Dolinsky J.S.
        • Chase D.M.
        • Dunlop C.L.
        • Chao E.C.
        • Monk B.J.
        Hereditary predisposition to ovarian cancer, looking beyond BRCA1/BRCA2.
        Gynecol. Oncol. 2015; 137: 86-92
        • Walsh T.
        • Casadei S.
        • Lee M.K.
        • Pennil C.C.
        • Nord A.S.
        • Thornton A.M.
        • Roeb W.
        • Agnew K.J.
        • Stray S.M.
        • Wickramanayake A.
        • Norquist B.
        • Pennington K.P.
        • Garcia R.L.
        • King M.-C.
        • Swisher E.M.
        Mutations in 12 genes for inherited ovarian fallopian tube, and peritoneal carcinoma identified by massively parallel sequencing.
        Proc. Natl. Acad. Sci. U. S. A. 2011; 108: 18032-18037
        • Antoniou A.
        • Pharoah P.D.P.
        • Narod S.
        • Risch H.A.
        • Eyfjord J.E.
        • Hopper J.L.
        • Loman N.
        • Olsson H.
        • Johannsson O.
        • Borg Å.
        • Pasini B.
        • Radice P.
        • Manoukian S.
        • Eccles D.M.
        • Tang N.
        • Olah E.
        • Anton-Culver H.
        • Warner E.
        • Lubinski J.
        • Gronwald J.
        • Gorski B.
        • Tulinius H.
        • Thorlacius S.
        • Eerola H.
        • Nevanlinna H.
        • Syrjäkoski K.
        • Kallioniemi O.-P.
        • Thompson D.
        • Evans C.
        • Peto J.
        • Lalloo F.
        • Evans D.G.
        • Easton D.F.
        Average risks of Breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case series unselected for family history: a combined analysis of 22 studies.
        Am. J. Hum. Genet. 2003; 72: 1117-1130
        • Hoskins L.M.
        • Roy K.M.
        • Greene M.H.
        Toward a new understanding of risk perception among young female BRCA1/2 previvors.
        Fam. Syst. Health. 2012; 30: 32
        • Randall L.M.
        • Pothuri B.
        The genetic prediction of risk for gynecologic cancers.
        Gynecol. Oncol. 2016; 141: 10-16
        • Kim S.H.
        • Frey M.K.
        • Blank S.V.
        Occult tubal carcinoma found at risk reducing salpingectomy in a BRCA1 carrier.
        Gynecol. Oncol. Case Rep. 2014; 9: 1-2
        • Gaughan E.M.G.
        • Walsh T.A.
        Risk-reducing surgery for women at high risk of epithelial ovarian cancer.
        Obstetr. Gynaecol. 2014; 16: 185-191
        • Kauff N.D.
        • Domchek S.M.
        • Friebel T.M.
        • Robson M.E.
        • Lee J.
        • Garber J.E.
        • Isaacs C.
        • Evans D.G.
        • Lynch H.
        • Eeles R.A.
        • Neuhausen S.L.
        • Daly M.B.
        • Matloff E.
        • Blum J.L.
        • Sabbatini P.
        • Barakat R.R.
        • Hudis C.
        • Norton L.
        • Offit K.
        • Rebbeck T.R.
        Risk-reducing salpingo-oophorectomy for the prevention of BRCA1- and BRCA2-associated breast and gynecologic cancer: a multicenter prospective study.
        J. Clin. Oncol. 2008; 26: 1331-1337
        • Andriole G.L.
        • Levin D.L.
        • Crawford E.D.
        • Gelmann E.P.
        • Pinsky P.F.
        • Chia D.
        • Kramer B.S.
        • Reding D.
        • Church T.R.
        • Grubb R.L.
        • Izmirlian G.
        • Ragard L.R.
        • Clapp J.D.
        • Prorok P.C.
        • Gohagan J.K.
        • PLCO Project Team
        Prostate cancer screening in the prostate, lung, colorectal and ovarian (PLCO) cancer screening trial: findings from the initial screening round of a randomized trial.
        J. Natl. Cancer Inst. 2005; 97: 433-438
        • Finch A.P.M.
        • Lubinski J.
        • Møller P.
        • Singer C.F.
        • Karlan B.
        • Senter L.
        • Rosen B.
