Breast cancer, the most common cancer in women and also a leading cause of death due to cancer, is amenable to treatment if diagnosed at an early stage. Very small tumors are subjected to surgical removal of the tumor alone. However, larger tumors require removal of the entire breast. Absence of a breast could affect the sexuality of the woman. Though it may not directly affect a woman's ability to have sexual intercourse, it could have a psychological effect on the sexual life, due to alteration in the body image. Breast implants are now often offered to women post surgical removal of the breast.
Besides the psychological aspect, breast cancer treatment can also affect other aspects of sexual functioning. It could result in a decrease in sexual drive, painful intercourse, decreased lubrication and lack of satisfaction. This aspect is often ignored during management of a patient with breast cancer. Doctors often tend to concentrate on the removal of the cancer and fail to pay attention to this aspect of care.
A study was conducted in Moroccan female breast cancer survivors to examine the impact of diagnosis and treatment of breast cancer on their sexual lives. 120 sexually -active women diagnosed with breast cancer were included in the study. They had undergone prior treatment for breast cancer, including surgery and some adjuvant treatment such as chemotherapy, radiotherapy and hormone therapy.
The women were interviewed and assessed based on two scales: the first scale was the Body Image Scale. It assessed changes in body image perception, with questions regarding impact of treatment on self-consciousness, physical and sexual attractiveness, femininity, satisfaction with body and scars, body integrity, and avoidance behavior. The second scale was called the Female Sexual Function Index. It evaluated desire, arousal, lubrification, orgasm, satisfaction and pain during sexual intercourse.
The study found that half the patients experienced problems related to body image perception. These were often associated with surgical removal of the breast, hair loss, fatigue, weakness and changes in hormonal status from chemotherapy, concern regarding weight gain or loss, poorer mental health, and lower self-esteem.
The study also found that none of the patients had discussed the sexual aspect of their cancer treatment with their doctors. 84% women continued to be sexually active following treatment. However, 65% women experienced painful intercourse. Lubrication difficulties and decreased sexual drive were reported by about half the women. About one third of women complained of inhibited female orgasm, lack of satisfaction and brevity of intercourse and arousal.
Sexual dysfunction was absent before treatment in most patients. However, all the patients complained of worsening of symptoms following treatment, especially after chemotherapy. All the patients reported that they were not explained this aspect prior to treatment.
Though the study does have some limitations in the methodology, it demonstrates that discussion regarding sexual activity is an important aspect during management of breast cancer and should not be ignored. The psychological aspects such as decrease in sexual desire, difficulty to reach orgasm and brevity of intercourse, as well as the physical aspects such as painful intercourse and lubrication difficulties should be addressed.
The study thus highlights the importance of discussing and managing sexual issues during the treatment of breast cancer in women.
1. Sbitti Y, Kadiri H, Essaidi I, Fadoukhair Z, Kharmoun S, Slimani K, et al. Breast cancer treatment and sexual dysfunction: Moroccan women's perception. BMC Women's Health 2011, 11:29