Sexuality and Disability

, Volume 20, Issue 4, pp 261–275 | Cite as

Breast Cancer and Sexuality

  • Helene K. Henson


Breast cancer is the most common form of cancer among women today. With early detection and advanced treatment options, survival rates are continuing to improve, but not without some long-term physical and emotional side effects. This article reviews the effects of breast cancer in general and breast cancer treatment specifically on sexuality in cancer survivors. How the cancer and its treatment may affect women at different ages is discussed. The psychological impact of cancer therapy on both the patient and her spouse are noted; and options for treatment interventions are reviewed.

breast cancer sexuality quality of life female self-concept 


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  1. 1.
    Anllo, LM: Sexual life after breast cancer. J Sex Marital Ther 26: 241-248, 2000.Google Scholar
  2. 2.
    Ganz PA, Desmond K, Meyerowitz BE, Wyatt GE: Life with breast cancer: Understanding women's health-related quality of life and sexual functioning. J Clin Oncol 16: 501-514, 1998.Google Scholar
  3. 3.
    Maslow, A: A theory of human motivation. Psychology Review. 50: 370-396, 1943.Google Scholar
  4. 4.
    Wilmoth, MC. “Sexuality.” in Psychosocial Dimensions of Oncology Nursing Care. Burke, CC (ed). Pittsburgh: Oncology Nursing Press.1998.Google Scholar
  5. 5.
    Schain WS: The sexual and intimate consequences of breast cancer treatment. Cancer 38: 130186, 1988.Google Scholar
  6. 6.
    Schover LR: The impact of breast cancer on sexuality, body image, and intimate relationships. Cancer 41: 112-120, 1991.Google Scholar
  7. 7.
    Schover LR, Jensen SB. Sexuality and chronic illness: a comprehensive approach. New York. 1997.Google Scholar
  8. 8.
    Kennedy SH, et al: Sexual dysfunction before antidepressant therapy in major depression. J Affect Disord 56: 210-218, 1999.Google Scholar
  9. 9.
    Segraves RT: Female sexual disorders: psychiatric aspects. Can J Psychiatry 47: 419-425, 2002.Google Scholar
  10. 10.
    Weisman AD, Worden W: The fallacy of the post-mastectomy depression. Amer J Med Sci 273: 169-175, 1977.Google Scholar
  11. 11.
    Vinokur AD, Threatt BA, Caplan RD, Zimmermann BL: Physical and psychosocial functioning and adjustment to breast cancer: Long term follow-up of a screening population. Cancer 63:394-405, 1989.Google Scholar
  12. 12.
    Kissane DW, Clark DM, Ikin J, Bloch S, Smith GC, Vitetta L. Psychological morbidity and quality of life in Australian women with early-stage breast cancer: a cross-sectional survey. Med J Aust 169: 192-196, 1998.Google Scholar
  13. 13.
    Spencer SM, Lehman JM, Wynings C, Arena P, Carver CS, Antoni MH, Derhagopian RP, Ironson G, Love N: Concerns about breast cancer and relations to psychosocial well being in a multiethnic sample of early-stage patents. Health Psychol 18: 159-168, 1999.Google Scholar
  14. 14.
    Monga U: Sexuality in Cancer Patients. In: Sexuality and Disability, State of the Art Reviews: Physical Medicine and Rehabilitation. Philadelphia, Hanley & Belfus, 9:2: 417-442, 1995.Google Scholar
  15. 15.
    Renneker R, Cutler M: Psychological problems of adjustment to cancer of the breast. JAMA 148:833-838, 1952.Google Scholar
  16. 16.
