Sexuality after breast cancer

Abstract

Breast cancer (BC) may affect three main domains of women's sexuality: sexual identity, sexual function and sexual relationship. Age, lymphedema, side-effects of surgery, radio-, chemo- and hormonotherapy, pregnancy-related problems, infertility, iatrogenic premature menopause, with its cohort of symptoms secondary to the chronic loss of estrogens on the brain, on the sensory organs, on the pathophysiology of sexual response and on the function of the pelvic floor, may all affect sexuality after breast cancer. Women carriers of BRCA mutations, who might consider bilateral prophylactic mastectomy, may have a specific iatrogenic impact of surgery on their self-image and femininity. Unfortunately, biological factors, secondary to the diagnosis and treatment of breast cancer, are usually understudied with respect to the psychosocial ones. Physicians should improve their skill in understanding and listening to sexual concerns and in addressing the basic biological issues that BC raises for female sexual identity. Physicians should also at least diagnose and recommend clinical help for the most common sexual symptoms in BC survivors: loss of libido, arousal disorders, dyspareunia, anorgasmia and loss of satisfaction. The best results will be obtained in sharing a "twin competence" with a good psychosexologist or a psychiatrist with an interest in this field, to whom patients with clear psychodynamic or relational problems should be referred for specific help, after having excluded or cured the potential biological roots of them. Attention to the anatomy and function of the pelvic floor should become a mandatory part of a thorough clinical gynaecological and sexological examination, to give BC survivors the right to a full diagnosis and competent help. This paper will focus on the biological factors that are of main interest for the daily practice of health care providers.