Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Sexual functioning among early post-treatment breast cancer survivors

  • 496 Accesses

  • 3 Citations



This study aims (1) to estimate percentages of partnered women who are sexually active over the first 2 years post-breast cancer diagnosis; (2) to identify factors related to sexual inactivity; and (3) to evaluate separately, among both sexually active and inactive survivors, the relation between sexual problems and treatment-related variables, symptoms, and psychosocial factors.


Longitudinal observational study of breast cancer survivors recruited within 8 months of cancer diagnosis and followed for 18 months. The main outcome measures were (1) being sexually active/inactive in the past month and (2) sexual problems assessed with the four-item sexual problem domain of the Quality of Life in Adult Cancer Survivors (QLACS) scale.


At baseline, 52.4% of women reported being sexually active in the past month. This percentage increased to 60.7% 18 months later. In multivariable repeated-measures analyses, age, past chemotherapy, depressive symptoms, and lower perceived attractiveness were related to inactivity. Sexually inactive women reported more problems on the QLACS than sexually active women. In stratified multivariable analyses, depressive symptoms were related to greater sexual problems for both sexually active and inactive women, as was vaginal dryness. Among the sexually active women, younger age at diagnosis, less illness intrusiveness, and lower perceived attractiveness were related to more problems.


Research has shown that sexual functioning/sexual health are key aspects of quality of life for many cancer survivors, and are often not addressed by health care providers. Future studies should examine how such topics are handled by clinicians in their interactions with survivors.

This is a preview of subscription content, log in to check access.


  1. 1.

    World Cancer Research Fund International, Breast Cancer Statistics. http://www.wcrf.org/int/cancer-facts-figures/data-specific-cancers/breast-cancer-statistics, 2012. Accessed 29 Mar 2017

  2. 2.

    Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, Stein KD, Alteri R, Jemal A (2016) Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin 66:271–289. https://doi.org/10.3322/caac.21349

  3. 3.

    Aerts L, Christiaens MR, Enzlin P, Neven P, Amant F (2014) Sexual functioning in women after mastectomy versus breast conserving therapy for early-stage breast cancer: a prospective controlled study. Breast 23:629–636. https://doi.org/10.1016/j.breast.2014.06.012

  4. 4.

    Bober SL, Varela VS (2012) Sexuality in adult cancer survivors: challenges and intervention. J Clin Oncol 30:3712–3719. https://doi.org/10.1200/JCO.2012.41.7915

  5. 5.

    Dizon DS, Suzin D, McIlvenna S (2014) Sexual health as a survivorship issue for female cancer survivors. Oncologist 19:202–210. https://doi.org/10.1634/theoncologist.2013-0302

  6. 6.

    Gilbert E, Ussher JM, Perz J (2010) Sexuality after breast cancer: a review. Maturitas 66:397–407. https://doi.org/10.1016/j.maturitas.2010.03.027

  7. 7.

    Sohl SJ, Levine B, Avis NE (2015) Evaluation of the quality of life in adult cancer survivors (QLACS) scale for early post-treatment breast cancer survivors. Qual Life Res 24:205–212. https://doi.org/10.1007/s11136-014-0749-x

  8. 8.

    Flynn KE, Reese JB, Jeffery DD, Abernethy AP, Lin L, Shelby RA, Porter LS, Dombeck CB, Weinfurt KP (2012) Patient experiences with communication about sex during and after treatment for cancer. Psychooncology 21:594–601. https://doi.org/10.1002/pon.1947

  9. 9.

    Avis NE, Crawford S, Manuel J (2004) Psychosocial problems among younger women with breast cancer. Psychooncology 13:295–308. https://doi.org/10.1002/pon.744

  10. 10.

    Burwell SR, Case LD, Kaelin C, Avis NE (2006) Sexual problems in younger women after breast cancer surgery. J Clin Oncol 24:2815–2821. https://doi.org/10.1200/JCO.2005.04.2499

  11. 11.

    Boehmer U, Ozonoff A, Timm A, Winter M, Potter J (2014) After breast cancer: sexual functioning of sexual minority survivors. J Sex Res 51:681–689. https://doi.org/10.1080/00224499.2013.772087

  12. 12.

    Fobair P, Stewart SL, Chang S, D'Onofrio C, Banks PJ, Bloom JR (2006) Body image and sexual problems in young women with breast cancer. Psychooncology 15:579–594. https://doi.org/10.1002/pon.991

  13. 13.

    Boquiren VM, Esplen MJ, Wong J, Toner B, Warner E, Malik N (2016) Sexual functioning in breast cancer survivors experiencing body image disturbance: sexual function and body image disturbance. Psychooncology 25:66–76. https://doi.org/10.1002/pon.3819

  14. 14.

    Ganz PA, Rowland JH, Desmond K, Meyerowitz BE, Wyatt GE (1998) Life after breast cancer: understanding women’s health-related quality of life and sexual functioning. J Clin Oncol 16:501–514. https://doi.org/10.1200/JCO.1998.16.2.501

  15. 15.

