Skip to main content

Advertisement

Log in

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

  • Review
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

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.

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

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  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

    Article  PubMed  Google Scholar 

  2. American Psychiatric Association (ed) (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington DC

  3. Avis NE, Crawford S, Manuel J (2004) Psychosocial problems among younger women with breast cancer. Psychooncology 13:295–308

    Article  PubMed  Google Scholar 

  4. Barni S, Mondin R (1997) Sexual dysfunction in treated breast cancer patients. Ann Oncol 8:149–153

    Article  PubMed  CAS  Google Scholar 

  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 163:888–893

    Article  PubMed  CAS  Google Scholar 

  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 18:276–283

    Article  PubMed  Google Scholar 

  7. Berglund G (1994) A randomized study of a cancer rehabilitation program for cancer patients: ‘the starting again’ group. Psychooncology 3:109–120

    Article  Google Scholar 

  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 19:2788–2796

    PubMed  CAS  Google Scholar 

  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 26:404–412

    Article  PubMed  CAS  Google Scholar 

  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. 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

    Article  PubMed  Google Scholar 

  12. Christensen DN (1983) Postmastectomy couple counseling: an outcome study of a structured treatment protocol. J Sex Marital Ther 9:266–275

    Article  PubMed  CAS  Google Scholar 

  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. 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

    Article  PubMed  Google Scholar 

  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. 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 11:427–438

    Article  PubMed  Google Scholar 

  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 17:2371–2380

    PubMed  CAS  Google Scholar 

  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 92:1054–1064

    Article  PubMed  CAS  Google Scholar 

  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 1:9558

    Google Scholar 

  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 304:675–680

    Article  PubMed  CAS  Google Scholar 

  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 9:691–697

    PubMed  Google Scholar 

  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 www.cochrane-handbook.org

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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 96:235–240

    Article  PubMed  Google Scholar 

  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. 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 19:923–932

    Article  PubMed  Google Scholar 

  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 37:182–188

    PubMed  CAS  Google Scholar 

  29. Masters WJ V (1970) Human sexual inadequacy. Little Brown, Boston

    Google Scholar 

  30. McKee AL Jr, Schover LR (2001) Sexuality rehabilitation. Cancer 92:1008–1012

    Article  PubMed  Google Scholar 

  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 Library

  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

    Article  PubMed  CAS  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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):e19522

    Google Scholar 

  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 118:99–111

    Article  PubMed  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  37. Schag CA, Heinrich RL (1990) Development of a comprehensive quality of life measurement tool: CARES. Oncology 4:135–138 (discussion 147)

    PubMed  CAS  Google Scholar 

  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 24:1620–1626

    Article  PubMed  Google Scholar 

  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. 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 121:421–430

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  CAS  Google Scholar 

  42. Thirlaway K, Fallowfield L, Cuzick J (1996) The sexual activity questionnaire: a measure of women’s sexual functioning. Qual Life Res 5:81–90

    Article  PubMed  CAS  Google Scholar 

  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 73:276–285

    Article  PubMed  Google Scholar 

  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 25:37–60

    Article  PubMed  Google Scholar 

  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

    Article  CAS  Google Scholar 

  46. Wiggins DL, Dizon DS (2008) Dyspareunia and vaginal dryness after breast cancer treatment. Sex Reprod Menopause 6:18–22

    Google Scholar 

  47. World Health Organisation (1992) ICD-10: international statistical classification of disease and related health problems. In: World Health Organisation, Geneva

Download references

Acknowledgments

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

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sally Taylor.

Additional information

Julia Brown and Galina Velikova are joint senior authors.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 24 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Taylor, S., Harley, C., Ziegler, L. et al. Interventions for sexual problems following treatment for breast cancer: a systematic review. Breast Cancer Res Treat 130, 711–724 (2011). https://doi.org/10.1007/s10549-011-1722-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-011-1722-9

Keywords

Navigation