        • Maehle L.
        • Ghadirian P.
        • Cybulski C.
        • Huzarski T.
        • Eisen A.
        • Foulkes W.D.
        • Kim-Sing C.
        • Ainsworth P.
        • Tung N.
        • Lynch H.T.
        • Neuhausen S.
        • Metcalfe K.A.
        • Thompson I.
        • Murphy J.
        • Sun P.
        • Narod S.A.
        Impact of oophorectomy on cancer incidence and mortality in women with a BRCA1 or BRCA2 mutation.
        J. Clin. Oncol. 2014; 32: 1547-1553
        • Rebbeck T.R.
        • Kauff N.D.
        • Domchek S.M.
        Meta-analysis of risk reduction estimates associated with risk-reducing salpingo-oophorectomy in BRCA1 or BRCA2 mutation carriers.
        J. Natl. Cancer Inst. 2009; 101: 80-87
        • Domchek S.M.
        • Friebel T.M.
        • Singer C.F.
        • Evans D.G.
        • Lynch H.T.
        • Isaacs C.
        • Garber J.E.
        • Neuhausen S.L.
        • Matloff E.
        • Eeles R.
        • Pichert G.
        • Van t’veer L.
        • Tung N.
        • Weitzel J.N.
        • Couch F.J.
        • Rubinstein W.S.
        • Ganz P.A.
        • Daly M.B.
        • Olopade O.I.
        • Tomlinson G.
        • Schildkraut J.
        • Blum J.L.
        • Rebbeck T.R.
        Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality.
        JAMA. 2010; 304: 967-975
        • Kwon J.S.
        • Tinker A.
        • Pansegrau G.
        • McAlpine J.
        • Housty M.
        • McCullum M.
        • Gilks C.B.
        Prophylactic salpingectomy and delayed oophorectomy as an alternative for BRCA mutation carriers.
        Obstet. Gynecol. 2013; 121: 14-24
        • Moorman P.G.
        • Havrilesky L.J.
        • Gierisch J.M.
        • Coeytaux R.R.
        • Lowery W.J.
        • Peragallo Urrutia R.
        • Dinan M.
        • McBroom A.J.
        • Hasselblad V.
        • Sanders G.D.
        • Myers E.R.
        Oral contraceptives and risk of ovarian cancer and breast cancer among high-risk women: a systematic review and meta-analysis.
        J. Clin. Oncol. 2013; 31: 4188-4198
        • Friebel T.M.
        • Domchek S.M.
        • Rebbeck T.R.
        Modifiers of cancer risk in BRCA1 and BRCA2 mutation carriers: a systematic review and meta-analysis.
        J. Natl. Cancer Inst. 2014; 106https://doi.org/10.1093/jnci/dju091
        • Erlik Y.
        • Meldrum D.R.
        • Judd H.L.
        Estrogen levels in postmenopausal women with hot flashes.
        Obstet. Gynecol. 1982; 59: 403-407
        • Randall C.L.
        • Birtch P.K.
        • Harkins J.L.
        Ovarian function after the menopause.
        Am. J. Obstet. Gynecol. 1957; 74 (discussion 729–732): 729
        • Finch A.
        • Metcalfe K.A.
        • Chiang J.K.
        • Elit L.
        • McLaughlin J.
        • Springate C.
        • Demsky R.
        • Murphy J.
        • Rosen B.
        • Narod S.A.
        The impact of prophylactic salpingo-oophorectomy on menopausal symptoms and sexual function in women who carry a BRCA mutation.
        Gynecol. Oncol. 2011; 121: 163-168
        • Celik H.
        • Gurates B.
        • Yavuz A.
        • Nurkalem C.
        • Hanay F.
        • Kavak B.
        The effect of hysterectomy and bilaterally salpingo-oophorectomy on sexual function in post-menopausal women.
        Maturitas. 2008; 61: 358-363
        • Leiblum S.R.
        • Koochaki P.E.
        • Rodenberg C.A.
        • Barton I.P.
        • Rosen R.C.
        Hypoactive sexual desire disorder in postmenopausal women: US results from the Women’s International Study of Health and Sexuality (WISHeS).
        Menopause. 2006; 13: 46-56
        • Nappi R.E.
        • Lachowsky M.
