Introduction/Background Women with a BRCA1/2 pathogenic variant are advised to undergo premenopausal risk-reducing salpingo-oophorectomy (RRSO), to reduce their risk of ovarian cancer. Our aim was to study long-term sexual functioning in women at increased familial risk of breast/ovarian cancer who underwent a RRSO either before the age of 46 years (premenopausal group), or after the age of 54 years (postmenopausal group).

Methodology Between 2018 and 2021, 368 women with a high familial risk of breast/ovarian cancer participated in the study (premenopausal group, n=226, postmenopausal group, n=142). Differences between groups were analyzed using multiple regression analyses adjusting for current age, breast cancer history, use of hormone replacement therapy, BMI, chronic medication use (yes/no) and body image.

Results Mean time since RRSO was 20.6 years in the premenopausal group and 10.6 years in the postmenopausal group (p-value <.001). In the premenopausal group, mean age at questionnaire completion was 62.7 years, versus 67.0 years in the postmenopausal group (p<.001). In the premenopausal group, 47.4% was still sexually active, compared to 48.9% of the postmenopausal group (p-value:.80). Current sexual pleasure scores were similar for women in the premenopausal group and the postmenopausal group (mean pleasure score 8.6, p-value.99). However, women in the premenopausal group more often reported substantial discomfort than women in the postmenopausal group (35.6% compared with 20.9%, p-value .04). After adjusting for confounders, premenopausal RRSO was associated with substantially more discomfort during sexual intercourse, compared to postmenopausal RRSO (OR 3.1, 95%CI 1.04; 9.4). Moreover, following premenopausal RRSO, more severe complaints of vaginal dryness were observed (OR 2.6, 95%CI 1.4; 4.7).

Conclusion More than 15 years after premenopausal RRSO, women experienced more vaginal dryness and more often had substantial sexual discomfort during sexual intercourse. This did not lead to less pleasure with sexual activity.