Sexual Health after a Breast Cancer Diagnosis: Addressing a Forgotten Aspect of Survivorship

Abstract

Breast cancer is the most common cancer in women. The life expectancy after a breast cancer diagnosis is improving steadily, leaving many more persons with the long-term consequences of treatment. Sexual problems are a common concern for breast cancer survivors yet remain overlooked in both the clinical setting and the research literature. Factors that contribute to sexual health concerns in breast cancer survivors are biopsychosocial, as are the barriers to addressing and treating these health concerns. Sexual health needs and treatment may vary by anatomy and gender. Multidisciplinary management may comprise lifestyle modifications, medications, sexual health aids such as vibrators, counseling, and referrals to pelvic health physical therapy and specialty care. In this article, we review the contributing factors, screening, and management of sexual difficulties in cisgender female breast cancer survivors. More information is needed to better address the sexual health of breast cancer survivors whose sexual/gender identity differs from that of cisgender women.

Screening, Surveillance, and Survivorship after Breast Reconstruction

“…Physical intimacy with a significant other or spouse is a challenge for these individuals and many of them do not engage with their loved ones on that level for a prolonged period of time. A woman's breasts are also deeply rooted in their maternal nature as well and that loss can be devastating to a young woman looking to having children or with young children at home [6,7].…”

“…In addition, for the many woman whom anti-estrogen therapies are recommended, they may suffer from side effects that further decrease their libido and may actually make intimacy painful. Preoperative, post-operative, and survivorship resources should be offered in counseling, psychological therapy, support groups, and management of treatment related side effects to ease the journey [6,7].…”

Breast Cancer Survivorship: Understanding Breast Tissues’ Potentiating Role in Precipitating Deviations from Baseline Sexual Function Post Oncologic Resection

“…5 Recent evidence suggests that individuals undergoing less-invasive breast cancer resections may retain better function outcomes, improving overarching sexual wellbeing following treatment. 4 Although researchers characterize these findings to denote that larger resections of breast tissue influence sexual well-being secondary to adversely impacted self-esteem/image, 4 these findings are limited in scope, overlooking the fact that native breast tissue itself may have a direct impact on sexual well-being. Our understanding of the physiologic and molecular processes performed by breast tissue in relation to maintaining baseline sexual well-being is unspecified.…”

“…However, recent literature examining how postoperative breast sensation impacts sexual well-being demonstrates the paradigm shift toward retaining/restoring patients' functional outcomes. 4 Previous research investigating sexual wellbeing in breast cancer survivors characterizes the impacts of pharmacotherapy, surgical intervention type (eg, BCS versus mastectomy), breast reconstruction status/type/ timing, and other psychosocial factors on sexual well-being (Table 2). Although significant evidence has illuminated the role of pharmacotherapy and psychosocial factors on sexual well-being, limited literature exists examining how resection of molecularly active breast tissue modifies baseline, physiologic sexual function/well-being.…”

A guide for addressing sexual health in breast cancer patients

“…19,23 Whenever possible, providers should take advan- Some patients may experience anxiety and mood disorders within their cancer experience, in particular with estrogen deprivation -these disorders can directly impact patients' sexual health. 28,29 Hormonal changes can be challenging, especially for young breast cancer patients, those on ovarian suppression and/or endocrine therapy. 30 Depression and anxiety can negatively impact the sexual function as well as many of the treatments for these conditions.…”