    Bard M, Sutherland AM: Psychological impact of cancer and its treatment: IV. Adaptation to radical mastectomy. Cancer 8:656-672, 1955.Google Scholar
  17. 17.
    Al-Ghazal SK, Sully L, Fallowfield L, Blamey RW: The psychological impact of immediate rather than delayed breast reconstruction. Eur J Surg Oncol 26:17-19, 2000.Google Scholar
  18. 18.
    Bloom JR, Ross RD, Burnell G: The effect of social support on patient adjustment after breast surgery. Patient Couns Health Educ I. 50-59, 1978.Google Scholar
  19. 19.
    Jamison KR, Wellisch DK, Pasnau RO: Psychosocial aspects of mastectomy: I The women's perspective. Am J Psychiatry 135:432-436, 1978.Google Scholar
  20. 20.
    Lasry JC-M, Margolese RG, Poisson R, Shibata H, Fleisher D, Lafleur D, Legault S, Taillefer S: Depression and body image following mastectomy and lumpectomy. J Chronic Dis 40:529-534, 1987.Google Scholar
  21. 21.
    Maguire P: Breast conservation vs mastectomy: psychological considerations. Semin Surg Oncol 5:137-144, 1989.Google Scholar
  22. 22.
    Morris T, Greer HS, White P: Psychological and social adjustment to mastectomy: A two year follow up. Cancer 40:2381-2387, 1977.Google Scholar
  23. 23.
    Polivy J: Psychological effects of mastectomy on a women's feminine self-concept J Nerv Ment Dis 164: 77-87, 1977.Google Scholar
  24. 24.
    Stienberg MD, Juliano MA, Wise L: Psychological outcome of lumpectomy versus mastectomy in treatment of breast cancer. Am J Psychiatry 142:32-39, 1985.Google Scholar
  25. 25.
    Ganz PA, Coscarelli A, Fred C, Kahn B, Polinsky ML, Petersen L: Breast cancer survivors: psychosocial concerns and quality of life. Breast Cancer Res Treat 38: 183-199, 1996.Google Scholar
  26. 26.
    Margolis G, Goodman RL, Rubin A: Psychological effects of breast conserving cancer treatment and mastectomy. Psychosom 31:33-39, 1990.Google Scholar
  27. 27.
    Rabinowitz B: Understanding and intervening in breast cancer's emotional and sexual side effects. Curr Womens Health Rep 2:140-147, 2002.Google Scholar
  28. 28.
    Rabinowitz B: Psychosocial issues in breast cancer. Obstet Gynecol Clin North Am 29:233-247, 2002.Google Scholar
  29. 29.
    Becker H: Psychodynamic aspects of breast cancer: Differences in younger and older patients. Psychther Psychosom 32:287-296, 1979.Google Scholar
  30. 30.
    Frank D, Dornbush RL, Webster SK, et al: Mastectomy and sexual behavior: A pilot study. Sex Disabil 1:16-26, 1978.Google Scholar
  31. 31.
    Lee ECG, Maguire GP: Proceedings: Emotional distress in patients attending a breast clinic. Br J Surg 62:162, 1975.Google Scholar
  32. 32.
    Fallowfield LJ, Hall A: Psychosocial and sexual impact of diagnosis and treatment of breast cancer. Br Med Bull 47:388-399, 1991.Google Scholar
  33. 33.
    Maguire GP, Lee EG, Bevington DJ, Kuchemann CS, Crabtree RJ, Cornell CE: Psychiatric problems in the first year after mastectomy Br Med J 1:963-965, 1978.Google Scholar
  34. 34.
    Schover LR: Counseling cancer patients about changes in sexual function. Oncology 13: 1585-1591, 1995.Google Scholar
  35. 35.
    Northhouse LL: Breast cancer in younger women: effects on interpersonal and family relations. J National Cancer Institute Monograph 16: 183-190, 1994.Google Scholar
  36. 36.
    Miller JJ, Williams GF, Leissring JC: Multiple late complications of therapy with cyclo-phosphamide including ovarian destruction. Am J Med 50: 530-535, 1971.Google Scholar