        Menopause and sexuality: prevalence of symptoms and impact on quality of life.
        Maturitas. 2009; 63: 138-141
        • Judd H.L.
        • Judd G.E.
        • Lucas W.E.
        • Yen S.S.C.
        Endocrine function of the postmenopausal ovary: concentration of androgens and estrogens in ovarian and peripheral vein blood.
        J. Clin. Endocrinol. Metab. 1974; 39: 1020-1024
        • Akkuzu G.
        • Ayhan A.
        Sexual functions of Turkish women with gynecologic cancer during the chemotherapy process.
        Asian Pac. J. Cancer Prev. 2013; 14: 3561-3564
        • Judd H.L.
        Hormonal dynamics associated with the menopause.
        Clin. Obstet. Gynecol. 1976; 19: 775-788
        • Michelsen T.M.
        • Dørum A.
        • Tropé C.G.
        • Fosså S.D.
        • Dahl A.A.
        Fatigue and quality of life after risk-reducing salpingo-oophorectomy in women at increased risk for hereditary breast-ovarian cancer.
        Int. J. Gynecol. Cancer. 2009; 19: 1029-1036
      1. WHO. | Defining sexual health, (2014). http://www.who.int/reproductivehealth/topics/sexual_health/sh_definitions/en/ (Accessed 5 March 2017).

        • Robinson B.
        • Feldman J.
        • Striepe M.
        • Raymond N.
        • Mize S.
        Women’s sexual health: an interdisciplinary approach to treating low sexual desire.
        Minn. Med. 2003; 86: 34-41
        • Hollingsworth M.
        • Berman J.
        The role of androgens in female sexual dysfunction.
        Sex. Reprod. Menopause. 2006; 4: 27-32
        • Gladu R.H.
        Female sexual dysfunction: classification, physiology, diagnosis and treatment.
        J. Sex. Reprod. Med. 2002; 2: 21-27
        • Rhodes J.C.
        • Kjerulff K.H.
        • Langenberg P.W.
        • Guzinski G.M.
        Hysterectomy and sexual functioning.
        JAMA. 1999; 282: 1934-1941
        • Fang C.Y.
        • Cherry C.
        • Devarajan K.
        • Li T.
        • Malick J.
        • Daly M.B.
        A prospective study of quality of life among women undergoing risk-reducing salpingo-oophorectomy versus gynecologic screening for ovarian cancer.
        Gynecol. Oncol. 2009; 112: 594-600
        • Hawighorst S.
        • Schonefuss G.
        • Konig Y.
        • Trautmann K.
        • Knapstein P.G.
        Genital cancer: the impact of surgery on quality of life-a prospective longitudinal study.
        Psycho-Oncology. John Wiley & Sons Ltd., Baffins Lane Chichester, W Sussex PO19 1UD, England2001: S24
        • Hawighorst-Knapstein S.
        • Fusshoeller C.
        • Franz C.
        • Trautmann K.
        • Schmidt M.
        • Pilch H.
        • Schoenefuss G.
        • Georg Knapstein P.
        • Koelbl H.
        • Kelleher D.K.
        • Vaupel P.
        The impact of treatment for genital cancer on quality of life and body image—results of a prospective longitudinal 10-year study.
        Gynecol. Oncol. 2004; 94: 398-403
        • Hawighorst S.
        • Schonefuss G.
        • Konig Y.
        • Trautmann K.
        • Knapstein P.G.
        Women with cancer: impact of genital surgery on partnership and sexuality.
        Psycho-Oncology. John Wiley & Sons Ltd., BAFFINS LANE CHICHESTER, W SUSSEX PO19 1UD, ENGLAND2001: S79
        • Reis N.
        • Beji N.K.
        • Coskun A.
        Quality of life and sexual functioning in gynecological cancer patients: results from quantitative and qualitative data.
        Eur. J. Oncol. Nurs. 2010; 14: 137-146
        • Traa M.J.
        • De Vries J.
        • Roukema J.A.
        • Rutten H.J.T.
        • Den Oudsten B.L.
        The sexual health care needs after colorectal cancer: the view of patients, partners, and health care professionals.
        Support. Care Cancer. 2014; 22: 763-772
        • Schover L.R.
        • van der Kaaij M.
        • van Dorst E.
        • Creutzberg C.
