The Effect of Group Counselling on Body Image and Sexual Satisfaction Among Women with Breast Cancer: A Randomized Clinical Trial

Breast cancer treatments and the traumatic nature of the cancer experience frequently elicit considerable sexual difficulties. Breast cancer survivors (BCS) experiencing body image (BI) issues may represent a vulnerable group for developing sexual dysfunction posttreatment. The current study explores sexual functioning (SF) in this unique clinical group. A descriptive study assessed 127 BCS who were engaged in sexual activity. Standardized baseline measures included the following: BI Scale, BI after Breast Cancer Questionnaire, Female Sexual Function Index (FSFI), Kansas Marital Satisfaction Scale, and Functional Assessment of Cancer Therapy - Breast. Levels of SF were compared with BCS, heterogeneous cancer, and healthy female populations. Correlational analyses were conducted between SF, BI, relationship, and health-related quality of life variables. Guided by a conceptual framework, regression analyses were conducted to determine significant demographic, clinical, and psychosocial predictors of sexual desire, satisfaction, and overall SF. Eighty-three per cent of BCS met the FSFI clinical cutoff score for a sexual dysfunction. Participants exhibited poorer SF when compared with other female cancer and healthy groups. No significant correlations were found between BI questionnaire total scores and SF. BI after Breast Cancer Questionnaire - Body Stigma subscale showed significant associations with FSFI Arousal, Orgasm, Satisfaction (average r = -0.23), and overall SF (r = -0.25). Vaginal dryness (β = -0.50), body stigma (β = -0.24), and relationship satisfaction (β = 0.27) were significant predictors of overall SF. Difficulties in SF appear to be highly prevalent in BCS experiencing BI disturbance posttreatment. Brief screening tools assessing SF should adopt a biopsychosocial model, which includes questions regarding vaginal dryness, relationship satisfaction, and body stigma issues.

Doživljaj tijela, seksualnost i kvaliteta partnerskog odnosa u različitim fazama tranzicije u roditeljstvo

Background: The diagnosis and treatment of breast cancer can profoundly affect women’s marital dynamics, frequently impacting body image, sexual satisfaction, and overall marital quality. This study sought to examine the relationships between marital expectations and body image with marital quality of life in women with breast cancer, with a particular focus on the mediating role of sexual satisfaction in these associations. Methods: This study employed a cross-sectional descriptive correlational design, utilizing path analysis to examine the relationships between key variables, including marital quality of life, marital expectations, body image, and sexual satisfaction. The target population comprised all women with breast cancer attending subspecialty clinics in Ahvaz, Iran, with data collected from January to June 2024. A sample of 161 women with breast cancer was recruited via convenience sampling. Data were collected using the Revised Dyadic Adjustment Scale, Marital Expectations Questionnaire, Multidimensional Body-Self Relations Questionnaire, and Marital Intimacy Questionnaire. Data analysis involved descriptive statistics, Pearson’s correlation coefficient, and path analysis. Results: The mean score for marital quality of life was 42.95 (SD, 8.89). The results indicated significant positive direct relationships between marital expectations and sexual satisfaction, body image and sexual satisfaction, body image and marital quality of life, and sexual satisfaction and marital quality of life among women with breast cancer (P<0.001). However, no significant direct relationship was found between marital expectations and the quality of life in marriage. Furthermore, significant indirect relationships were observed between body image and marital quality of life, mediated by sexual satisfaction, and between marital expectations and marital quality of life, mediated by sexual satisfaction (P<0.001). Conclusion: This study highlights the intricate links between marital quality of life, sexual satisfaction, body image, and marital expectations in women with breast cancer, with sexual satisfaction as a key mediator. These insights call for holistic interventions, integrating psychological counseling, body image therapy, and couples’ support, to enhance relational well-being and overall quality of life.

To evaluate the effect of sociodemographic and clinical factors on body image, sexual function and sexual satisfaction in women following breast cancer treatment. Women with breast cancer may experience a wide range of symptoms associated with body image and sexuality that can severely affect their quality of life. Therefore, the health care professional's ability to understand the patient's complaints and her sexual history is highly relevant in specialised multidisciplinary care. A cross-sectional survey. Seventy-seven participants were included. Body image, sexual function and sexual satisfaction were evaluated using the EORTC QLQ-BR23 questionnaire. Results were shown as means, standard deviations, frequencies and percentages. Cronbach's alpha was calculated. Spearman's correlation test,the chi-square test and multivariate logistic regression were used in the statistical analysis, conducted using the spss statistical software package, version 17.0. Low scores were found in the desire (34·63), frequency (32·03) and sexual satisfaction (45·91) domains, while body image scores were higher (63·57). No strong correlation was found between body image and any of the other domains. Patients without a steady partner experienced more sexual desire (p<0·04) and more frequent sexual activity (p<0·01). Sexual activity was also more frequent (p<0·03) in women with a higher education level and in those using aromatase inhibitors. Sexual function and satisfaction were affected to a greater extent than body image. No association was found between body image and sexual performance. The effect of marital status and education level on sexual function merits particular attention. A well-trained multidisciplinary team should be available to evaluate women's need for support and to provide information on the disease, its treatment and its impact on their lives and on their sexuality.

