Sexual Health and BRCA
Sexual health is an essential part of overall well-being, but for those with a BRCA mutation, it can present unique challenges.
In this session, Dr. Melanie Altas, Gynaecologist & Clinical Associate Professor at UBC, explores how BRCA mutations impact sexual health and shares expert guidance.
Watch to learn about:
Effects of BRCA-related surgeries
Hormone changes and sexual health
Navigating intimacy and emotional well-being
Strategies for maintaining a fulfilling sex life
You can find the recording here.
Transcript of Q&A with Dr. Melanie Altas
Tess
The chat is open, folks so you can pop questions you have in there. I've collected a couple that came to me directly throughout, so maybe I'll just start with those ones.
So one of the questions that came to me was, does low estrogen cause low desire? It seems like my desire, plummeted after starting an aromatase inhibitor.
Dr. Melanie Altas
Yeah. So the answer to that is possibly it may? So there are so many things that contribute to a woman's low desire. And there are some women, and we think it's a small percentage of women where their sexual desire is hormone dependent. And by hormone dependent I would mean estrogen as well as the ovaries do make a little bit of testosterone as well.
So when we, when we've looked at research overall, the research doesn't support a relationship necessarily between estrogen, testosterone and desire. But if you think about research, remember research, we do it with huge groups of people, right? And so what we're not good at with research is kind of looking at well, does it maybe work for some people in this huge group? And that's where that's where I think we're at. So I think that I see women in my practice where they go through menopause, and they and their desire plummets right away. Those are people where I think their desire is probably hormone dependent and could maybe benefit from hormone therapy around sexual desire. And now, of course, if you've had a breast cancer history, so if you're on the aromatase inhibitor, then hormone therapy systemic hormone therapy is not not an option for you, and what I would encourage people to do is explore kind of more of the psychological approach.
some people do find when they come off the aromatase inhibitors. So whether that's 5 or 10 years that their desire may improve may improve a little bit.
Tess
Thank you. I'll pop to a couple of questions that have.
Dr. Melanie Altas
Sure.
Tess
One that just came in direct a moment ago that just says you were wonderful, thank you so much, and asking, Will I have access to the recording? So I can answer that one. Yes, you will. If you're registered, you're going to get an email from us once it's up and running on the website but anyone can access it on the website. So yes, you will all have access to the recording.
Okay? And someone else asking, I've been prescribed premarin vaginal cream. How does this affect receiving oral sex?
Dr. Melanie Altas
Yeah. So with premarin vaginal cream. Then, either because it is a cream, you could be inserting it into the vagina as well as on the vulva with the creams. They're absorbed pretty quickly. So it like usually within I'd say, I usually tell people they're absorbed within 20 min, but just safely with like an hour. And so having oral sex anytime after it's absorbed. Totally fine. No impact at all. Yeah.
Tess
and one more here saying, so estrogen is okay, post cancer as long as it's topical. This person saying my cancer was hormone negative but my current Onco and Gyno are not on the same page. They've had a bilateral salpingo-oophorectomy after fighting breast cancer and being brca 2 carrier.
Dr. Melanie Altas
so I would support the use of topical estrogen in the forms that I had mentioned what I find, so I took over this clinic 5 or 6 years ago from a gynecologist named Sydney Thompson. Some people may know her, but she ran that clinic for about 20 years before me. And so I find, because we've had this clinic for such a long time. And we do a lot of education around sexual health and menopause after cancer that I find my experience has been the majority of oncologists, particularly at the Vancouver site, would be supportive of using topical estrogen.
I think my feeling is autonomy is a really strong value of mine, and I feel that if you have a discussion with your gynecologist and your oncologist. And you look at the impact of the symptoms on your quality of life. And I think you can make a decision about what you what you want to do.
and I will tell you that. So I am very confident, prescribing topical estrogen to people after breast cancer. So I have absolutely no concerns for safety at all. However, I have. I have maybe 5 to 8 breast cancer patients who have had such horrific menopause. So menopausal symptoms like hot flushes, sleep, disturbances, anxiety, joint, pain, brain fog, and after an informed discussion they have made a decision to go on systemic hormone therapy, which is very contraindicated post hormone, receptor, positive breast cancer. However these patients made a very informed consent, and they chose to take an unknown risk with breast cancer recurrence and go on the systemic hormone therapy, and that is something that I would very actively support as well. I think autonomy is very important value to hold.