        • Huyghe E.
        • Kiserud C.E.
        Sexual dysfunction and infertility as late effects of cancer treatment.
        EJC. 2014; : 41-53
        • Wiggins D.L.
        • Wood R.
        • Granai C.O.
        • Dizon D.S.
        Sex, intimacy, and the gynecologic oncologist: survey results of the New England Association of Gynecologic Oncologists (NEAGO).
        J. Psychosoc. Oncol. 2007; 25: 61-70
        • Ussher J.M.
        • Perz J.
        • Gilbert E.
        • Wong W.K.T.
        • Mason C.
        • Hobbs K.
        • Kirsten L.
        Talking about sex after cancer: a discourse analytic study of health care professional accounts of sexual communication with patients.
        Psychol. Health. 2013; 28: 1370-1390
        • Stead M.L.
        • Brown J.M.
        • Fallowfield L.
        • Selby P.
        Communication about sexual problems and sexual concerns in ovarian cancer: a qualitative study.
        West J. Med. 2002; 176: 18-19
        • Stead M.L.
        • Brown J.M.
        • Fallowfield L.
        • Selby P.
        Lack of communication between healthcare professionals and women with ovarian cancer about sexual issues.
        Br. J. Cancer. 2003; 88: 666-671
        • Manson J.E.
        • Ames J.M.
        • Shapiro M.
        • Gass M.L.S.
        • Shifren J.L.
        • Stuenkel C.A.
        • Pinkerton J.V.
        • Kaunitz A.M.
        • Pace D.T.
        • Kagan R.
        • Schnatz P.F.
        • Kingsberg S.A.
        • Liu J.H.
        • Joffe H.
        • Richard-Davis G.
        • Goldstein S.R.
        • Schiff I.
        • Utian W.H.
        Algorithm and mobile app for menopausal symptom management and hormonal/non-hormonal therapy decision making: a clinical decision-support tool from The North American Menopause Society.
        Menopause. 2015; 22: 247-253
      2. ACOG Practice Bulletin No. 141: management of menopausal symptoms.
        Obstet. Gynecol. 2014; 123: 202-216
        • Sarrel P.M.
        • Sullivan S.D.
        • Nelson L.M.
        Hormone replacement therapy in young women with surgical primary ovarian insufficiency.
        Fertil. Steril. 2016; 106: 1580-1587
        • Faubion S.S.
        • Kuhle C.L.
        • Shuster L.T.
        • Rocca W.A.
        Long-term health consequences of premature or early menopause and considerations for management.
        Climacteric. 2015; 18: 483-491
        • Atsma F.
        • Bartelink M.-L.E.L.
        • Grobbee D.E.
        • van der Schouw Y.T.
        Postmenopausal status and early menopause as independent risk factors for cardiovascular disease: a meta-analysis.
        Menopause. 2006; 13: 265-279
        • Løkkegaard E.
        • Jovanovic Z.
        • Heitmann B.L.
        • Keiding N.
        • Ottesen B.
        • Pedersen A.T.
        The association between early menopause and risk of ischaemic heart disease: influence of Hormone Therapy.
        Maturitas. 2006; 53: 226-233
        • Gierach G.L.
        • Pfeiffer R.M.
        • Patel D.A.
        • Black A.
        • Schairer C.
        • Gill A.
        • Brinton L.A.
        • Sherman M.E.
        Long-term overall and disease-specific mortality associated with benign gynecologic surgery performed at different ages.
        Menopause. 2014; 21: 592-601
        • Yoshida T.
        • Takahashi K.
        • Yamatani H.
        • Takata K.
        • Kurachi H.
        Impact of surgical menopause on lipid and bone metabolism.
        Climacteric. 2011; 14: 445-452
        • van der Klift M.
        • de Laet C.E.D.H.
        • McCloskey E.V.
        • Johnell O.
        • Kanis J.A.
        • Hofman A.
        • Pols H.A.P.
        Risk factors for incident vertebral fractures in men and women: the Rotterdam Study.
        J. Bone Miner. Res. 2004; 19: 1172-1180
        • Rebbeck T.R.
        • Friebel T.
        • Wagner T.
        • Lynch H.T.
        • Garber J.E.
        • Daly M.B.
        • Isaacs C.
        • Olopade O.I.