The purpose of this study is to examine the effects of a 16-week exercise intervention (mat Pilates or belly dance) on body image, self-esteem and sexual function in breast cancer survivors receiving hormone therapy. Seventy-four breast cancer survivors were randomly allocated into mat Pilates, belly dance, or control group. The physical activity groups received a 16-week intervention, delivered 3 days a week, and 60 min a session. The control group received three education sessions. Data collection occurred at baseline, post-intervention, 6 and 12 months of follow-up with a questionnaire including body image (Body Image After Breast Cancer Questionnaire), self-esteem (Rosenberg Self-Esteem Scale), and sexual function (Female Sexual Function Index) measures. The belly dance group significantly improved body image on limitations scale in the short term and long term, the mat Pilates significantly improved body image on limitations only in the long term, and the control group significantly decreased body image on limitations in the long term. The belly dance group experienced reduced discomfort and pain during sexual relations in the short and long term. All groups showed a significant improvement in self-esteem, but orgasm sub-scale scores declined over time. No adverse events were found for any of the exercise intervention groups. Belly dance seem to be more effective than mat Pilates and control group in improving limitations of body image and sexual discomfort in the short term for breast cancer survivors. ClinicalTrials.gov (NCT03194997) - "Pilates and Dance to Breast Cancer Patients Undergoing Treatment".

The Body Image after Breast Cancer Questionnaire (BIBCQ) is a breast cancer specific tool for body image assessment which measures the long-term effects of breast cancer on different aspects of body image in breast cancer survivors. Culturally-appropriate instruments are needed for body image after breast cancer assessment. This study was conducted to assess the psychometric properties of the Persian version of BIBCQ. In this methodological study, BIBCQ was translated into Persian through forward-backward translation. In totally, 400 breast cancer survivors in north of Iran completed the BIBCQ. The content validity was assessed by twelve experts. The construct validity of the questionnaire was evaluated through exploratory and confirmatory factor analyses and its convergent and discriminant validity were evaluated using Fornell and Larcker’s approach. The reliability of the questionnaire was also evaluated through Cronbach’s alpha and McDonald’s omega. In exploratory factor analysis, five factors were identified. Second-order factor analysis showed an overarching concept that labeled “Body image stigma”. The questionnaire had acceptable content and convergent validity and composite reliability. This scale can be used in future studies to assess body image in Iranian breast cancer survivors. Healthcare policy makers can use the findings of the present study to develop care plans for improving body image and mental health among breast cancer survivors.

