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Sexual function following risk-reducing salpingo-oophorectomy: a prospective cohort study
Åsa Ehlin von Kartaschew1,2, Angelica Lindén Hirschberg2,3, K Gemzell-Danielsson2,3
1LIVIO, 115 42 Stockholm, Sweden.
Background:
Increased access to and indications for genetic testing will lead to more women undergoing risk-reducing salpingo-oophorectomy (RRSO), with a potential impact on sexual function.
Aim:
Our objective was to prospectively investigate (1) sexual function in women with pathogenic variant (PV) in BRCA1/2 genes, before and 1 year after RRSO, and to compare with a healthy age-matched control group and (2) to study if testosterone levels correlate with sexual functioning after RRSO.
Methods:
A prospective observational follow-up study of 43 BRCA1/2-PV carriers planned for RRSO and 73 healthy-age matched controls. Data including personal medical history, the Female Sexual Function Index (FSFI) and blood samples for analysis of testosterone by tandem mass spectrometry and free androgen index (FAI) were collected before and 1 year after surgery or at inclusion (controls).
Outcomes:
Sexual function and testosterone levels following RRSO.
Results:
Median age in the RRSO group was 42 years at baseline, 55.8% were premenopausal and 53.5% had a history of breast cancer. The RRSO group had significantly lower median FSFI total score (P < .001), lower scores of all 6 FSFI domains (P < .001), as well as a higher proportion of female sexual dysfunction (FSD) (P < .001) compared to the control group at 1 year after surgery. In the RRSO group, users of menopausal hormone therapy (MHT) had a significantly higher median FSFI total score compared with the nonusers both at baseline (P = .023) and follow-up (P = .010). The proportion of FSD was significantly higher in the non-MHT group at both baseline (P = .041) and follow-up (P = .009). FAI was significantly lower in the RRSO group when compared to the controls at 1-year follow-up (P = .041); however, no significant correlations between testosterone levels and FSFI scores were found.
Clinical Implications:
The results highlight the need to counsel BRCA1/2-PV carriers before RRSO and offer a structured follow-up and support addressing sexual function and impact of MHT use.
Strengths And Limitations:
The main strength of this study is its prospective design with age-matched controls. Limitation is a small sample size.
Conclusion:
Our findings show that sexual function deteriorated 1 year after RRSO independent of testosterone levels, and the proportion with impaired sexual function was higher compared to healthy age-matched controls.