        • Neuhausen S.L.
        • van′t Veer L.
        • Eeles R.
        • Evans D.G.
        • Tomlinson G.
        • Matloff E.
        • Narod S.A.
        • Eisen A.
        • Domchek S.
        • Armstrong K.
        • Weber B.L.
        Effect of short-term hormone replacement therapy on breast cancer risk reduction after bilateral prophylactic oophorectomy in BRCA1 and BRCA2 mutation carriers: the PROSE study group.
        J. Clin. Orthod. 2005; 23: 7804-7810
        • Henderson B.E.
        The cancer question: an overview of recent epidemiologic and retrospective data.
        Am. J. Obstet. Gynecol. 1989; 161: 1859-1864
        • Weiderpass E.
        • Adami H.O.
        • Baron J.A.
        • Magnusson C.
        • Bergström R.
        • Lindgren A.
        • Correia N.
        • Persson I.
        Risk of endometrial cancer following estrogen replacement with and without progestins.
        J. Natl. Cancer Inst. 1999; 91: 1131-1137
        • Beresford S.A.
        • Weiss N.S.
        • Voigt L.F.
        • McKnight B.
        Risk of endometrial cancer in relation to use of estrogen combined with cyclic progestagen therapy in postmenopausal women.
        Lancet. 1997; 349: 458-461
        • Anderson G.L.
        • Judd H.L.
        • Kaunitz A.M.
        • Barad D.H.
        • Beresford S.A.A.
        • Pettinger M.
        • Liu J.
        • McNeeley S.G.
        • Lopez A.M.
        Women’s Health Initiative Investigators, Effects of estrogen plus progestin on gynecologic cancers and associated diagnostic procedures: the Women’s Health Initiative randomized trial.
        JAMA. 2003; 290: 1739-1748
        • Lacey J.V.
        • Leitzmann M.F.
        • Chang S.-C.
        • Mouw T.
        • Hollenbeck A.R.
        • Schatzkin A.
        • Brinton L.A.
        Endometrial cancer and menopausal hormone therapy in the National Institutes of Health-AARP Diet and Health Study cohort.
        Cancer. 2007; 109: 1303-1311
        • Judd H.L.
        • Mebane-Sims I.
        • Legault C.
        • Wasilauskas C.
        • Johnson S.
        • Merino M.
        • Barrett-Connor E.
        • Trabal J.
        • Miller V.T.
        • Barnabei V.
        • Levin G.
        • Bush T.
        • Foster D.
        • Zacur H.
        • Donald Woodruff J.
        • Stefanick M.
        • Wood P.D.
        • Akana A.
        • Leroy Heinrichs W.
        • O’Hanlan K.
        • Buyalos R.P.
        • Greendale G.
        • Lozano K.
        • Lou Carrion-Petersen M.
        • Cavero C.
        • Langer R.
        • Schrott H.G.
        • Benda J.A.
        • de Prosse C.
        • Fedderson D.
        • Johnson S.R.
        • Pauerstein C.J.
        • Ahmad M.M.
        • Brown H.P.
        • Schenken R.S.
        • Rodriguez-Sifuentes M.
        • Valente P.T.
        • Espeland M.
        • Bradley Wells H.
        • Lane K.
        • Mebane-Sims I.L.
        • Kelaghan J.
        • McGowan J.
        • Fradkin J.
        • Sherman S.
        • Scully R.
        Effects of hormone replacement therapy on endometrial histology in postmenopausal women: the postmenopausal Estrogen/Progestin interventions (PEPI) trial.
        JAMA. 1996; 275: 370-375
        • de Paula F.J.F.
        • Soares Jr., J.M.
        • Haidar M.A.
        • de Lima G.R.
        • Baracat E.C.
        The benefits of androgens combined with hormone replacement therapy regarding to patients with postmenopausal sexual symptoms.
        Maturitas. 2007; 56: 69-77
        • Penteado S.R.L.
        • Fonseca A.M.
        • Bagnoli V.R.
        • Abdo C.H.N.
        • Júnior J.M.S.
        • Baracat E.C.
        Effects of the addition of methyltestosterone to combined hormone therapy with estrogens and progestogens on sexual energy and on orgasm in postmenopausal women.
        Climacteric. 2008; 11: 17-25
        • Minkin M.J.