  37. 37.
    Bransfield DD: Breast cancer and sexual functioning: a review of the literature and implications for future research. Int J Psychiatry Med 12:197-211, 1983.Google Scholar
  38. 38.
    Schain WS, Edwards BK, Groell CR, et al: Psychosocial and physical outcomes of primary breast cancer therapy: Mastectomy versus excisional biopsy and irradiation. Breast Cancer Res Treat 3:377-382, 1983.Google Scholar
  39. 39.
    Schain WS, Jacobs E, Wellisch DK: Psychosocial issues in breast reconstruction: Intrapsychic, interpersonal, and practical concerns. Clin Plast Surg 11:237-251, 1984.Google Scholar
  40. 40.
    Schain WS, d' Angelo TM, Dunn ME, Lichter AS, Pierce LJ: Mastectomy versus conservative surgery and radiation therapy: Psychosocial consequences. Cancer 73: 1221-1228, 1994.Google Scholar
  41. 41.
    Schover LR, Yetman RJ, Tuason LJ, Meisler E, Esselstyn CB, Herman RE, et al.: Partial mastectomy and breast reconstruction: A comparison of their effects on psychosocial adjustment, body image, and sexuality. Cancer 75: 54-64, 1995.Google Scholar
  42. 42.
    Bartelink H, Van Dam F, Van Dongen J: Psychological effects of breast conserving therapy in comparison with radical mastectomy. Int J Radia Oncol Biol Phys 11:381-385, 1985.Google Scholar
  43. 43.
    Kiebert GM, DeHaes JCJM, Van DeVelde CJH: The impact of breast conserving treatment and mastectomy on the quality of life of early stage breast cancer patients: a review.J Clin Oncol 9:1059-1070,1991.Google Scholar
  44. 44.
    Vinokur AD, Threatt BA, Caplan RD, Zimmermann BL: Physical and psychosocial functioning and adjustment to breast conserving cancer treatment and mastectomy. Psychosom 31:33-39, 1990.Google Scholar
  45. 45.
    Kaplan HS: A neglected issue: the sexual side effects of current treatments for breast cancer. J Sex Marital Ther 18:3-19, 1992.Google Scholar
  46. 46.
    Dean C, Chetty U, Forrest APM: Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy. Lancet 1:459-462, 1983.Google Scholar
  47. 47.
    Gerard D: Sexual functioning after mastectomy: Life versus lab. J Sex Marital Ther 8:305-315, 1982.Google Scholar
  48. 48.
    Rowland JH, Desmond KA, Meyerowitz BE, Belin TR, Wyatt GE, Ganz PA: Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst 92: 1422-1429, 2000.Google Scholar
  49. 49.
    Yurek D, Farrar W, Andersen BL: Breast cancer surgery: comparing surgical groups and determining individual differences in postoperative sexuality and body change stress. Consult Clin Psychol 68: 697-709, 2000.Google Scholar
  50. 50.
    Nissen, MJ, Swensen KK, Ritz LJ, Farrell JB, Sladek ML, Lally RM: Quality of life after breast carcinoma surgery: A comparison of three surgical procedures. Cancer 91:1238-1246. 2001.Google Scholar
  51. 51.
    Nissen, M J, Swensen KK, Kina EA: Quality of life after postmastectomy breast reconstruction. Oncol Nurs 29:547-553. 2002.Google Scholar
  52. 52.
    Ganz PA, Rowland JH, Meyerowitz BE, Desmond KA: Impact of different adjuvanct therapy strategies on quality of life in breast cancer survivors. Recent Results Cancer Res 152: 396-411, 1998.Google Scholar
  53. 53.
    Ganz PA, Schag CA, Lee JJ, Sim MS: The CARES: A generic measure of health-related quality of life for patients with cancer. Qual Life Res 1: 19-29, 1992.Google Scholar
