Chemotherapy-Induced Spontaneous Orgasms in a Patient with Breast Cancer

TO THE EDITOR: Sexual dysfunction is one of the most important factors influencing the quality of life of patients with cancer. Many sexual dysfunctions, including decreased libido, delayed orgasm, and erectile dysfunction, may occur during and after chemotherapy or radiation. ¹ To date, chemotherapy-induced repeated spontaneous orgasms have not been described. To our knowledge, this is the first report of a case of chemotherapy-induced spontaneous orgasms in a patient with breast cancer.

Case Report. A 53-year-old postmenopausal female with a mass in her right breast was admitted. Mammography revealed a mass in the right upper quadrant. No distant metastases could be detected. Her medical history was unremarkable, with no previous history of sexual dysfunction. A modified radical mastectomy and lymph node dissection were performed. Pathologic examination suggested an invasive ductal carcinoma, with 4 of 16 metastatic lymph nodes excised from the axillary region. The c-erbB2 receptor was negative, but estrogen and progesterone receptors were positive. Consequently, a combined chemotherapy regimen including docetaxel, doxorubicin, and fluorouracil once every 3 weeks for 3 cycles was initiated.

Following both the first and second cycles of chemotherapy, the patient experienced increased libido and spontaneous orgasms without sexual stimulation approximately 5-6 times a day, with each episode lasting approximately 30 seconds to 1 minute. These symptoms appeared the day after chemotherapy administration and resolved gradually within 2 days. Except for the administration of chemotherapy and antiemetics, including granisetron, for 5 days, she did not receive any concomitant medications, including antidepressants, during the treatment period. Although the patient received 1 mg of granisetron for 5 days, these sexual symptoms were not observed after the third day. Serum follicle-stimulating hormone, luteinizing hormone, estradiol, and progesterone levels were within normal ranges. Consequently, the combined chemotherapy protocol was switched to anastrozole 1 mg per day. No sexual dysfunction was observed during the follow-up period after the initiation of the treatment with anastrozole.

Discussion. The incidence of sexual problems in females with breast cancer appears to be relatively higher than usual, especially when they receive chemotherapy and radiation. Chemotherapy regimens are significantly correlated with decreased sexual desire, as well as decreased frequency and/or intensity of orgasms. To our knowledge, there are no published reports about chemotherapy-induced orgasms. Our patient received a combined chemotherapy regimen containing docetaxel, doxorubicin, and fluorouracil and granisetron, to benefit from its antiemetic effects. On the second day following chemotherapy, repeated spontaneous orgasms occurred 5-6 times daily. This effect lasted for 2 days and then gradually improved.

Spontaneous orgasms have been described after the use of pharmaceuticals such as fluoxetine and venlafaxine.^2,3 Serotonin-specific reuptake inhibitors are known to have an effect on sexual function, such as decreasing libido and delaying orgasms, through the activation of 5-HT₂ receptors. ⁴ Spontaneous orgasms were reported to be associated with the agonism of 5-HT₁ receptors and the antagonism of 5-HT₂ receptors. Our patient was administered granisetron, which is an effective 5-HT₃ antagonist. Although she used granisetron for 5 days, repeated spontaneous orgasms occurred only for 2 days (second and third days). The Naranjo probability scale revealed that it was probable that these chemotherapeutic agents might be responsible for the spontaneous orgasms. ⁵

To our knowledge, this is the first case reporting spontaneous orgasms during a combined chemotherapy regimen containing docetaxel, doxorubicin, and fluorouracil in a patient with breast cancer. This effect should be considered carefully in patients treated with a cytotoxic chemotherapy regimen and symptoms related to increased sexual functions should be investigated in detail.