Breast Cancer Research and Treatment

, Volume 130, Issue 3, pp 711–724 | Cite as

Interventions for sexual problems following treatment for breast cancer: a systematic review

  • Sally TaylorEmail author
  • Clare Harley
  • Lucy Ziegler
  • Julia Brown
  • Galina Velikova


Sexual functioning is an important element of quality of life. Many women experience sexual problems as a result of a breast cancer diagnosis and its treatment. Little is known about the availability and the effectiveness of interventions for sexual problems in this patient population. Six electronic databases were searched using Medical Subject Headings and keywords. Additional hand searching of the references of relevant papers was also conducted. The searches were conducted between October 2010 and January 2011. Papers were included if they evaluated interventions for sexual problems caused as a result of breast cancer or its treatment. Studies were only included if sexual functioning was reported using a patient-reported outcome questionnaire. Studies were excluded if sexual functioning was measured but improving sexual problems was not one of the main aims of the intervention. 3514 papers were identified in the initial search. 21 papers were selected for inclusion. Studies were of mixed methodological quality; 15 randomised trials were identified, many included small sample sizes and the use of non-validated questionnaires. Three main types of interventions were identified: Exercise (2), medical (2) and psycho-educational (17). The psycho-educational interventions included skills-based training such as problem-solving and communication skills, counselling, hypnosis, education and specific sex-therapies. Interventions were delivered to individual patients, patients and their partners (couple-based) and groups of patients. The widespread methodological variability hinders the development of a coherent picture about which interventions work for whom. Tentative findings suggest the most effective interventions are couple-based psycho-educational interventions that include an element of sexual therapy. More methodologically strong research is needed before any intervention can be recommended for clinical practice. Improved screening and classification of sexual problems will ensure interventions can be more effectively targeted to suit individual patient needs.


Breast cancer Sexual functioning Sexual problems Systematic review 



The study was supported by Grants from Cancer Research UK (GV; Grant number: C7775/A7424) and NHS Research & Development (JMB). The funders were not involved in study design, data collection, analyses, interpretation of the results, the decision to submit the manuscript for publication or the writing of the manuscript. The study was sponsored by the University of Leeds.

Conflict of interest


Supplementary material

10549_2011_1722_MOESM1_ESM.pdf (24 kb)
Supplementary material 1 (PDF 24 kb)


