Sexuality and Breast Cancer Survivorship

A number of studies surveying breast cancer survivors have documented the impact of breast cancer diagnosis and breast cancer treatment on sexual function, sexual feeling, and sexual self-image.

Women with breast cancer may experience loss of sexual desire, decreased arousability, diminished orgasmic capacity, impaired vaginal physiology, depression, and a lessened sense of "femaleness." Untreated sexual problems negatively affect intimate relationships, self-confidence, and physical well-being.

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Addressing the issue of sexual function before cancer treatment begins alerts the patient to the clinician's interest in this aspect of survivorship and increases the chance that the patient will bring future sexual problems to the attention of the treatment team. Depending on the nature of the problem and the disease context, interventions are available for treatment of sexual problems in breast cancer survivors.

These include vaginal moisturizers, lubricants, medications or psychological therapy to alleviate depression-related sexual dysfunction, and couples therapy to address sexual and more general issues.

Introduction
According to Pelusi, sexuality is a complex and subjective concept that changes with age and experience and involves more than just being physically able to perform a sex act or conceive a child (Pelusi, 2006). Sexuality can include sexual response (interest, function, and satisfaction), body image (how a woman sees herself physically and views her overall health and sexuality), sexual roles, and relationships. Ultimately, "sexuality is a personal expression of one's self and one's relationship with others" (Pelusi, 2006).

A number of studies have looked at quality of life, including sexual function, in breast cancer survivors (Dorval et al., 1998; Ganz et al., 1998; Ganz et al., 2002; Kornblith et al., 2003; Bloom et al., 2004; Casso et al., 2004; Ganz et al., 2004; Kroenke et al., 2004; Arndt et al., 2005; Schultz et al., 2005). These studies suggest that sexuality in some women may be altered by breast cancer diagnosis and treatment.

Ganz et al. (1998) studied health-related quality of life and sexual functioning in a cross-sectional sample of breast cancer survivors from Los Angeles and Washington, D.C., who had been diagnosed 1-5 years earlier with early-stage (stage 0-II) disease, had completed all breast cancer therapy other than tamoxifen, and had no evidence of recurrent disease.

In this study, the respondents, who had a mean age of 56.2 years, reported health-related quality of life and sexual functioning that was similar to that of healthy age-matched women. With further follow-up, when women were 5-10 years from diagnosis, there was no change in the frequency of pain with intercourse, no change in sexual interest, and no change in body image, although there was a significant decline in the frequency of sexual activity (Ganz et al., 2002). In the Moving Beyond Cancer Study (Ganz et al., 2004), breast cancer survivors who had completed primary treatment that included chemotherapy were more likely to report worse sexual functioning than were survivors who had not received chemotherapy, regardless of the type of surgery.