Sexual Function in Breast Cancer Patients: A Review of the Literature

Abstract

Background: Breast cancer (BC) is the most prevalent cancer among females worldwide. Despite having survival rates beyond 90% in 5 years nowadays, BC has also the highest rates of lost disability-adjusted life years (DALYs) among all cancers. Sexual dysfunction (SD) is one of the most important causes of the problem, affecting between 40-80% of BC survivors. However, SD remains underdiagnosed and undertreated in the clinical practice. Therefore, this review is aimed to evaluate the assessment of SD in Breast Cancer Survivors (BCS) as well as specific causes affecting their sexual function and the potential therapeutic options for these patients. Methods: In December 2021, a search of observational studies evaluating the sexual function in BCS was performed through Ovid Medline, Embase, PubMed, Cochrane register of controlled trials (CCTR), Cochrane database of systematic reviews (CDSR), Cumulative Index to Nursing & Allied Health Literature (CINAHL) and Google scholar to identify potentially relevant publications. Articles that evaluated non-gynecological cancers were excluded, as well as those focusing on the sexuality of men. Results: Despite being such a prevalent entity and given the particularities of how BC affects the sexuality of patients, SD is not usually discussed in the clinical practice in BCS for various reasons, remaining therefore underdiagnosed and undertreated. SD in BC patients has a multifactorial aetiology, including among others, the effect of BC treatments (related to vaginal mucosae, fatigue, and joint pain), the psychological impact of the diagnostic itself and sociocultural influences related to the alteration of the breast. Various strategies have been suggested to treat SD in BC patients, including pharmacological, physical and psychological options. Evidence shows that vaginal moisturizers and psyco-educational therapies focusing on sexual health and couple-based ones improve sexual function; while systemic treatments and general psychological therapy have not demonstrated benefit. Regarding exercise programmes, body image perception has shown to be improved after a one-year strength training program. Conclusions: SD is a multifactorial condition that affects the quality of life of millions of BCS worldwide, severely underdiagnosed and undertreated up to date. A systematic assessment of sexual function in BCS could be useful to diagnose all cases prematurely to give adequate care and prevent its worsening. Specific treatment options for BCS are key potential investigation targets for the near future.

Assessing the Impact of Organ Failure and Metastases on Quality of Life in Breast Cancer Patients: A Prospective Study Based on Utilizing EORTC QLQ-C30 and EORTC QLQ-BR45 Questionnaires in Romania

“…The score values indicate that patients were not interested in sexual activity in the last month, and sexually active patients faced sexual-related issues [30]. Castillo et al highlighted in a review that physicians often do not discuss sexual functioning with breast cancer patients; hence, sexual dysfunction remains an underdiagnosed and undertreated entity in breast cancer patients [31]. Causes leading to sexual dysfunction include psychological factors related to breast cancer, on the one hand, and, on the other hand, the side effects of therapy [31].…”

Fear of cancer progression and the quality of sexual life of female cancer patients in Romania

“…In Arden-Close et al (54) study, only 16% of patients said that they had (10). However, by not talking about it, sexual dysfunctions remain therefore underdiagnosed and undertreated (18).…”

“…Another reason for this could be the lack of knowledge/training of medical staff in this area ( 10 ). However, by not talking about it, sexual dysfunctions remain therefore underdiagnosed and undertreated ( 18 ).…”

“…The number of patients affected from this point of view is considerable, especially if we consider the frequency of underreporting due to the delicate nature of the topic [sexuality as taboo, CBOS (13) as cited in (11)]. According to the literature, 60-100% (14) and 30-80% (15)(16)(17) of women diagnosed with cancer indicate the presence of some forms of sexual dysfunction (18).…”

Breast Cancer Survivors with Genitourinary Syndrome of Menopause Receiving Aromatase Inhibitors Are Willing to Sexual Assessment: Is a Dyspareunia Approach Enough?

“…In a recent metaanalysis focused on sexual function among BCS, female sexual dysfunction (FSD) prevalence was 73.4% with a mean Female Sexual Function Index (FSFI) of 19.28 [3]. BC diagnosis and/or its treatments (surgery/chemotherapy/radiotherapy/hormonal therapy) may alter sexual health [4]. BCS receiving aromatase inhibitors (AIs) defne one of the groups with greater likelihood of complaining with severe genitourinary syndrome of menopause (GSM) and sexual impairment [5], being 3 out of 4 BCS with AI distressed by their sexual problems [6].…”