  1. 1.
    Allen SM, Shah AC, Nezu AM, Nezu CM, Ciambrone D, Hogan J, Mor V (2002) A problem-solving approach to stress reduction among younger women with breast carcinoma: a randomized controlled trial. Cancer 94:3089–3100. doi: 10.1002/cncr.10586 PubMedCrossRefGoogle Scholar
  2. 2.
    American Psychiatric Association (ed) (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington DCGoogle Scholar
  3. 3.
    Avis NE, Crawford S, Manuel J (2004) Psychosocial problems among younger women with breast cancer. Psychooncology 13:295–308PubMedCrossRefGoogle Scholar
  4. 4.
    Barni S, Mondin R (1997) Sexual dysfunction in treated breast cancer patients. Ann Oncol 8:149–153PubMedCrossRefGoogle Scholar
  5. 5.
    Basson R, Berman J, Burnett A, Derogatis L, Ferguson D, Fourcroy J, Goldstein I, Graziottin A, Heiman J, Laan E, Leiblum S, Padma-Nathan H, Rosen R, Segraves K, Segraves RT, Shabsigh R, Sipski M, Wagner G, Whipple B (2000) Report of the international consensus development conference on female sexual dysfunction: definitions and classifications. J Urol 163:888–893PubMedCrossRefGoogle Scholar
  6. 6.
    Baucom DH, Porter LS, Kirby JS, Gremore TM, Wiesenthal N, Aldridge W, Fredman SJ, Stanton SE, Scott JL, Halford KW, Keefe FJ (2009) A couple-based intervention for female breast cancer. Psychooncology 18:276–283PubMedCrossRefGoogle Scholar
  7. 7.
    Berglund G (1994) A randomized study of a cancer rehabilitation program for cancer patients: ‘the starting again’ group. Psychooncology 3:109–120CrossRefGoogle Scholar
  8. 8.
    Berglund G, Nystedt M, Bolund C, Sjoden PO, Rutquist LE (2001) Effect of endocrine treatment on sexuality in premenopausal breast cancer patients: a prospective randomized study. J Clin Oncol 19:2788–2796PubMedGoogle Scholar
  9. 9.
    Biglia N, Peano E, Sgandurra P, Moggio G, Panuccio E, Migliardi M, Ravarino N, Ponzone R, Sismondi P (2010) Low-dose vaginal estrogens or vaginal moisturizer in breast cancer survivors with urogenital atrophy: a preliminary study. Gynecol Endocrinol 26:404–412PubMedCrossRefGoogle Scholar
  10. 10.
    Buijs C, Mom CH, Willemse PHB, Marike Boezen H, Maurer JM, Wymenga ANM, De Jong RS, Nieboer P, De Vries EGE, Mourits MJE (2009) Venlafaxine versus clonidine for the treatment of hot flashes in breast cancer patients: a double-blind, randomized cross-over study. Breast Cancer Res Treat 115:573–580. doi:10.1007/s10549-008-0138-7 Google Scholar
  11. 11.
    Burri AV, Cherkas LM, Spector TD (2009) The genetics and epidemiology of female sexual dysfunction: a review. J Sex Med 6:646–657. doi: 10.1111/j.1743-6109.2008.01144.x PubMedCrossRefGoogle Scholar
  12. 12.
    Christensen DN (1983) Postmastectomy couple counseling: an outcome study of a structured treatment protocol. J Sex Marital Ther 9:266–275PubMedCrossRefGoogle Scholar
  13. 13.
    Elkins G, Marcus J, Stearns V, Rajab M (2007) Pilot evaluation of hypnosis for the treatment of hot flashes in breast cancer survivors. Psychooncology 16:487–492. doi:10.1002/pon.1096 Google Scholar
  14. 14.
    Emilee G, Ussher JM, Perz J (2010) Sexuality after breast cancer: a review. Maturitas 66:397–407. doi: 10.1016/j.maturitas.2010.03.027 PubMedCrossRefGoogle Scholar
  15. 15.
    Flynn KE, Jeffery DD, Keefe FJ, Porter LS, Shelby RA, Fawzy MR, Gosselin TK, Reeve BB, Weinfurt KP (2010) Sexual functioning along the cancer continuum: focus group results from the Patient-Reported Outcomes Measurement Information System (PROMIS((R))). Psychooncology. doi: 10.1002/pon.1738
  16. 16.
    Fobair P, Koopman C, DiMiceli S, O’Hanlan K, Butler LD, Classen C, Drooker N, Davids HR, Loulan J, Wallsten D, Spiegel D (2002) Psychosocial intervention for lesbians with primary breast cancer. Psychooncology 11:427–438PubMedCrossRefGoogle Scholar
  17. 17.
    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 17:2371–2380PubMedGoogle Scholar
  18. 18.
    Ganz PA, Greendale GA, Petersen L, Zibecchi L, Kahn B, Belin TR (2000) Managing menopausal symptoms in breast cancer survivors: results of a randomized controlled trial. J Natl Cancer Inst 92:1054–1064PubMedCrossRefGoogle Scholar
  19. 19.
    Goldfarb SB, Dickler M, Sit L, Fruscione M, Barz T, Atkinson T, Hudis C, Basch E (2009) Sexual dysfunction in women with breast cancer: prevalence and severity. J Clin Oncol 1:9558Google Scholar
  20. 20.
    Greer S, Moorey S, Baruch JD, Watson M, Robertson BM, Mason A, Rowden L, Law MG, Bliss JM (1992) Adjuvant psychological therapy for patients with cancer: a prospective randomised trial. BMJ 304:675–680PubMedCrossRefGoogle Scholar
  21. 21.
    Gumus AB, Cam O (2008) Effects of emotional support-focused nursing interventions on the psychosocial adjustment of breast cancer patients. Asian Pac J Cancer Prev 9:691–697PubMedGoogle Scholar
  22. 22.
    Higgins JPT, Altman DG, Sterne JAC (eds) (2011) Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (eds) Cochrane handbook for systematic reviews of interventions version 5.1.0 (updated March 2011). The Cochrane collaboration. Available from
  23. 23.
    Hodges LJ, Walker J, Kleiboer AM, Ramirez AJ, Richardson A, Velikova G, Sharpe M (2011) What is a psychological intervention? A metareview and practical proposal. Psychooncology 20:470–478. doi: 10.1002/pon.1780 PubMedCrossRefGoogle Scholar
  24. 24.
    Hordern A (2008) Intimacy and sexuality after cancer: a critical review of the literature. Cancer Nurs 31:E9–17. doi: 10.1097/01.NCC.0000305695.12873.d5 PubMedCrossRefGoogle Scholar
