Highlights
- •71% of studies reported a negative impact of RRBSO on sexual function.
- •RRBSO has a statistically significant negative impact on sexual function (p = 0.03).
- •Vaginal dryness increases significantly post-RRBSO (p < 0.00001).
- •Sexual function deteriorates post RRBSO irrespective of menopausal status.
- •The effect of RRBSO on sexual function cannot be fully reversed by HRT.
Abstract
Objective
In the absence of an effective screening test, women with a high genetic predisposition
for ovarian cancer are recommended to undergo risk-reducing bilateral salpingo-oophorectomy
(RRBSO) once childbearing is complete. This reduces the risk of ovarian cancer by
up to 96%, but can result in undesirable side effects, including menopausal symptoms
and sexual dysfunction.
We have performed a systematic review and meta-analysis to investigate the effect of RRBSO on sexual function in women at high risk
of breast/and or ovarian cancer.
Methods
A literature search of the AMED (Allied and complementary medicine), Embase and Medline
databases was performed, using search terms including sexual function, risk reducing
and oophorectomy. Results were filtered according to the PRISMA protocol. Quality
assessment of studies was performed using the Newcastle-Ottawa scale. Data were pooled
in meta-analysis.
Results
There were 21 eligible studies, 10 of which reported sufficient data for meta-analysis. Most studies were retrospective cohort or observational studies. Fifteen
of the 21 studies (71%) reported a negative impact of RRBSO on sexual function. Participant
numbers ranged from 37 to 1522. Meta-analysis was performed with studies including
3201 patients. This demonstrated that RRBSO has a statistically significant negative
impact on sexual function (SMD −0.63, [−0.82, −0.44], p = 0.03). There was a trend
towards reduced sexual pleasure and increased discomfort but this did not reach statistical
significance. There was minimal change in the frequency of sex. There was a significant
increase in vaginal dryness post-RRBSO (SMD 9.25, [3.66, 14.83], p < 0.00001). There
was no significant difference in sexual function between pre-menopausal and post-menopausal
RRBSO. Hormone replacement therapy (HRT) did not abolish this negative impact.
Conclusion
Sexual function declines post RRBSO, independent of menopausal status. Comprehensive
pre-operative counselling regarding anticipated menopausal and sexual symptoms is
key to setting realistic patient expectations and minimising post-operative distress.
Information and support regarding management of these side effects should be available
to all patients.
Keywords
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Article info
Publication history
Published online: August 06, 2021
Accepted:
August 4,
2021
Received in revised form:
August 3,
2021
Received:
April 29,
2021
Identification
Copyright
Crown Copyright © 2021 Published by Elsevier B.V. All rights reserved.