  54. 54.
    Ganz PA, Desmond KA, Belin TR, Meyerowitz BE, Rowland JH: Predictors of sexual health in women after a breast cancer diagnosis. J Clin Oncol 17:2371-2385, 1999.Google Scholar
  55. 55.
    Moyer A: Psychosocial outcomes of breast conserving surgery versus mastectomy: a meta-analytic review. Health Psychol 16: 284-298, 1997.Google Scholar
  56. 56.
    Clifford E, Clfford M, Georgiade NG: Breast reconstruction following mastectomy: II. Marital characteristics of patients seeking this procedure. Ann Plast Surg 5:344-346, 1980.Google Scholar
  57. 57.
    Stillerman AH: Sexual adjustment to mastectomy: Description comparison with partner's perspective and prediction of sexual adjustment. Dis Abstr Northwestern Univ, 1984.Google Scholar
  58. 58.
    Goldstein MK, Teng NNH: Gynecologic factors in sexual dysfunction of the older woman. Clin Geriatric Med 7: (1) 41-61, 1991.Google Scholar
  59. 59.
    Wellisch DK, Jamison KR, Pasnau RO: Psychological aspects of mastectomy: II. The man's perspective. Ann J Psychiatry 135:543-546, 1978.Google Scholar
  60. 60.
    Mor V, Malin M, Allen S: Age differences in the psychosocial problems encountered by breast cancer patients. J NCI Monograph 16: 191-198, 1994.Google Scholar
  61. 61.
    Goin MK, Goin JM: Midlife reactions to mastectomy and subsequent breast reconstruction. Arch Gen Psychiatry 38:225-227, 1981.Google Scholar
  62. 62.
    Theriault RL, Sellin RV: Estrogen replacement therapy in younger women with breast cancer. J Natl Cancer Inst Monogr 16:149-152, 1994.Google Scholar
  63. 63.
    Theriault, RL. Hormone replacement therapy and breast cancer: an overview. Br J Obstet Gyneacol 103: 87-90, 1996.Google Scholar
  64. 64.
    Stillman RJ, Schinfeld JS, Schiff I, Gelber RD, Greensberger J, Larson M, Jaffe N, Li FP: Ovarian failure in long-term survivors of childhood malignancy. Am J Obstet Gynecol 139:62-66, 1981.Google Scholar
  65. 65.
    Warne GL, Fairley KF, Hobbs JB, Martin FI: Cyclophosphamide induced ovarian failure. N Engl J Med 289:1159-1162, 1973.Google Scholar
  66. 66.
    Gradishar W, Schilsky RI: Effects of cancer treatment on the reproductive system. Crit Rev Oncol Hematol 8:153-171, 1988.Google Scholar
  67. 67.
    Miller PJ: Mastectomy: A review of psychosocial research. Health Soc Work 6:60-66, 1981.Google Scholar
  68. 68.
    Young-McCaughan S: Sexual functioning in women with breast cancer after treatment with adjuvant therapy. Cancer Nurs 19:308-319, 1996.Google Scholar
  69. 69.
    Berglund G, Nystedt M, Bolund C, Sjoden PO, Rutquist LE: Effect of endocrine treatment on sexuality in premenopausal breast cancer patients: a prospective randomized study. J Clin Oncol 19:2788-2796, 2001.Google Scholar
  70. 70.
    Winningham, ML, Nail LM, Burke MB, Brophy L, Cimprich B, Jones LS, Pickard-Holley S, Rhodes V, St Pierre B, Beck S, et al: Fatigue and the cancer experience: The state of the knowledge. Oncol Nurs Forum 21: 23-36, 1994.Google Scholar
  71. 71.
    Monga U, Kerrigan A, Thornby J, Monga TN: Prospective study of fatigue in localized prostate cancer patients undergoing radiotherapy. Radiat Oncol Investig 7: 178-185.1999.Google Scholar
  72. 72.
    Bower JE, Ganz PA, Desmond KA, Rowland JH, Meyerowitz BE, Belin TR: Fatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life. J Clin Oncol 18 (4): 743-753, 2000.Google Scholar
