Incidence and severity of sexual dysfunction among women with breast cancer: a meta-analysis based on female sexual function index

  • Liwei Jing
  • Chao Zhang
  • Wei Li
  • Feng Jin
  • Aiping WangEmail author
Review Article



Previous meta-analyses have examined the prevalence of sexual dysfunction among women with cancer, but there is no breast cancer (BC)-specific study. We therefore conducted a meta-analysis to examine the prevalence and severity of female sexual dysfunction (FSD) in women with BC.


We searched PubMed, Embase, Cochrane Library, CNKI, WanFang Data, and VIP for relevant studies published between April 2000 and January 2017. Data were extracted from studies which assessed FSD prevalence and sexual function in women with BC using the female sexual function index (FSFI). Meta-analyses were performed by pooling the prevalence rates of FSD and total FSFI scores. Meta regression was performed to explore the sources of heterogeneity.


We selected 19 published studies involving a total of 2684 women with BC. In this study population, overall FSD prevalence was 73.4% (95% confidence interval (CI) 64.0%, 82.8%), and the total FSFI score was 19.28 (95% CI 17.39, 21.16). Among Asian, American, and European women with BC, there were significant differences in FSD prevalence (P < 0.001), and there was marginally significant difference (P = 0.07) in sexual function between these groups. There was also a marginally significant difference between individuals from mainland China and from other countries in FSD prevalence (P = 0.06) and FSFI score (P = 0.07).


Overall, women with BC have high FSD prevalence and low sexual function. American women with BC have a higher average FSD prevalence and lower average sexual function than Asian women with BC. The FSD prevalence in women with BC in mainland China was slightly higher than in other countries.


Breast cancer Female sexual function index Female sexual dysfunction Prevalence Meta-analysis 



We thank Guangxiao Li, Department of Clinical Epidemiology and Evidence-based Medicine of China Medical University, for his kindly help.

Funding information

This study was supported by National Natural Science Foundation of China (No. 81803106), Ph.D. Foundation of North China University of Science and Technology (No. BS2017057).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Human and animal rights

This article does not contain any studies with human participants performed by any of the authors.