    Rosenberg SM, Tamimi RM, Gelber S, Ruddy KJ, Bober SL, Kereakoglow S, Borges VF, Come SE, Schapira L, Partridge AH (2014) Treatment-related amenorrhea and sexual functioning in young breast cancer survivors. Cancer 120:2264–2271. https://doi.org/10.1002/cncr.28738

  16. 16.

    Ganz PA, Desmond KA, Belin TR, Meyerowitz BE, Rowland JH (1999) Predictors of sexual health in women after a breast cancer diagnosis. J Clin Oncol 17:2371–2380. https://doi.org/10.1200/JCO.1999.17.8.2371

  17. 17.

    Speer JJ, Hillenberg B, Sugrue DP, Blacker C, Kresge CL, Decker VB, Zakalik D, Decker DA (2005) Study of sexual functioning determinants in breast cancer survivors. Breast J 11:440–447. https://doi.org/10.1111/j.1075-122X.2005.00131.x

  18. 18.

    Lee M, Kim YH, Jeon MJ (2015) Risk factors for negative impacts on sexual activity and function in younger breast cancer survivors: sexual activity and dysfunction in cancer survivors. Psychooncology 24:1097–1103. https://doi.org/10.1002/pon.3772

  19. 19.

    Ganz PA, Greendale GA, Petersen L, Kahn B, Bower JE (2003) Breast cancer in younger women: reproductive and late health effects of treatment. J Clin Oncol 21:4184–4193. https://doi.org/10.1200/JCO.2003.04.196

  20. 20.

    Avis NE, Levine B, Naughton MJ, Case DL, Naftalis E, van Zee KJ (2012) Explaining age-related differences in depression following breast cancer diagnosis and treatment. Breast Cancer Res Treat 136:581–591. https://doi.org/10.1007/s10549-012-2277-0

  21. 21.

    Avis NE, Levine B, Naughton MJ, Case LD, Naftalis E, van Zee KJ (2013) Age-related longitudinal changes in depressive symptoms following breast cancer diagnosis and treatment. Breast Cancer Res Treat 139:199–206. https://doi.org/10.1007/s10549-013-2513-2

  22. 22.

    Avis NE, Smith KW, McGraw S, Smith RG, Petronis VM, Carver CS (2005) Assessing quality of life in adult cancer survivors (QLACS). Qual Life Res 14:1007–1023

  23. 23.

    Barnabei VM, Cochrane BB, Aragaki AK, Nygaard I, Williams RS, McGovern PG, Young RL, Wells EC, OʼSullivan MJ, Chen B, Schenken R, Johnson SR (2005) Menopausal symptoms and treatment-related effects of estrogen and progestin in the Women’s health initiative. Obstet Gynecol 105:1063–1073. https://doi.org/10.1097/01.AOG.0000158120.47542.18

  24. 24.

    Beck AT, Steer RA, Ball R, Ranieri WF (1996) Comparison of Beck depression inventories-IA and-II in psychiatric outpatients. J Pers Assess 67:588–597. https://doi.org/10.1207/s15327752jpa6703_13

  25. 25.

    Lasry JC, Margolese RG, Poisson R et al (1987) Depression and body image following mastectomy and lumpectomy. J Chronic Dis 40:529–534

  26. 26.

    Devins GM (2010) Using the illness intrusiveness ratings scale to understand health-related quality of life in chronic disease. J Psychosom Res 68:591–602. https://doi.org/10.1016/j.jpsychores.2009.05.006

  27. 27.

    Oberguggenberger A, Martini C, Huber N, Fallowfield L, Hubalek M, Daniaux M, Sperner-Unterweger B, Holzner B, Sztankay M, Gamper E, Meraner V (2017) Self-reported sexual health: Breast cancer survivors compared to women from the general population – an observational study BMC Cancer 17. doi:https://doi.org/10.1186/s12885-017-3580-2, Self-reported sexual health: Breast cancer survivors compared to women from the general population—an observational study, 17

  28. 28.

    Dorval M, Maunsell E, Deschênes L, Brisson J, Mâsse B (1998) Long-term quality of life after breast cancer: comparison of 8-year survivors with population controls. J Clin Oncol 16:487–494. https://doi.org/10.1200/JCO.1998.16.2.487

  29. 29.

    Addis IB, Van Den Eeden SK, Wassel-Fyr CL et al (2006) Sexual activity and function in middle-aged and older women. Obstet Gynecol 107:755–764. https://doi.org/10.1097/01.AOG.0000202398.27428.e2

  30. 30.

    Broeckel JA, Thors CL, Jacobsen PB, Small M, Cox CE (2002) Sexual functioning in long-term breast cancer survivors treated with adjuvant chemotherapy. Breast Cancer Res Treat 75:241–248. https://doi.org/10.1023/A:1019953027596

  31. 31.