        • Wright C.V.
        What Every Woman Needs to Know About Menopause: The Years Before, During and After.
        Yale University Press, 1997
        • Bachmann G.A.
        • Komi J.O.
        Ospemifene Study Group, Ospemifene effectively treats vulvovaginal atrophy in postmenopausal women: results from a pivotal phase 3 study.
        Menopause. 2010; 17: 480-486
        • Portman D.
        • Palacios S.
        • Nappi R.E.
        • Mueck A.O.
        Ospemifene, a n non-oestrogen selective oestrogen receptor modulator for the treatment of vaginal dryness associated with postmenopausal vulvar and vaginal atrophy: a randomised, placebo-controlled, phase III trial.
        Maturitas. 2014; 78: 91-98
        • Somboonporn W.
        • Bell R.J.
        • Davis S.R.
        Testosterone for peri and postmenopausal women.
        Reviews. 2005
        • Nachtigall L.
        • Utian W.
        • Katz M.
        • Miller S.
        Testosterone patch increases sexual activity and desire in surgically menopausal women with hypoactive sexual desire disorder.
        J. Clin. Endocrinol. Metab. 2005; 90: 5226-5233https://doi.org/10.1210/jc.2004-1747
        • Miller D.T.
        • Overton E.
        • Ratner E.S.
        Addressing the sexual health concerns of women with gynecologic cancer: guidance for primary care physicians.
        J. Clin. Outcomes Manag. 2015; 22
        • Loprinzi C.L.
        • Sloan J.A.
        • Perez E.A.
        • Quella S.K.
        • Stella P.J.
        • Mailliard J.A.
        • Halyard M.Y.
        • Pruthi S.
        • Novotny P.J.
        • Rummans T.A.
        Phase III. evaluation of fluoxetine for treatment of hot flashes.
        J. Clin. Oncol. 2002; 20: 1578-1583
        • Loprinzi C.L.
        • Kugler J.W.
        • Sloan J.A.
        • Mailliard J.A.
        • LaVasseur B.I.
        • Barton D.L.
        • Novotny P.J.
        • Dakhil S.R.
        • Rodger K.
        • Rummans T.A.
        • Christensen B.J.
        Venlafaxine in management of hot flashes in survivors of breast cancer: a randomised controlled trial.
        Lancet. 2000; 356: 2059-2063
        • Higgins A.
        • Nash M.
        • Lynch A.M.
        Antidepressant-associated sexual dysfunction: impact, effects, and treatment.
        Drug Healthc. Patient Saf. 2010; 2: 141-150
        • Modell J.G.
        • Katholi C.R.
        • Modell J.D.
        • DePalma R.L.
        Comparative sexual side effects of bupropion fluoxetine, paroxetine, and sertraline.
        Clin. Pharmacol. Ther. 1997; 61: 476-487
        • Serretti A.
        • Chiesa A.
        Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis.
        J. Clin. Psychopharmacol. 2009; 29: 259-266
        • Fisher W.I.
        • Johnson A.K.
        • Elkins G.R.
        • Otte J.L.
        • Burns D.S.
        • Yu M.
        • Carpenter J.S.
        Risk factors pathophysiology, and treatment of hot flashes in cancer.
        CA Cancer J. Clin. 2013; 63: 167-192
        • Freeman E.W.
        • Guthrie K.A.
        • Caan B.
        • Sternfeld B.
        • Cohen L.S.
        • Joffe H.
        • Carpenter J.S.
        • Anderson G.L.
        • Larson J.C.
        • Ensrud K.E.
        • Reed S.D.
        • Newton K.M.
        • Sherman S.
        • Sammel M.D.
        • LaCroix A.Z.
        Efficacy of escitalopram for hot flashes in healthy menopausal women: a randomized controlled trial.
        JAMA. 2011; 305: 267-274
        • Reed S.D.
        • Guthrie K.A.
        • Joffe H.
        • Shifren J.L.
        • Seguin R.A.
        • Freeman E.W.
        Sexual function in nondepressed women using escitalopram for vasomotor symptoms: a randomized controlled trial.
        Obstet. Gynecol. 2012; 119: 527-538
        • Perez D.G.
        • Loprinzi C.L.
        • Barton D.L.
        • Pockaj B.A.