  1. 1.
    Joanna Briggs Institute Reviewers’ Manual 2011 Edition [EB/OL] (2013-12-21). Accessed 18 Jan 2017.
  2. 2.
    Bartula I, Sherman KA (2013) Screening for sexual dysfunction in women diagnosed with breast cancer: systematic review and recommendations. Breast Cancer Res Treat 141:173–185CrossRefGoogle Scholar
  3. 3.
    Bo Chen LZ (2013) Epidemiology progress on the influencing factors of female sexual dysfunction. Chin J Obstr Gynecol 48:385–387Google Scholar
  4. 4.
    Boquiren VM, Esplen MJ, Wong J, Toner B, Warner E, Malik N (2016) Sexual functioning in breast cancer survivors experiencing body image disturbance. Psychooncology 25:66–76CrossRefGoogle Scholar
  5. 5.
    Du J, Ruan X, Gu M, Bitzer J, Mueck AO (2016) Prevalence of and risk factors for sexual dysfunction in young Chinese women according to the female sexual function index: an internet-based survey. Eur J Contracept Reprod Health Care 21:259–263CrossRefGoogle Scholar
  6. 6.
    Faghani S, Ghaffari F (2016) Effects of sexual rehabilitation using the PLISSIT model on quality of sexual life and sexual functioning in post-mastectomy breast cancer survivors. Asian Pac J Cancer Prev 17:4845–4851Google Scholar
  7. 7.
    Harirchi I, Montazeri A, Zamani Bidokhti F, Mamishi N, Zendehdel K (2012) Sexual function in breast cancer patients: a prospective study from Iran. J Exp Clin Cancer Res 31:20CrossRefGoogle Scholar
  8. 8.
    Huber C, Ramnarace T, McCaffrey R (2006) Sexuality and intimacy issues facing women with breast cancer. Oncol Nurs Forum 33:1163–1167CrossRefGoogle Scholar
  9. 9.
    Juliato PT, Rodrigues AT, Stahlschmidt R, Juliato CR, Mazzola PG (2017) Can polyacrylic acid treat sexual dysfunction in women with breast cancer receiving tamoxifen? Climacteric 20:62–66CrossRefGoogle Scholar
  10. 10.
    Laumann EO, Paik A, Rosen RC (1999) Sexual dysfunction in the United States: prevalence and predictors. JAMA 281:537–544CrossRefGoogle Scholar
  11. 11.
    Lee M, Kim YH, Jeon MJ (2015) Risk factors for negative impacts on sexual activity and function in younger breast cancer survivors. Psychooncology 24:1097–1103CrossRefGoogle Scholar
  12. 12.
    Liao MN, Chen SC, Lin YC, Chen MF, Wang CH, Jane SW (2014) Education and psychological support meet the supportive care needs of Taiwanese women three months after surgery for newly diagnosed breast cancer: a non-randomised quasi-experimental study. Int J Nurs Stud 51:390–399CrossRefGoogle Scholar
  13. 13.
    Maiorino MI, Chiodini P, Bellastella G, Giugliano D, Esposito K (2016) Sexual dysfunction in women with cancer: a systematic review with meta-analysis of studies using the female sexual function index. Endocrine 54:329–341CrossRefGoogle Scholar
  14. 14.
    Morton H, Gorzalka BB (2013) Cognitive aspects of sexual functioning: differences between East Asian-Canadian and Euro-Canadian women. Arch Sex Behav 42:1615–1625CrossRefGoogle Scholar
  15. 15.
    Neto MS, de Aguiar Menezes MV, Moreira JR, Garcia EB, Abla LE, Ferreira LM (2013) Sexuality after breast reconstruction post mastectomy. Aesthet Plast Surg 37:643–647CrossRefGoogle Scholar
  16. 16.
    Ozturk D, Akyolcu N (2016) Assessing sexual function and dysfunction in Turkish women undergoing surgical breast cancer treatment. Jpn J Nurs Sci 13:220–228CrossRefGoogle Scholar
  17. 17.
    Paiva CE, Rezende FF, Paiva BS, Mauad EC, Zucca-Matthes G, Carneseca EC, Syrjanen KJ, Schover LR (2016) Associations of body mass index and physical activity with sexual dysfunction in breast cancer survivors. Arch Sex Behav 45:2057–2068CrossRefGoogle Scholar
  18. 18.
    Park H, Yoon HG (2013) Menopausal symptoms, sexual function, depression, and quality of life in Korean patients with breast cancer receiving chemotherapy. Support Care Cancer 21:2499–2507CrossRefGoogle Scholar
  19. 19.
    Quintard B, Constant A, Lakdja F, Labeyrie-Lagardere H (2014) Factors predicting sexual functioning in patients 3 months after surgical procedures for breast cancer: the role of the sense of coherence. Eur J Oncol Nurs 18:41–45CrossRefGoogle Scholar
  20. 20.
    Raggio GA, Butryn ML, Arigo D, Mikorski R, Palmer SC (2014) Prevalence and correlates of sexual morbidity in long-term breast cancer survivors. Psychol Health 29:632–650CrossRefGoogle Scholar
  21. 21.
    Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, Ferguson D, D’Agostino R Jr (2000) The female sexual function index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 26:191–208CrossRefGoogle Scholar
  22. 22.
    Safarinejad MR, Shafiei N, Safarinejad S (2013) Quality of life and sexual functioning in young women with early-stage breast cancer 1 year after lumpectomy. Psychooncology 22:1242–1248CrossRefGoogle Scholar
  23. 23.
    Sbitti Y, Kadiri H, Essaidi I, Fadoukhair Z, Kharmoun S, Slimani K, Ismaili N, Ichou M, Errihani H (2011) Breast cancer treatment and sexual dysfunction: Moroccan women's perception. BMC Womens Health 11:29CrossRefGoogle Scholar
  24. 24.
    Schover LR, Baum GP, Fuson LA, Brewster A, Melhem-Bertrandt A (2014) Sexual problems during the first 2 years of adjuvant treatment with aromatase inhibitors. J Sex Med 11:3102–3111CrossRefGoogle Scholar
  25. 25.
    Schover LR, Jenkins R, Sui D, Adams JH, Marion MS, Jackson KE (2006) Randomized trial of peer counseling on reproductive health in African American breast cancer survivors. J Clin Oncol 24:1620–1626CrossRefGoogle Scholar
  26. 26.
    Schover LR, Rhodes MM, Baum G, Adams JH, Jenkins R, Lewis P, Jackson KE (2011) Sisters peer counseling in reproductive issues after treatment (SPIRIT): a peer counseling program to improve reproductive health among African American breast cancer survivors. Cancer 117:4983–4992CrossRefGoogle Scholar
  27. 27.
    Shaohua Liu WQ, Chen Y, Wang Q, Li X (2015) Study for the influencing factors on the quality of life for women with breast cancer undergoing post-operative chemotherapy. J Nurs Training 30:2115–2118Google Scholar
  28. 28.
    Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65:87–108CrossRefGoogle Scholar
  29. 29.
    Wanmin Qiang SL, Wu P, Chen Y, Liu X (2015) The investigation of influencing factors on sexual life of the breast cancer patients undergoing chemotherapy. Tianjin J Nurs 23:213–215Google Scholar
  30. 30.
    Wanqing Chen RZ (2015) Incidence, mortality and survival analysis of breast cancer in China. Chin J Clin Oncol 13:173–185Google Scholar
  31. 31.
    Yang X (2015) Sexual function evaluation on the surgery or not of the breast cancer patients. Mod Med 04:493–495Google Scholar
  32. 32.
    Yule M, Woo JS, Brotto LA (2010) Sexual arousal in East Asian and Euro-Canadian women: a psychophysiological study. J Sex Med 7:3066–3079CrossRefGoogle Scholar
  33. 33.
    Zhang AX, Pan LJ, Chen XY, Pan F, Kan YJ (2011) An investigation on female sexual dysfunction among urban Chinese women in Nanjing. Zhonghua Nan Ke Xue 17:488–491Google Scholar
  34. 34.
    Zhifen Xie QW, Zheng X, Ouyang C, Li L, Gong H, Zhang S (2016) Relationship between posttraumatic growth and quality of sexual life for productive breast cancer women after radical mastectomy. J Nurs Sci 31:15–18Google Scholar
  35. 35.
    Zhou ES, Falk SJ, Bober SL (2015) Managing premature menopause and sexual dysfunction. Curr Opin Support Palliat Care 9:294–300CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Liwei Jing
    • 1
    • 2
  • Chao Zhang
    • 3
  • Wei Li
    • 4
  • Feng Jin
    • 5
  • Aiping Wang
    • 6
    Email author
  1. 1.National Academy of Development and StrategyRenmin University of ChinaBeijingChina
  2. 2.College of Nursing and RehabilitationNorth China University of Science and TechnologyTangshanChina
  3. 3.Affiliated Hospital of North China University of Science and TechnologyTangshanChina
  4. 4.Radiotherapy DepartmentTangshan People’s HospitalTangshanChina
  5. 5.Breast SurgeryFirst Affiliated Hospital of China Medical UniversityShenyangChina
  6. 6.Department of NursingFirst Affiliated Hospital of China Medical UniversityShenyangChina

Personalised recommendations