Background: Sexual challenges are frequently reported by breast cancer survivors (BCSs). The treatment and associated side effects may all contribute to sexual problems in BCSs. Knowledge concerning sexual activity and functioning among long term BCSs (&amp;gt;5 years after diagnosis) is however limited. The aims of this study were therefore to assess the prevalence of sexual activity and to explore modifiable factors associated with reduced sexual functioning in BCSs 7-8 years after diagnosis, with the ultimate aim of improving follow-up care for BCSs. Methods: The SWEET (survivorship-work-sexual health) study is a cross-sectional nation-wide questionnaire study examining work and sexual health among long-term BCSs in Norway. All women diagnosed with early stage breast cancer (BC) at the age of 20-65 years in 2011 or 2012 without pre- or post- malignancies were identified by the Cancer Registry of Norway (CRN) and invited to study-participation during the fall 2019. Of 2803 BCSs invited, 1361(49%) returned the questionnaire. Of these, 54 were excluded due to incomplete questionnaire, inadequate consent or self-reported BC recurrence, resulting in a final sample of 1307 BCSs. Data were collected using validated questionnaires (Sexual Activity Questionnaire, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 and BR23, Fatigue Questionnaire, The Patient Health Questionnaire-9 and Godin Leisure Time Questionnaire) and questions regarding socio-demography, general health, sleep and cancer treatment. Supplementary cancer related information was obtained from the CRN. Logistic regression analyses examined variables associated with partnered sexual activity. Linear regression analyses examined variables associated with sexual pleasure and sexual discomfort in sexually active BCSs. Results were presented as odds ratio (OR) and beta coefficients (B) with p-values (p). Results: Mean age of BCSs was 51.7 years at diagnosis and 59.7 years at survey. Most participants lived with a partner (74%) and had been treated for BC stage I (45%) or II (36%) with breast conserving surgery (59%), radiotherapy (80%), endocrine therapy (65%) and chemotherapy (69%), while 23 % reported current use of endocrine therapy. Forty-eight percent of the BCSs were sexually active with a partner. Living with a partner (OR 5.2, p&amp;lt;0.001) and having a better body image*(OR 1.01, p&amp;lt;0.001) were positively associated with sexual activity, while older age (OR 0.96, p&amp;lt;0.001) and treatment with aromatase inhibitor (OR 0.58, p=0.002) were negatively associated with sexual activity. Physical activity (B 0.61, p=0.04) was associated with more sexual pleasure, while living with a partner (B -1.68, p&amp;lt;0.001) and experiencing a major depression (B -1.04, p 0.046) were associated with less pleasure. Obesity (B -0.63, p=0.005) was associated with less sexual discomfort, while living with partner (B 0.87, p&amp;lt;0.001), treatment with aromatase inhibitor (B 0.61, p=0.003), sleep problems (B 0.37, p=0.03), breast symptoms* (B 0.01, p=0.01) and chronic fatigue (B 0.43, p=0.03) were associated with more discomfort. Conclusion: Almost 50% of BCSs were sexually active 7-8 years post diagnosis. Several modifiable factors associated with sexual challenges were identified, including a negative body image, physical inactivity, major depression, sleep problems, breast symptoms and chronic fatigue. In the follow-up of BCSs experiencing sexual problems, these factors should be assessed and handled appropriately. BCSs treated with aromatase inhibitor should be offered treatment for gynecological symptoms and a switch to tamoxifen may be discussed. *continuous variable with scale 0-100 Citation Format: Solveig Katrine Smedsland, Kathrine Vandraas, Synne Bøhn, Alv Dahl, Cecilie Kiserud, Mette Brekke, Ragnhild Falk, Kristin Reinertsen. How to stay sexually active and sexually well-functioning after breast cancer - Reporting from the SWEET study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-11-05.

Body Image, Orgasmic Response, and Sexual Relationship Satisfaction: Understanding Relationships and Establishing Typologies Based on Body Image Satisfaction

Sexual dysfunction in women with cancer

Women often undergo physical changes during the menopause transition, but the relationship between body image and sexual function in midlife is unclear. We used a qualitative approach to explore how body image relates to sexual function and satisfaction in midlife women. We conducted 19 individual interviews and 3 focus groups (total N = 39) among sexually active women 45-60 years of age using a semistructured guide. Sessions were audiorecorded and transcribed. Two investigators developed a codebook using an iterative process; the primary investigator then coded all data. Codes relating to body image were examined to identify key themes. The mean age was 58 (range 46-59); 54% were White, 36% Black, and 10% were of another race. Most (72%) were peri- or postmenopausal. All but two women identified as heterosexual. Feeling attractive was an important reason for sexual activity. Changes in appearance, especially weight gain and breast changes, were common among these women. Women's body image impacted their sexual satisfaction; women who felt self-conscious about their bodies reported that these concerns had a negative impact on their sexual satisfaction, whereas women who felt confident discussed better sexual satisfaction, even in the face of bodily changes. Black women were more likely to discuss feeling confident than White women. Feeling attractive is important to sexual satisfaction in midlife women. Bodily changes, especially weight gain, are common during midlife. While many women are self-conscious about their appearance, some women develop increased self-acceptance. Supporting positive body image may help midlife women maintain sexual satisfaction with aging.

Dissatisfaction with physical appearance can cause problems in experiencing sexual satisfaction. In this randomized controlled clinical trial, we analyzed the effects of an educational-behavioral online intervention on transgender women’s body image satisfaction and sexual satisfaction from December 2020 to March 2021, when the data collection of the study was completed in Tehran, Iran. 70 transgender women who met the inclusion criteria were randomly assigned to the control group and the experimental groups (i.e., 35 in each group). Both groups first received routine training and then the experimental group received four 90-minute training sessions. In both groups, body image satisfaction (as a primary outcome) and sexual satisfaction of transgender women (as a secondary outcome) were evaluated by questionnaire prior to the intervention and three months after the intervention. Independent and paired t-test were used for data analysis, and the significance level was considered P < 0.05. According to the research findings, the educational-behavioral intervention improved transgender women’s body images but had no effects on their sexual satisfaction. More research is recommended because having a larger and more diverse sample (samples with different cultures and socioeconomic status) may provide a better understanding of the underlying socio-cultural influence on body image and sexual satisfaction. Trial registration Iranian Registry of Clinical Trials (IRCTID: IRCT20201114049379N1) (date of registration 13/01/2021)

