The following is a summary of “Sexual functioning more than 15 years after premenopausal risk-reducing salpingo-oophorectomy,” published in the APRIL 2023 issue of Obstetrics and Gynecology by Terra, et al.

Women who carry a pathogenic variant in the BRCA1/2 genes are often recommended to undergo premenopausal risk-reducing salpingo-oophorectomy (removal of the fallopian tubes and ovaries) after completing their childbearing years to reduce the risk of ovarian cancer. Previous studies have reported decreased sexual pleasure within 1 to 3 years after premenopausal oophorectomy. However, the long-term effects of the procedure on sexual functioning were not well understood. 

Therefore, for a study, researchers sought to investigate the long-term sexual functioning of women at increased familial risk of breast or ovarian cancer who underwent risk-reducing salpingo-oophorectomy either before the age of 46 years (premenopausal group) or after the age of 54 years (postmenopausal group). In addition, subgroup analyses were also conducted within the premenopausal group to compare the effects of early oophorectomy (before age 41) and later oophorectomy (at ages 41-45 years) on sexual functioning.

Between 2018 and 2021, 817 women with a high familial risk of breast or ovarian cancer were invited to participate in an ongoing cohort study. For the comparison of sexual functioning between the premenopausal and postmenopausal salpingo-oophorectomy groups, the study focused on 368 women who were 60 to 70 years old when they completed the questionnaire (226 in the premenopausal group and 142 in the postmenopausal group). Within the premenopausal group, sexual functioning was compared between 151 women who underwent early oophorectomy and 345 women who underwent later oophorectomy. Multiple regression analyses were conducted to assess differences between the groups, adjusting for factors such as current age, history of breast cancer, hormone replacement therapy use, body mass index, chronic medication use, and body image.

The average time since risk-reducing salpingo-oophorectomy was 20.6 years in the premenopausal group and 10.6 years in the postmenopausal group (P<.001). The mean age at questionnaire completion was 62.7 years in the premenopausal group and 67.0 years in the postmenopausal group (P<.001). The proportion of sexually active women was similar between the premenopausal group (47.4%) and the postmenopausal group (48.9%) (P=.80). Current sexual pleasure scores were comparable between the two groups (mean pleasure score of 8.6; P=.99). However, women in the premenopausal group reported significantly more substantial discomfort during sexual intercourse compared to women in the postmenopausal group (35.6% vs. 20.9%; P=.04). After adjusting for confounding factors, premenopausal risk-reducing salpingo-oophorectomy was associated with a significantly higher likelihood of experiencing discomfort during sexual intercourse (odds ratio, 3.1; 95% CI, 1.04-9.4). Additionally, more severe complaints of vaginal dryness were observed after premenopausal oophorectomy (odds ratio, 2.6; 95% CI, 1.4-4.7). Women who underwent oophorectomy before age 41 reported similar pleasure and discomfort scores compared to those who underwent oophorectomy between ages 41 and 45.

More than 15 years after premenopausal risk-reducing salpingo-oophorectomy, the proportion of sexually active women was comparable to that of women who underwent postmenopausal risk-reducing salpingo-oophorectomy. However, women who underwent premenopausal oophorectomy experienced more vaginal dryness and were more likely to have substantial discomfort during sexual intercourse. Despite these issues, it did not result in less pleasure from sexual activity.

Source: ajog.org/article/S0002-9378(22)02177-9/fulltext