    Avis NE, Colvin A, Karlamangla AS, Crawford S, Hess R, Waetjen LE, Brooks M, Tepper PG, Greendale GA (2017) Change in sexual functioning over the menopausal transition: results from the study of Womenʼs health across the nation. Menopause 24:379–390. https://doi.org/10.1097/GME.0000000000000770

  32. 32.

    Krebber AM, Buffart LM, Kleijn G et al (2014) Prevalence of depression in cancer patients: a meta-analysis of diagnostic interviews and self-report instruments. Psychooncology 23:121–130. https://doi.org/10.1002/pon.3409

  33. 33.

    de Villiers TJ, Gass MLS, Haines CJ, Hall JE, Lobo RA, Pierroz DD, Rees M (2013) Global consensus statement on menopausal hormone therapy. Climacteric 16:203–204. https://doi.org/10.3109/13697137.2013.771520

  34. 34.

    Hummel SB, van Lankveld JJDM, Oldenburg HSA, Hahn DEE, Kieffer JM, Gerritsma MA, Kuenen MA, Bijker N, Borgstein PJ, Heuff G, Lopes Cardozo AMF, Plaisier PW, Rijna H, van der Meij S, van Dulken EJ, Vrouenraets BC, Broomans E, Aaronson NK (2017) Efficacy of internet-based cognitive behavioral therapy in improving sexual functioning of breast cancer survivors: results of a randomized controlled trial. J Clin Oncol 35:1328–1340. https://doi.org/10.1200/JCO.2016.69.6021

  35. 35.

    Goldfarb SB, Abramsohn E, Andersen BL, Baron SR, Carter J, Dickler M, Florendo J, Freeman L, Githens K, Kushner D, Makelarski JA, Yamada SD, Lindau ST (2013) A national network to advance the field of cancer and female sexuality. J Sex Med 10:319–325. https://doi.org/10.1111/jsm.12061

  36. 36.

    Carter J, Lacchetti C, Andersen BL et al (2017) Interventions to address sexual problems in people with cancer: American Society of Clinical Oncology clinical practice guideline adaptation of Cancer Care Ontario guideline. J Clin Oncol 36:492–511. https://doi.org/10.1200/JCO.2017.75.8995

  37. 37.

    Canzona M, Ledford CJW, Fisher CL et al (in press) clinician barriers to initiating sexual health conversations with breast cancer survivors: the influence of assumptions and situational constraints. Fam Syst Health

  38. 38.

    Boswell EN, Dizon DS (2015) Breast cancer and sexual function. Transl Androl Urol 4:160–168. https://doi.org/10.3978/j.issn.2223-4683.2014.12.04

  39. 39.

    Arena PL, Carver CS, Antoni MH, Weiss S, Ironson G, Durán RE (2007) Psychosocial responses to treatment for breast cancer among lesbian and heterosexual women. Women Health 44:81–102. https://doi.org/10.1300/J013v44n02_05

  40. 40.

    Fobair P, O’Hanlan K, Koopman C et al (2001) Comparison of lesbian and heterosexual women’s response to newly diagnosed breast cancer. Psychooncology 10:40–51. https://doi.org/10.1002/1099-1611(200101/02)10:1<40::AID-PON480>3.0.CO;2-S

  41. 41.

    Boehmer U, Potter J, Bowen DJ (2009) Sexual functioning after cancer in sexual minority women. Cancer J 15:65–69. https://doi.org/10.1097/PPO.0b013e31819587cc

  42. 42.

    Marino JL, Saunders CM, Emery LI, Green H, Doherty DA, Hickey M (2016) How does adjuvant chemotherapy affect menopausal symptoms, sexual function, and quality of life after breast cancer? Menopause 23:1000–1008. https://doi.org/10.1097/GME.0000000000000664

  43. 43.

    Tay R, Gibney T, Antill YC (2017) Sexual dysfunction after breast cancer: a review of treatments and strategies. Cancer Forum 41:25–31

  44. 44.

    Hawkins Y, Ussher J, Gilbert E, Perz J, Sandoval M, Sundquist K (2009) Changes in sexuality and intimacy after the diagnosis and treatment of cancer: the experience of partners in a sexual relationship with a person with cancer. Cancer Nurs 32:271–280. https://doi.org/10.1097/NCC.0b013e31819b5a93

  45. 45.

    Ligibel JA, Denlinger CS (2013) New NCCN guidelines for survivorship care. J Natl Compr Cancer Netw 11:640–644

Download references


This work was supported by the National Institutes of Health grant 2R25 CA122061 and the Department of Defense grant #DAMD17-01-1-0447.

Author information

Correspondence to Nancy E. Avis.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interests.

We have full control of all primary data and we agree to allow the journal to review our data if requested.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Avis, N.E., Johnson, A., Canzona, M.R. et al. Sexual functioning among early post-treatment breast cancer survivors. Support Care Cancer 26, 2605–2613 (2018). https://doi.org/10.1007/s00520-018-4098-0

Download citation


  • Sexual problems
  • Breast cancer
  • Quality of life
  • Cancer survivorship