Tess
Maybe this question is related. Somebody asking, What do I do if my oncologist is really opposed to estrogen therapy after breast cancer. How do I get a second opinion.
Dr. Melanie Altas
You can just come to see me. So my so my clinic, let me see if I can. I'll put the link to how to how to refer to to my clinic in the in the chat box. But I think most particularly the breast cancer oncologist. Most of them should know me. I think, particularly if you're in in the Fraser, lower mainland area, and you can just ask for a referral to see me to discuss it. And I'm very comfortable. I'd be comfortable going against an oncologist opinion and prescribing that. And I do see, I have to say I find with maybe the newer oncologists or the newer oncologists who haven't trained in British Columbia, who've moved to British Columbia, maybe have just started, because certainly my experience with the breast oncologists have been. They're very supportive, and I've had a lot of them even prescribe it.
I have a few who will even prescribe it while someone is waiting to see me. So that's not something I would worry I'd worry about. I'll try to find my my clinic here if you do.
Tess
We can pop that in the chat for you folks.
Dr. Melanie Altas
Yeah, let me copy that copy that there. Yeah. So I see and even you know, I think your oncologist would would refer you to me for sure if you asked for it and but I also get referrals from family doctors as well, too.
Tess
And that answers another question of how do we get in to see you? So there we go. Perfect! There it is in the chat! Everybody.
Dr. Melanie Altas
Yeah, so that's a link to a BC cancer site that has my brochure. And so you could even just print out the brochure and bring it to an appointment. And just say you want a referral to this clinic, and even the nurse, if there's a nurse that works with your oncology group, or a nurse practitioner or Gp. Oncologist. They can send in referrals, too.
Tess
All right. And yeah, I see someone here. This is maybe a bit more of a comment. But that's something that came right to me saying that they haven't had cancer. They're brca positive, but relating to a lot of these things, and that the scary pieces and saying it's been hard to accept that cancer is a possibility and has affected my sex life.
Dr. Melanie Altas
Yeah, yeah, what are your thoughts about that Tess as a, as a counselor, like, what.
Tess
Yeah. The 1st thing that comes to mind is just how impactful anxiety is on sexual well-being and how much anxiety comes with any kind of diagnosis, cancer, receiving information about being Brca positive.
Tess
All of the anxiety with that can have a profound effect on sexual well-being and all kinds of well-being. So that makes a lot of sense to me.
Dr. Melanie Altas
Yeah, yeah, for sure.
Dr. Melanie Altas
Yeah, do you have like in your practice? You know, I just put down some kind of simple approaches to mindfulness and being present and body image. And I, you know, as a gynecologist, I'm not. I'm not a sex therapist or a counselor, so I'm not able to go into into really comprehensive sex therapy. Although I do have some advanced training. But I do definitely refer people on to sex therapists. But, Tess, I was wondering, did you have anything to add to what I you know what I was talking about?
Tess
You know, I think what you shared is actually beautiful Dr. Altus, you did a beautiful job. And of course these things are so individual and context specific for people's lives. So, my, as you've already said, my one addition would be if you're experiencing this, there's supports out there, and It's a good segue to say at the end, Folks, I am going to put up a resource page, including the inspire health website which does have counseling. So if you're wanting to dive into body image and work on self-compassion or mindfulness, those are certainly the psychosocial pieces that can be supported there as well. So we do have some resources for you there. If that part feels like, it might be a good fit for you.
Participant
Dr. Just asking, do you only see patients who have had cancer? Many of the high risk clinic patients haven't had cancer, but have had preventative surgeries that impact sexual well-being.