        • Sloan J.
        • Novotny P.J.
        • Christensen B.J.
        Pilot evaluation of mirtazapine for the treatment of hot flashes.
        J. Support. Oncol. 2004; 2: 50-56
        • Pérez D.G.
        • Loprinzi C.L.
        • Sloan J.
        • Novotny P.
        • Barton D.
        • Carpenter L.
        • Smith D.
        • Christensen B.
        • Rummans T.
        Pilot evaluation of bupropion for the treatment of hot flashes.
        J. Palliat. Med. 2006; 9: 631-637
        • Joffe H.
        • Partridge A.
        • Giobbie-Hurder A.
        • Li X.
        • Habin K.
        • Goss P.
        • Winer E.
        • Garber J.
        Augmentation of venlafaxine and selective serotonin reuptake inhibitors with zolpidem improves sleep and quality of life in breast cancer patients with hot flashes: a randomized, double-blind, placebo-controlled trial.
        Menopause. 2010; 17: 908-916
        • Gao Z.
        • Yang D.
        • Yu L.
        • Cui Y.
        Efficacy and safety of flibanserin in Women with hypoactive sexual desire disorder: a systematic review and meta-analysis.
        J. Sex. Med. 2015; 12: 2095-2104
        • Simon J.A.
        • Kingsberg S.A.
        • Shumel B.
        • Hanes V.
        • Garcia Jr., M.
        • Sand M.
        Efficacy and safety of flibanserin in postmenopausal women with hypoactive sexual desire disorder: results of the SNOWDROP trial.
        Menopause. 2014; 21: 633-640
        • Finch A.
        • Pillans P.
        P-glycoprotein and its role in drug–drug interactions.
        Aust. Prescr. 2014; 37: 137-139
        • Nachtigall L.E.
        Comparative study: replens versus local estrogen in menopausal women.
        Fertil. Steril. 1994; 61: 178-180
        • Juliato P.T.
        • Rodrigues A.T.
        • Stahlschmidt R.
        • Juliato C.R.T.
        • Mazzola P.G.
        Can polyacrylic acid treat sexual dysfunction in women with breast cancer receiving tamoxifen?.
        Climacteric. 2017; 20: 62-66
        • Biglia N.
        • Peano E.
        • Sgandurra P.
        • Moggio G.
        • Panuccio E.
        • Migliardi M.
        • Ravarino N.
        • Ponzone R.
        • Sismondi P.
        Low-dose vaginal estrogens or vaginal moisturizer in breast cancer survivors with urogenital atrophy: a preliminary study.
        Gynecol. Endocrinol. 2010; 26: 404-412
        • Shaw D.
        • Graeme L.
        • Pierre D.
        • Elizabeth W.
        • Kelvin C.
        Pharmacovigilance of herbal medicine.
        J. Ethnopharmacol. 2012; 140: 513-518
        • Roberts H.
        Safety of herbal medicinal products in women with breast cancer.
        Maturitas. 2010; 66: 363-369
        • Leach M.J.
        • Moore V.
        Black cohosh (Cimicifuga spp.) for menopausal symptoms.
        Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd, 1996
        • Shahnazi M.
        • Nahaee J.
        • Mohammad-Alizadeh-Charandabi S.
        • Bayatipayan S.
        Effect of black cohosh (cimicifuga racemosa) on vasomotor symptoms in postmenopausal women: a randomized clinical trial.
        J. Car. Sci. 2013; 2: 105-113
        • Beer A.-M.
        • Osmers R.
        • Schnitker J.
        • Bai W.
        • Mueck A.O.
        • Meden H.
        Efficacy of black cohosh (Cimicifuga racemosa) medicines for treatment of menopausal symptoms – comments on major statements of the Cochrane Collaboration report 2012 black cohosh (Cimicifuga spp.) for menopausal symptoms (review).
        Gynecol. Endocrinol. 2013; 29: 1022-1025
        • Ross S.M.
        Menopause: a standardized isopropanolic black cohosh extract (remifemin) is found to be safe and effective for menopausal symptoms.
        Holist. Nurs. Pract. 2012; 26: 58-61
        • Leach M.J.
        • Moore V.
        Black cohosh (Cimicifuga spp.) for menopausal symptoms.