  73. 73.
    Monga U, Garber S, Kerrigan AJ, Monga TN: Pre-and Post-Radiotherapy Sexual Functioning in Prostate Cancer Patients. Sex Dis 19:239-252, 2002.Google Scholar
  74. 74.
    Jereczek-Fossa BA, Marsiglia HR, Orecchia R: Radiotherapy-related fatigue. Crit Rev Oncol Hem 42: 317-325. 2002.Google Scholar
  75. 75.
    Geinitz H, Zimmermann FB, Stoll P, Thamm R, Kaffenberger W, Ansorg K, Keller M, Busch R, van Beuningen D, Molls M: Fatigue, serum cytokine levels, and blood cell counts during radiotherapy of patients with breast cancer. Int J Radiat Oncol Biol Phys 51: 691-698. 2001.Google Scholar
  76. 76.
    Nail, L: Fatigue in patients with cancer. Oncol Nurs 29: 537-544, 2002.Google Scholar
  77. 77.
    Visser MRM, Smets EMA: Fatigue, depression and quality of life in cancer patients: How are they related? Supportive Care in Cancer 6:101-108, 1998.Google Scholar
  78. 78.
    Schover LR: Sexual dysfunction in Psychooncology. Holland JC (ed.). New York. 1998Google Scholar
  79. 79.
    Hughes MK: Sexuality and the cancer survivor: a silent coexistence. Cancer Nurs 23: 477-482, 2000.Google Scholar
  80. 80.
    Barni S, Mondin R: Sexual dysfunction in treated breast cancer patients. Ann Oncol 8: 149-153, 1997.Google Scholar
  81. 81.
    Lichtman RR, Taylor SE, Wood JV: Social support and marital adjustment after breast cancer. J Psychosocial Oncol 5: 47-74, 1987.Google Scholar
  82. 82.
    Ganz PA: Late effects of cancer and its treatment. Semin Oncol Nurs 17:241-248. 2001.Google Scholar
  83. 83.
    McKee AL Jr, Schover L: Sexuality rehabilitation. Cancer 92:1008-1012, 2001.Google Scholar
  84. 84.
    Sherwin, BB: A comparative analysis of the role of androgen in human male and female sexual behavior: Behavioral specificity, critical thresholds and sensitivities. Psychobiology 16: 416-425, 1988.Google Scholar
  85. 85.
    Weitzner MA, Moncello J, Poisson R, Shibata H, Fleischer D, Lafleur D, Legault S, Tailler S: A pilot trial of paroxetine for the treatment of hot flashes and associated symptoms in women with breast cancer. J Pain Symptom Manage 23: 337-345. 2002.Google Scholar
  86. 86.
    Swain S, Santeen R, Burger H, Pritchard K, editors: Treatment of estrogen deficiency symptoms in women surviving breast cancer. Part 4: Urogenital atrophy, vasomotor instability, sleep disorders and related symptoms. Oncology 13: 551-575, 1999.Google Scholar
  87. 87.
    Stead, ML: Communications about sexual problems and sexual concerns in ovarian cancer: qualitative study. Br Med J 323: 836-837, 2001.Google Scholar
  88. 88.
    Hordern A: Intimacy and sexuality for the woman with breast cancer. Cancer Nurs 23: 230-236, 2000.Google Scholar
  89. 89.
    Thaler-DeMers, D: Intimacy issues: sexuality, fertility and relationships. Semin Oncol Nurs 17:255-262, 2001.Google Scholar
  90. 90.
    Schover LR: Sexuality and body image in younger women with breast cancer. J Natl Cancer Inst Monogr 16: 177-182, 1994.Google Scholar

Copyright information

© Human Sciences Press, Inc. 2002

Authors and Affiliations

  • Helene K. Henson
    • 1
    • 2
  1. 1.Rehabilitation Care Line (RCL117), Houston VA Medical CenterHouston
  2. 2.Department of Physical Medicine and RehabilitationBaylor College of MedicineHouston

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