Dr. Melanie Altas
I don't actually, yeah, I only see post cancer. But if you know, if they're just having like menopausal symptoms like related to the painful sex definitely Lisa Dawson. That would kind of be her clinic who would be able to to address, I think, address that part.
Tess
Yeah. And for anyone. Lisa Dawson's presentation was last month. So her recording is up on the website with her contacts as well. So you can also peruse that there. And a few folks have asked in the chat how to get previous recordings. Those are all up on the Brca in BC website, which is where this recording will go as well once it's uploaded.
Dr. Melanie Altas
What about I can the question about the weight. Gain the belly fat. I can talk a little bit about that.
Tess
Yes that’s the next one, go right ahead.
Dr. Melanie Altas
Yeah. That's a really common one as well weight gain associated with menopause and that there's a few things that I think are important to engage in around menopause. So if you kept eating exactly the same way that you eat before menopause, and you go through menopause and continue to eat the same way you will gain, you'll gain weight, and you'll gain mostly like midsection weight.So metabolism does slow down a little bit, and it becomes really important at menopause to be mindful of the calorie intake according to your your kind of your your height, your ideal body weight and the activity level that you do?
So that's something that I would look at monitoring a little bit closer. It's also really important to do strength training around menopause, and beyond. So over Cardio. For sure, so strength. Training is really good at building muscle mass. And when you have muscle, that muscle has a higher metabolism than fat. So when you have more muscle, stronger muscles, it increases your metabolism a bit.
and strength training is also really good for long term function. So when you become older, like 80 90 for maintaining doing your daily activities, protein intake becomes really important around menopause. And we definitely the vast majority of people in our society don't do not eat enough protein, so this would be a time where I would explore doing the macro counting. So I look at your protein fat carbohydrates. There's some calculators where you can determine how much protein you should eat every day, and I would just be a little bit more mindful of those things.
Tess
Wonderful.
Dr. Melanie Altas
Yeah. Oh, there was another question about vagifem being expensive. Yeah, it is. It's expensive and the same thing with the E string, the ring and the invexi is also expensive. There was talk, maybe last year the year before about the BC. Government covering menopausal hormone therapy, because they're you know they're covering the Birth Control pills and Iuds now, so I haven't heard anything recently. But I'm hoping that that that comes through where they pull through. With that I know it would be really wonderful.
Tess
Yeah, wonderful.
Dr. Melanie Altas
Yeah.
Tess
Okay, I think you got both parts of that question. So that's great. Thank you. And I think we're, we're coming to the end of our questions. Here I have one more stored for you, which is someone just asking, noting you recommended silicone lubricants and saying, I'm currently using silicone dilators that say, do not use with a silicone lubricant. What should I use with these, oil-based?
Dr. Melanie Altas
So yeah, so you can use oil-based just like a coconut oil is good. But yeah, there's a little that's a little bit of a myth, though so, and it comes from decades ago, when silicone sex toys were not made with high grade silicone. They were very poorly made, and at that time If you used a silicone lube with a silicone sex toy the silicone Lube would degrade the sex toy. Now the sex toys are made of high quality silicone. They're really well made, I think that's very unlikely to happen so. But some people just like to use an oil base like coconut oil or something. Any type of oil is fine.
Tess
Okay, I think that's the end of my stored questions, folks. So we're coming to the end of our time. But we certainly have time for one more. Oh, sorry, Jen, I missed yours in the chat there, just oh, and you you're on it. You're a step ahead confirming that. Yes, the clinic does offer telephone appointments for anyone who's not in the lower mainland. That's good.
Tess
Any final questions. Folks that anyone wants to share here, where we still have Dr. Altas with us.
Tess
Just lots of thank yous coming into the chat.
Dr. Melanie Altas
Oh, thank you, guys, thanks for attending and for being so interested in this topic. I love it.
Tess
Yeah, a big thank you to you for taking your time, Dr. To share this incredible information and answer all of these great questions. Thanks for all the questions, everyone. Those were wonderful.