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Breast Cancer Treatment Doesn't Have to Kill Your Sex Life
- Jonathan Psenka
- May 14, 2025
- 3 min read
One of the most frequent concerns I hear from breast cancer survivors is a decrease in the quality of their sex life. Often this decrease in the quality of a women’s sex life is characterized by vaginal dryness, atrophy, which contribute to the painful intercourse. This frequently is the result of their being a decreased level of estrogen in the women’s body.
The decreased level of estrogens, which is often below that level typically seen in post-menopausal women, is the result of medically induced estrogen suppression. A mainstay of conventional breast cancer treatment for women is the use of medications called aromatase inhibitors, like anastrozole or letrozole. These drugs are used to reduce the level of circulating estrogens in a woman's body. In women with hormone sensitive breast cancer, the suppression of estrogen levels is thought to be protective against the recurrence of breast cancer.
While minimizing the estrogens in a woman's body may potentially be beneficial for inhibiting the recurrence of cancer, it is not without risk. Estrogen is a very important for a woman’s body and without it, there is an increased risk of other health concerns such as osteoporosis, impaired cognition, heart disease, and decreased vaginal health.
Most women with a history of breast cancer are told to avoid anything that might increase the level of estrogen in their body. Some women are even told to avoid certain foods, like soy, that might have an estrogen-like effect in the body. That’s bad advice. Check out this article in the Journal of the American Medical Association showing a significant reduction in recurrence risk for women who regularly consume soy.
Those women who experience painful intercourse are often told to use oils, lubes, or that they just might have to abstain and endure the decreased quality of life. In some women the reduction in quality of life is so severe that they may discontinue use of their aromatase medication. Although even a little bit of estrogen could fix the problem, many are advised that to use it would increase the risk of their cancer coming back. Turns out that this too may be bad advice.
This is because, “estrogen” isn’t just “estrogen.” What is typically called "estrogen" is actually three molecules: estrone (E1), estradiol (E2) and estriol (E3). Each type of estrogen has different strengths and different effects in the body. Estradiol is often considered the strongest of the estrogens and estriol the weakest.
All of the estrogens must be transported across the cell membrane via receptors to gain access to the interior of the cell where they have their action. There are different types of receptors for the different types of estrogens. Estrogen receptor alpha transports estradiol (E2) and estrogen receptor beta transports estriol (E3). Breast tissue is rich in alpha receptors and the vagina contains mostly beta receptors. This difference in the location of estrogen receptors and types was the basis for research showing that estriol (E3) is a safe treatment for estrogen-starved vaginas in women with a history of breast cancer being treated by an aromatase inhibitor.
An article published in June of 2020 reported the safe use and effectiveness of low dose estriol gel in the treatment of vulvovaginal atrophy. This placebo-controlled study included 61 women with a history of estrogen receptor positive breast cancer who were concurrently being treated with aromatase inhibitor drugs. The women were all experiencing moderate-to-severe vaginal dryness. The women used a 0.05% estriol gel intravaginally daily for 12 weeks. Researchers tracked levels of hormones and used specific measures of sexual functioning to assess the effect of the estriol. The study found that there were undetectable to negligible changes of all hormones assessed. Furthermore, women in the study reported a significant reduction in painful intercourse, vaginal dryness, itchiness, and improved signs and symptoms of vaginal atrophy. The research concluded that the use of low-dose intravaginal estriol was safe and effective in the treatment of vaginal atrophy and painful intercourse in women with a history of breast cancer.
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