(289) Application of the Ex-PLISSIT Model in Breast Cancer Patients With Sexual Dysfunction Within the Context of a Randomized, Double-Blind Clinical Trial of Co₂ Laser Versus Sham-Laser Treatment for Genitourinary Syndrome of Menopause

Introduction Patients with breast cancer (BC) often experience sexual dysfunction, which significantly impacts their health and quality of life. The diagnosis and/or its treatments can negatively affect sexual health. Patients receiving aromatase inhibitors (AIs) are at particularly high risk of developing severe Genitourinary Syndrome of Menopause (GSM) and sexual dysfunction. However, these symptoms are frequently underdiagnosed and undertreated. Sexual health also encompasses intimacy, eroticism, reproduction, and body image-all of which may be affected and influence other dimensions of female sexuality, such as desire, arousal, orgasm, and satisfaction. Any intervention aimed at addressing GSM in BC patients should adopt a comprehensive approach considering the full spectrum of sexual health needs. Objective To assess the qualitative results of the sex therapy based on the Ex-PLISSIT model in the improvement of sexual health in BC patients treated within a multidisciplinary public healthcare setting. Methods We present a secondary analysis to evaluate the Ex-PLISSIT model as a sex therapy tool for sexual dysfunction in a randomized, double-blind study comparing CO₂-laser versus sham-laser treatment for GSM. All participants were current or former AI users. All participants received standardized moisturizing and lubricating treatments and were provided with a vaginal vibrator. Sexual dysfunctions were classified according to DSM-V criteria. Variables included baseline clinical and sexual characteristics, treatment details, attendance patterns, and post-intervention sexual health status. Results Eighty-four patients were randomized in the trial: one declined participation post-randomization. All were offered a specialized sexual assessment, with 67 accepting. A total of 61 patients (age 52.5±8.4 years) attended the baseline visit. The average time since BC diagnosis was 4.2 years. Most participants (98.4%) identified as heterosexual, and 77.0% had a partner (mostly cohabiting). At baseline, 70.5% were sexually active (SA), with a median monthly frequency of 2.6 (range 0–16). Among SA patients, 25.6% engaged only in solo sex, and 44.2% only in partnered sex. Vaginal and non-vaginal sex were practiced by 65.1%; 27.9% engaged only in non-vaginal sex, and 6.9% only in vaginal sex despite pain. Diagnoses included GPPPD in 80.0%, FSIAD in 66.7%, and FOD in 26.7%. A total of 63.3% had two or more concurrent dysfunctions. Most had not received prior sex therapy. The mean number of sex therapy sessions was 3.2 (range 1–9), with a median treatment duration in months of 3.9 (IQR: 0.175–7.8). Permission, Limited Information and Specific Suggestions were applied to all patients; 18 required Intensive Therapy. The most frequently used strategies included positive sexuality, pelvic floor exercises, and sensate focus exercises (solo or with a partner). At follow-up, sexual symptoms had resolved in 74.5% of patients; 13.7% reported persistent symptoms but adapted and satisfactory sexuality; 3.9% showed no improvement; and 7.8% expressed no interest in sexuality. At the end of the intervention, 92.1% were SA. Conclusions A comprehensive approach to sexual dysfunction in BC patients using the Ex-PLISSIT model can improve sexual health and satisfaction within multidisciplinary public health units. Further research, specialized training, and policy initiatives are needed to promote sexual health programs in public healthcare settings. Disclosure No