Effects of risk-reducing salpingo-oophorectomy on sexual functioning

In a recent study, women who received risk-reducing salpingo-oophorectomy when premenopausal more often experienced discomfort during sexual activity and vaginal dryness than those receiving it when postmenopausal.

Premenopausal risk-reducing salpingo-oophorectomy (RRSO) does not reduce sexual activity in women but does often lead to vaginal dryness and increased discomfort during sexual intercourse, according to a recent study published in the American Journal of Obstetrics & Gynecology.

Women who received RRSO when premenopausal, defined as aged 45 years or less, were compared with women who received RRSO when postmenopausal, defined as aged over 54 years. Individuals with ovarian cancer, metabolic disease, and therapy-induced menopause more than 5 years before RRSO were excluded from the analysis.

Substantial discomfort during sexual intercourse was seen in 35.6% of the premenopausal group and 20.9% of the postmenopausal group.

Complaints of vaginal dryness were seen in 47% of sexually inactive women in the premenopausal group and 31.1% of women in the postmenopausal group. Substantial complaints of vaginal dryness were found in the premenopausal group following adjustment for cofounders.

Similar results were seen when comparing sexually active women in both groups, with vaginal dryness reported in 46.1% of sexually active women in the premenopausal group and 24.2% of women in the postmenopausal group.

Women with high familial risk of ovarian or tubal cancer receive RRSO to prevent these cancers. Guidelines recommend RRSO when aged 35 to 40 years for BRCA1 pathogenic variant (PV) carriers and when aged 40 to 45 years for BRCA2 carriers, as both populations are at increased risk.

Menopause occurs immediately following RRSO, which has been associated with vulvovaginal atrophy. Studies have associated RRSO with increased discomfort and decreased pleasure during sexual activity shortly after RRSO, but long-term effects are unknown.

Investigators conducted this study to determine the effects of premenopausal RRSO on sexual functioning after at least 10 years. Women aged 55 years or older with a high familial risk of breast or ovarian cancer were included in the analysis.

Participants were selected from the HARMOny study, a cross-sectional study with a cohort consisting of women at high familial risk of breast or ovarian cancer. From 2018 to 2021, women in this cohort were invited to participate in an analysis on how RRSO impacts health outcomes and quality of life.

Medical data was gathered through a questionnaire on general health, cancer-specify outcomes, and medical treatments. Sexual functioning data was gathered through the Sexual Activity Questionnaire (SAQ).

There are 3 parts to the SAQ. The first determines sexual activity, and women not sexually active complete the second part to explain their reasons. The third part evaluates elements of sexual function, including satisfaction, desire, pleasure, penetration pain, vaginal dryness, and frequency of intercourse.

Of the 787 women in the analysis, 525 were in the premenopausal RRSO group and 262 were in the postmenopausal RRSO group. Women in the premenopausal RRSO group were aged a mean 60 years, while those in the postmenopausal RRSO group were aged a mean 70.2 years.

While women in the premenopausal group more often had a partner and were sexually active, this could be explained by the younger average age of these participants. To control this difference, investigators compared women aged 60 to 70 years in both groups.

Women aged 60 to 70 years had mean times since RRSO of 20.6 years in the premenopausal group and 10.6 years in the postmenopausal group. BRCA1/2 PV was seen in 63.8% of the postmenopausal group and 69% of the premenopausal group.

A significant difference was not found in sexual activity among women aged 60 to 70 years in both groups. The mean pleasure score was also the same between both groups at 8.6. However, differences in discomfort scores were seen, with an average score of 2 for sexually active women in the premenopausal group and 1.5 in the postmenopausal group.

Reference

Terra L, Beekman MJ, Engelhardt EG. Sexual functioning more than 15 years after premenopausal risk-reducing salpingo-oophorectomy. American Journal of Obstetrics & Gynecology. 2022;228(4):440.E1-440.E20. doi:10.1016/j.ajog.2022.11.1289

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Gloria Richard-Davis MD, MBA, NCMP, FACOG
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