        Cochr. Database Syst. Rev. 2012; (CD007244)
        • Amato P.
        • Marcus D.M.
        Review of alternative therapies for treatment of menopausal symptoms.
        Climacteric. 2003; 6: 278-284
        • Jiang K.
        • Jin Y.
        • Huang L.
        • Feng S.
        • Hou X.
        • Du B.
        • Zheng J.
        • Li L.
        Black cohosh improves objective sleep in postmenopausal women with sleep disturbance.
        Climacteric. 2015; 18: 559-567
        • Gonzales G.F.
        • Gonzales C.
        • Gonzales-Castañeda C.
        Lepidium meyenii (Maca): a plant from the highlands of Peru–from tradition to science.
        Forsch. Komplementmed. 2009; 16: 373-380
        • Shin B.-C.
        • Lee M.S.
        • Yang E.J.
        • Lim H.-S.
        • Ernst E.
        Maca (L. meyenii) for improving sexual function: a systematic review.
        BMC Complement. Altern. Med. 2010; 10: 44
        • Dording C.M.
        • Schettler P.J.
        • Dalton E.D.
        • Parkin S.R.
        • Walker R.S.W.
        • Fehling K.B.
        • Fava M.
        • Mischoulon D.
        A double-blind placebo-controlled trial of maca root as treatment for antidepressant-induced sexual dysfunction in women.
        Evid. Based. Complement. Alternat. Med. 2015; 2015: 949036
        • Rosenbaum T.Y.
        Pelvic floor involvement in male and female sexual dysfunction and the role of pelvic floor rehabilitation in treatment: a literature review.
        J. Sex. Med. 2007; 4: 4-13
        • Bø K.
        Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction.
        World J. Urol. 2012; 30: 437-443
        • Yang E.J.
        • Lim J.-Y.
        • Rah U.W.
        • Kim Y.B.
        Effect of a pelvic floor muscle training program on gynecologic cancer survivors with pelvic floor dysfunction: a randomized controlled trial.
        Gynecol. Oncol. 2012; 125: 705-711
        • Leonarczyk T.J.
        • Mawn B.E.
        Cancer risk management decision making for BRCA+ women.
        West. J. Nurs. Res. 2015; 37: 66-84
        • Tucker P.E.
        • Bulsara M.K.
        • Salfinger S.G.
        • Tan J.J.-S.
        • Green H.
        • Cohen P.A.
        Discussing sexuality with women considering risk-reducing salpingo-oophorectomy: an international survey of current practice in gynecologic oncology.
        Int. J. Gynecol. Cancer. 2016; 26: 1338-1344
        • Michelsen T.M.
        • Dørum A.
        • Dahl A.A.
        A controlled study of mental distress and somatic complaints after risk-reducing salpingo-oophorectomy in women at risk for hereditary breast ovarian cancer.
        Gynecol. Oncol. 2009; 113: 128-133
        • Brotto L.A.
        • Heiman J.R.
        • Goff B.
        • Greer B.
        • Lentz G.M.
        • Swisher E.
        • Tamimi H.
        • Van Blaricom A.
        A psychoeducational intervention for sexual dysfunction in women with gynecologic cancer.
        Arch. Sex. Behav. 2008; 37: 317-329
        • Brotto L.A.
        • Erskine Y.
        • Carey M.
        • Ehlen T.
        • Finlayson S.
        • Heywood M.
        • Kwon J.
        • McAlpine J.
        • Stuart G.
        • Thomson S.
        • Miller D.
        A brief mindfulness-based cognitive behavioral intervention improves sexual functioning versus wait-list control in women treated for gynecologic cancer.
        Gynecol. Oncol. 2012; 125: 320-325
        • Buys S.S.
        • Sandbach J.F.
        • Gammon A.
        • Patel G.
        • Kidd J.
        • Brown K.L.
        • Sharma L.
        • Saam J.
        • Lancaster J.
        • Daly M.B.
        A study of over 35,000 women with breast cancer tested with a 25-gene panel of hereditary cancer genes.
        Cancer. 2017; https://doi.org/10.1002/cncr.30498
        • Sopik V.
        • Akbari M.R.
        • Narod S.A.
        Genetic testing for RAD51C mutations: in the clinic and community.
        Clin. Genet. 2015; 88: 303-312