  25. 25.
    Kalaitzi C, Papadopoulos VP, Michas K, Vlasis K, Skandalakis P, Filippou D (2007) Combined brief psychosexual intervention after mastectomy: effects on sexuality, body image, and psychological well-being. J Surg Oncol 96:235–240PubMedCrossRefGoogle Scholar
  26. 26.
    Manne S, Badr H (2008) Intimacy and relationship processes in couples’ psychosocial adaptation to cancer. Cancer 112:2541–2555. doi:10.1002/cncr.23450 Google Scholar
  27. 27.
    Marcus AC, Garrett KM, Cella D, Wenzel L, Brady MJ, Fairclough D, Pate-Willig M, Barnes D, Powell Emsbo S, Kluhsman BC, Crane L, Sedlacek S, Flynn PJ (2010) Can telephone counseling post-treatment improve psychosocial outcomes among early stage breast cancer survivors? Psychooncology 19:923–932PubMedCrossRefGoogle Scholar
  28. 28.
    Markopoulos C, Tsaroucha AK, Kouskos E, Mantas D, Antonopoulou Z, Karvelis S (2009) Impact of breast cancer surgery on the self-esteem and sexual life of female patients. J Int Med Res 37:182–188PubMedGoogle Scholar
  29. 29.
    Masters WJ V (1970) Human sexual inadequacy. Little Brown, BostonGoogle Scholar
  30. 30.
    McKee AL Jr, Schover LR (2001) Sexuality rehabilitation. Cancer 92:1008–1012PubMedCrossRefGoogle Scholar
  31. 31.
    Miles C, Candy B, Jones L, Williams R, Tookman A, King M (2010) Interventions for sexual dysfunction following treatments for cancer (Review). The Cochrane LibraryGoogle Scholar
  32. 32.
    Nystedt M, Berglund G, Bolund C, Fornander T, Rutqvist LE (2003) Side effects of adjuvant endocrine treatment in premenopausal breast cancer patients: a prospective randomized study. J Clin Oncol 21:1836–1844. doi: 10.1200/JCO.2003.04.024 PubMedCrossRefGoogle Scholar
  33. 33.
    Ofman U (2004) “…And how are things sexually?” Helping patients adjust to sexual changes before, during, and after cancer treatment. Support Cancer Ther 1:243–247. doi: 10.3816/SCT.2004.n.017 PubMedCrossRefGoogle Scholar
  34. 34.
    Revenson TA, Temple LK, McClelland SI (2010) Improving sexual function in female cancer survivors: a systematic review of psychosocial interventions. J Clin Oncol 28(Suppl 15):e19522Google Scholar
  35. 35.
    Rowland JH, Meyerowitz BE, Crespi CM, Leedham B, Desmond K, Belin TR, Ganz PA (2009) Addressing intimacy and partner communication after breast cancer: a randomized controlled group intervention. Breast Cancer Res Treat 118:99–111PubMedCrossRefGoogle Scholar
  36. 36.
    Salonen P, Tarkka M-T, Kellokumpu-Lehtinen P-L, Astedt-Kurki P, Luukkaala T, Kaunonen M (2009) Telephone intervention and quality of life in patients with breast cancer. Cancer Nurs 32:177–190 (quiz 191–172)PubMedCrossRefGoogle Scholar
  37. 37.
    Schag CA, Heinrich RL (1990) Development of a comprehensive quality of life measurement tool: CARES. Oncology 4:135–138 (discussion 147)PubMedGoogle Scholar
  38. 38.
    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 24:1620–1626PubMedCrossRefGoogle Scholar
  39. 39.
    Scott JL, Halford W, Ward BG (2004) United we stand? The effects of a couple-coping intervention on adjustment to early stage breast or gynecological cancer. J Consult Clin Psychol 72:1122–1135. doi:10.1037/0022-006X.72.6.1122 Google Scholar
  40. 40.
    Speck RM, Gross CR, Hormes JM, Ahmed RL, Lytle LA, Hwang W-T, Schmitz KH (2010) Changes in the body image and relationship scale following a one-year strength training trial for breast cancer survivors with or at risk for lymphedema. Breast Cancer Res Treat 121:421–430PubMedCrossRefGoogle Scholar
  41. 41.
    Stead ML, Brown JM, Fallowfield L, Selby P (2003) Lack of communication between healthcare professionals and women with ovarian cancer about sexual issues. Br J Cancer 88:666–671. doi: 10.1038/sj.bjc.6600799 PubMedCrossRefGoogle Scholar
  42. 42.
    Thirlaway K, Fallowfield L, Cuzick J (1996) The sexual activity questionnaire: a measure of women’s sexual functioning. Qual Life Res 5:81–90PubMedCrossRefGoogle Scholar
  43. 43.
    Vos PJ, Garssen B, Visser AP, Duivenvoorden HJ, de Haes HCJM (2004) Psychosocial intervention for women with primary, non-metastatic breast cancer: a comparison between participants and non-participants. Psychother Psychosom 73:276–285PubMedCrossRefGoogle Scholar
  44. 44.
    Vos PJ, Visser AP, Garssen B, Duivenvoorden HJ, de Haes HCJM (2007) Effectiveness of group psychotherapy compared to social support groups in patients with primary, non-metastatic breast cancer. J Psychosoc Oncol 25:37–60PubMedCrossRefGoogle Scholar
  45. 45.
    White ID (2008) The assessment and management of sexual difficulties after treatment of cervical and endometrial malignancies. Clin Oncol 20:488–496. doi: 10.1016/j.clon.2008.03.015 CrossRefGoogle Scholar
  46. 46.
    Wiggins DL, Dizon DS (2008) Dyspareunia and vaginal dryness after breast cancer treatment. Sex Reprod Menopause 6:18–22Google Scholar
  47. 47.
    World Health Organisation (1992) ICD-10: international statistical classification of disease and related health problems. In: World Health Organisation, GenevaGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2011

Authors and Affiliations

  • Sally Taylor
    • 1
    Email author
  • Clare Harley
    • 1
  • Lucy Ziegler
    • 1
  • Julia Brown
    • 2
  • Galina Velikova
    • 1
  1. 1.Psychosocial Oncology and Clinical Practice Research Group, St James’s Institute of OncologyUniversity of LeedsLeedsUK
  2. 2.Clinical Trials and Research UnitUniversity of LeedsLeedsUK

Personalised recommendations