Body image is a complex issue with the potential to impact many aspects of cancer survivorship, particularly for the younger breast cancer survivor. The purpose of this review is to synthesize the current state of the science for body image in younger women with breast cancer. Combinations of the terms "body image," "sexuality intervention," "women," "younger women," and "breast cancer" were searched in the PubMed, PsycINFO, CINAHL, Web of Knowledge, and Science Direct databases through January 2014. Inclusion criteria for this review were (1) original research, (2) published in English from the year 2000 forward, (3) measuring body image as an outcome variable, and (4) results included reporting of age-related outcomes. Thirty-six articles met the inclusion criteria. The majority of studies were cross-sectional, with extensive variation in body image assessment tools. Age and treatment type had a significant impact on body image, and poorer body image was related to physical and psychological distress, sex and intimacy, and the partnered relationship among younger women. Only 1 intervention study found a significant improvement in body image after intervention. Findings suggest body image is a complex posttreatment concern for breast cancer survivors, particularly younger women. The findings of this review are limited by the high level of variation in the methods for assessing body image. Further research of interventions to address body image concerns following treatment for breast cancer is warranted. Improvement of body image may improve the quality of life of younger breast cancer survivors.

This study aimed to explore the relationships between gender-role socialization, objectified body consciousness and quality of life in breast cancer (BC) survivors with body image (BI) disturbance post-treatment. A total of 150 BC survivors participating in an ongoing randomized clinical trial of a group psychotherapy intervention for BI-related concerns completed a baseline battery of standardized measures including the following: Body Image Scale (BIS), Body Image after Breast Cancer Questionnaire (BIBCQ), Objectified Body Consciousness Scale (OBCS) measuring Body Shame and Surveillance, Gender-Role Socialization Scale (GRSS) measuring internalization of traditional gender roles and attitudes and the Functional Assessment of Cancer Therapy-Breast Quality-of-Life Instrument (FACT-B). Correlational analyses were conducted between the two BI questionnaires, the two primary psychosocial variables GRSS and OBCS, and FACT-B. Path analysis was conducted on a proposed theoretical model delineating pathways between the two primary psychosocial variables and BI disturbance. Significant positive correlations were found between the two BI scales and (a) GRSS (average r = 0.53, p < 0.000), (b) Body Shame (average r = 0.53, p < 0.000) and Surveillance (average r = 0.48, p < 0.000). The BIS and BIBCQ were negatively associated with the FACT-B (r = -0.62, -0.73, respectively; p < 0.000). Results from the path analysis demonstrated support for the proposed model. Breast cancer survivors who endorsed greater internalization of traditional gender roles and attitudes, who engaged in greater self-surveillance and experienced greater body shame, reported greater BI disturbance and poorer quality of life post-treatment. Women with these predispositions are likely to be more vulnerable for psychological distress and may experience poorer adjustment after BC treatment.

Prospective studies regarding the psychosexual impact after different types of breast reconstruction (BR) are scarce. The impact of either implant or deep inferior epigastric artery perforator (DIEP) flap BR on body image and sexual relationship satisfaction was investigated in time. At baseline, 98 women opting for delayed implant or DIEP flap BR after mastectomy for breast cancer completed a survey. The majority was followed up at 6 months (96%) and 20 months (86%) postoperatively. Questionnaires included the body image scale, Dutch Relationship Questionnaire, Short Form - 36 Health Survey and the Impact of Event Scale. Mixed modeling analyses indicated that preoperative body image improved significantly after 20 months (p < 0.001), and there was no statistically significant difference between the two types of BR. A better body image was related to a better general mental health (p = 0.02), less cancer distress (p < 0.001) and a higher partner relationship satisfaction (p < 0.001). Sexual relationship satisfaction also increased after 20 months (p = 0.01), and it was positively related to higher partner relationship satisfaction but negatively affected by hormonal therapy. Body image and sexual relationship satisfaction significantly improved after BR, and this was not related to the BR type. Psychosexual consequences from previous cancer treatment may interfere. Lower general mental health, higher cancer distress, less partner relationship satisfaction or receiving hormonal therapy can negatively affect body image or sexual relationship satisfaction.

Sexual Dysfunction and Satisfaction in Kidney Transplant Patients