Breast cancer survivors report poor sexual health

An Austrian study highlights the need for ob/gyns to counsel breast cancer survivors about sexual health issues, even years after their treatment for the disease. Conducted at the Medical University of Innsbruck in Austria, the research included 105 breast cancer survivors and 97 women with no history of breast cancer who were assessed to develop a better understanding of sexual health issues post-diagnosis and post-treatment.

Breast cancer survivors were recruited between January and December 2014 when they presented for routine after-care checkups to their treating physicians; the control subjects were recruited when they presented for mammography. All patients completed a battery of instruments, including the Sexual Activity Questionnaire (SAQ), Sexual Interest and Desire Inventory-Female (SIDI-F), Menopause-specific Quality of Life Questionnaire (MENQOL), Body Image Scale (BIS), and Hospital Anxiety and Depression Scale (HADS).

The breast cancer survivors were, on average, 3 years away from their diagnosis at the time of the study (range 0.3 years to 17 years). Subjects in both groups had a mean age of 49 years and 77% had < 12 years of education. There were no differences between the two groups in terms of other sociodemographic characteristics.

Results Highlight Sexual Issues

Twenty-eight percent of the breast cancer survivors reported that they were not currently sexually active, versus 20% in the group of women who had no history of breast cancer. Primary reasons for not being sexually active were a lack of a partner and lack of interest in sex.

Survivors had significantly more sexual health issues than women in the control group in terms of sexual desire and discomfort with intercourse. The mean score on the SIDI-F for breast cancer survivors was 24.9 compared with 29.8 among the women in the control group (a lower score on the SIDI-F=lower sexual functioning), and 68.8% of women in the survivor group versus 58.8% of women in the control group met the criteria for HSDD. There were also correlations between depression, older age, and less satisfaction with a partner and sexual issues. Because those factors are well known to be associated with sexual impairments, the study confirmed that dogma. In contrast to other research, however, the authors were surprised to find that body image was not central to sexual health problems in breast cancer survivors as might be expected. They attributed this disparity to differences in study groups, designs, and sample sizes, and suggested that a prospective, longitudinal study might provide “a more precise picture of this association.”

Putting the Results into Context

“Even years after treatment, [breast cancer] patients still reported distinct levels of sexual health impairments that differed significantly from that of women without a history of [breast cancer],” wrote the authors. “[Breast cancer survivors] were not only more frequently sexually inactive, but also met the criteria for HSDD more often.”

The 70% rate of sexual impairment is comparable to other reports, they noted, which have ranged between 70% and 77%.^2,3 They also stated, however, that women without a history of breast cancer also had a high rate of HSDD, and that “a [breast cancer] diagnosis and treatment seems to aggravate this problem of a pretty high pre-diagnosis impairment ‘level.’”

Limitations of the study included the cross-sectional design, possible selection bias, inclusion of a broad range of cancer survivors, and the use of a self-reported SIDI-F, which has not been validated in previous studies.               

How Clinicians Can Help

Based on their findings, the authors recommended that healthcare providers who care for breast cancer survivors give attention to sexual health issues as a “major health care demand,” and begin to routinely discuss sexual health issues with patients as part of routine post-survivorship care and counseling. They also suggested that clinicians offer referrals to psychologists and gynecologists who specialize in sexual health for patients who demonstrate a need for it.

REFERENCES

1. Oberguggenberger A, Martini C, Huber N, et al. Self-reported sexual health: Breast cancer survivors compared to women from the general population-an observational study. BMC Cancer. 2017;17:599. DOI 10.1186/s12885-017-3580-2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5577863/

2. Panjari M, Bell RJ, Davis SR. Sexual function after breast cancer. J Sex Med. 2011;8(1):294-302.

3. Raggio GA, Butryn ML, Arigo D, Mikorski R, Palmer SC. Prevalence and correlates of sexual morbidity in long-term breast cancer survivors. Psychol Health. 2014;29(6):632-650.