title: Effects of tamoxifen on vaginal blood flow and epithelial morphology in the rat.
abstract: BACKGROUND
  Tamoxifen, a selective estrogen receptor modulator with both estrogenic and anti-estrogenic activity, is widely used as adjuvant therapy in breast cancer patients. Treatment with tamoxifen is associated with sexual side effects, such as increased vaginal dryness and pain/discomfort during sexual activity. There have been limited investigations of the effect of tamoxifen on estrogen-dependent peripheral genital arousal responses. The objective of this study was to investigate the effects of tamoxifen on vaginal physiology in the rat.
  
  
  METHODS
  Female Sprague-Dawley rats were subjected to sham surgery or bilateral ovariectomy. After 2 weeks, sham-operated rats were implanted with subcutaneous osmotic infusion pumps containing vehicle (control) or tamoxifen (150 microg/day). Ovariectomized rats were similarly infused with vehicle. After an additional 2 weeks, vaginal blood flow responses to pelvic nerve stimulation were measured by laser Doppler flowmetry and vaginal tissue was collected for histological and biochemical assay.
  
  
  RESULTS
  Tamoxifen treatment did not change plasma estradiol concentrations relative to control animals, while ovariectomized rats exhibited a 60% decrease in plasma estradiol. Tamoxifen treatment caused a significant decrease in mean uterine weight, but did not alter mean vaginal weight. Vaginal blood flow was significantly decreased in tamoxifen-infused rats compared to controls. Similar to ovariectomized animals, estrogen receptor binding was increased and arginase enzyme activity was decreased in tamoxifen-infused rats. However, different from control and ovariectomized animals, the vaginal epithelium in tamoxifen-infused rats appeared highly mucified. Periodic acid-Schiff staining confirmed a greater production of carbohydrate-rich compounds (e.g. mucin, glycogen) by the vaginal epithelium of tamoxifen-infused rats.
  
  
  CONCLUSIONS
  The observations suggest that tamoxifen exerts both anti-estrogenic and pro-estrogenic effects in the vagina. These physiological alterations may eventually lead to vaginal atrophy and compromise sexual function.
authors.affiliation: Institute for Sexual Medicine, Department of Urology, Boston University School of Medicine, Boston, Massachusetts, USA. nnkim@bu.edu
authors.forename: Noel N
authors.initials: NN
authors.lastname: Kim
authors.forename: Miljan
authors.initials: M
authors.lastname: Stankovic
authors.forename: Abdullah
authors.initials: A
authors.lastname: Armagan
authors.forename: Tulay T
authors.initials: TT
authors.lastname: Cushman
authors.forename: Irwin
authors.initials: I
authors.lastname: Goldstein
authors.forename: Abdulmaged M
authors.initials: AM
authors.lastname: Traish