Sexual dysfunction may persist after breast cancer treatment and may include vaginal discomfort, hot flashes and alterations in bioavailable testosterone, luteinizing hormone and sex hormone binding globulin (49). Menopausal symptoms such as hot flashes, vaginal dryness and stress urinary incontinence are very common in breast cancer survivors and cannot be managed with standard estrogen replacement therapy in these patients (50). The normal life expectancy of survivors of early-stage cancers during these years of life underscores the need to address their long-term health and quality-of-life issues.