Sexual dysfunction and body image in BRCA mutation carriers before and after risk-reducing salpingo-oophorectomy: a cross-sectional study.

Abstract

Background: BRCA mutation carriers opting for prophylactic risk-reducing salpingo-oophorectomy (RRSO) face potential impacts on sexual functioning and body image.

Aim: The aim of the study was to assess the extent of sexual dysfunction (SD) and body image impairment in BRCA patients, both with and without cancer, and before and after undergoing RRSO.

Methods: The present cross-sectional study involved a group of BRCA-positive patients (n = 220) from the Gynecological Hereditary Cancer Risk Clinic, categorized into two different subgroups: A-premenopausal and B-postmenopausal women, with (1) or without and (2) a breast cancer (BC) diagnosis. Before RRSO and at a 6-month follow-up assessment, all participants were requested to complete a validated survey on body image (the Body Image Scale), sexual functioning (Female Sexual Function Index), and psychological well-being (the Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index fatigue subscale of the Functional Assessment of Chronic Illness Therapy-Fatigue).

Outcomes: The outcomes include scores on measures of body image, sexual functioning, and psychological well-being across the four study groups (A1-premenopausal women with BC, A2-premenopausal women without BC, B1-postmenopausal women with BC, and B2-postmenopausal women without BC).

Results: After RRSO, a significant decrease in sexual function and body image was observed across all groups (P < 0.01 in A1 and B1 groups and P < 0.02 in A2 and B2 groups). The most relevant changes were observed in the premenopausal and cancer-affected BRCA carriers (A2) (P < 0.001). The multivariate logistic regression analysis identified obesity, prior cancer, depression, and fatigue as risk factors for SD, while younger age and hormone replacement therapy emerged as protective factors.

Clinical implications: Surgical menopause, body image concerns, anxiety, and depression contribute to the observed SD following RRSO and should be addressed by healthcare providers.

Strengths and limitations: This study's strength lies in its comprehensive evaluation of the impact of RRSO on BRCA mutation carriers, both before and after the procedure. The assessment includes measures of anxiety and fatigue. The limitations of the study include possible selection bias among participants, the lack of measures for sexual distress and a control group without BRCA mutation, and the limited number of patients without SD.

Conclusion: Patients undergoing RRSO frequently experience substantial psychosexual dysfunction; therefore, preoperative counseling is necessary to mitigate the incidence of SD and body image concerns in this population.