Breast cancer and sexual dysfunction: Does surgery matter?

Abstract

ABSTRACT Introduction It is well known that breast cancer and its associated treatments have negative effects on women's physical, emotional, and overall sexual health. Studies have shown that the incidence of sexual dysfunction is significantly higher after the diagnosis and associated treatments of breast cancer. For surgical procedures, there is evidence of an increase in sexual problems 6 months after surgery. . Objective The aim of this review is to examine the available research on the impact of breast cancer surgery on women's sexuality. Methods A comprehensive search of Medline, Scopus, and Web of Science databases was conducted to find Englishlanguage articles published since January 2000. We used a list of keywords combining "breast cancer" AND "surgery" AND "sexual function" AND "sexual dysfunction". Results We found 1947 results, and after selecting quantitative and original articles on the effects of breast cancer surgery on female sexuality, there were 14 eligible articles. Three articles from other sources were included. Studies comparing the sexuality of the general population with that of women who had undergone breast cancer surgery found a higher risk of sexual dysfunction in these women. When comparing different types of surgery, namely mastectomy with or without reconstruction and breast-conserving surgery, different results were obtained. Four studies found no differences in sexual function between the different types of surgery. Mastectomy without reconstruction was associated with a negative impact on sexual function in four other studies, with all sexual domains affected in some of these studies. In contrast, two studies found lower scores in women who had undergone breast-conserving surgery. Axillary lymph node removal has also been associated with genital arousal disorder. Two studies found no association between sexuality and breast cancer surgery. Conclusions Breast cancer and related treatments, including surgery, have a negative impact on women's sexuality. Different types of surgery appear to have different effects, with mastectomy without reconstruction associated with worse outcomes, while breast-conserving surgery was associated with lower sexual function scores in only two studies. All of these studies relied on different methods and populations with different expectations, which may explain some of the disparity in outcomes. By pointing out the surgical consequences of mastectomy preoperatively, surgeons can make patients' expectations of esthetic and functional outcomes after breast cancer surgery more realistic and help patients make better treatment decisions. Disclosure Work supported by industry: no.